"The Idea of Being Without It is Frightening". Uncertainty and Psychological Dependency for Patients Using Immuno-, Biological, or Precision Therapies: A Qualitative Study.

BACKGROUND: IBP therapies (immunotherapies, biologics and precision therapies) have had a significant impact on cancer survival. They differ from conventional cancer treatments in that they may be used long term and have less predictable adverse effects. We aimed to explore the psychological impact of IBP therapies from the perspectives of those living with advanced cancer. METHODS: Semi-structured interviews with 20 women and 11 men with advanced cancer - (lung, colorectal, ovary, (female) breast, renal and malignant melanoma) - about their experiences of IBP therapies. Data were analysed thematically. RESULTS: We elicited two overarching themes from the data: (1) the psychological impact of a stage IV diagnosis and living with advanced cancer, and (2) uncertainty and dependency associated with IBP therapies. Although some were relieved to have a diagnosis, others responded with shock and disbelief. Day to day, cancer was foremost in the minds of many, and the remainder chose to push these thoughts aside and focus on making the most of life. Living with cancer led to a shift in their sense of self. Uncertainty and dependency throughout the care pathway were centred around treatment effectiveness, heightened by the belief that the therapy was keeping them alive. Participants were uncertain and anxious about any interruption of, or changes to, their current treatment regimen, stopping their current treatment and next steps. CONCLUSION: Interventions are needed to support the psychological needs of people using IBP therapies. These should go beyond monitoring and managing IBP treatment-related adverse effects and address uncertainty and psychological dependency.