Optimizing Supportive Care for Patients with Metastatic Lung Cancer in the Era of Precision Oncology

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PROJECT SUMMARY Lung cancer is the leading cause of cancer-related death in the United States, yet precision oncology discoveries have substantially improved survival and quality of life for a subset of patients. Patients with lung cancer with targetable oncogenic driver mutations represent an emerging population of patients living with chronic, life-limiting cancer. Such patients struggle with uncertainty about when their cancer will progress and how to make decisions about their personal lives and medical care. They also infrequently discuss their prognosis and preferences for end-of-life care with their clinicians. This proposal details a five-year plan to develop and pilot test a palliative care intervention that incorporates elements of survivorship care to address the unmet needs of patients with oncogene-driven lung cancer. Specifically, the aims of this project are to 1) refine a population-specific palliative care intervention informed by survivorship care for patients with oncogene-driven lung cancer with feedback from stakeholders (N=15) and an open pilot (N=10); 2) evaluate the feasibility and acceptability of the intervention in a randomized controlled trial compared to usual care (N=80), and estimate the preliminary effects of the intervention on patients’ distress related to prognostic uncertainty, self-efficacy for managing chronic disease, prognostic awareness, and discussions about goals and values to inform future decision making. This proposal also details the plans of the candidate, Dr. Laura Petrillo, a palliative care physician-investigator, to gain mentorship, didactic training, and career development to facilitate her transition to research independence. Dr. Petrillo’s long-term career goal is to become a leader in supportive care in oncology, specializing in developing and evaluating supportive care interventions tailored to the needs of patients receiving novel therapies. This proposal includes Dr. Petrillo’s plans for gaining expertise in 1) behavioral intervention development; 2) approach to cancer survivorship research and practice; and 3) clinical trial design and conduct. She will achieve this training through experiential learning leading the proposed project with guidance from mentors Dr. Jennifer Temel and Joseph Greer, leading experts in palliative care research, and a scientific advisory team with expertise in oncogene-driven lung cancer, behavioral psychology, palliative care and survivorship research. She will gain additional skills through coursework in behavioral research methods, clinical trial design and conduct, and longitudinal data analysis. This project will position Dr. Petrillo to compete for R01-level funding and launch an independent career leading a research program at the interface of supportive care and oncology.