ABSTRACT The psychosocial care of patients with advanced lung cancer (ALC) has not kept pace with current medical treatments, creating significant gaps in care. Treatments like immunotherapy have radically changed ALC care, yielding less toxicity and unprecedented increases in 5-year survival. However, mental health and quality of life concerns persist, which must be addressed to fully realize the survival benefits of these medical advancements. To meet the needs of patients in this new treatment context, psychosocial and palliative care for ALC must shift from a predominant end-of-life framework to one of survivorship. A hope-based intervention to support patients’ goal pursuits in their family, social, work, and leisure lives is a promising approach to support mental health and quality of life in this current context. The long-term goal of this research is to improve ALC patient mental health and quality of life during cancer treatment. The overall objective in this application is to test the efficacy of a novel psychosocial intervention called “Pathways” to support personal goal pursuit during ALC treatment. The central hypothesis is that Pathways will reduce goal disruption and thereby improve mental health and quality of life during ALC treatment. The rationale for this project is that Pathways, a brief, hope-based intervention delivered primarily at the point of ALC patient care by a range of healthcare providers (e.g., nurse, occupational therapist, social worker) has demonstrated feasibility and acceptability to ALC patients, with encouraging preliminary effects on goal disruption, mental health, and quality of life outcomes. The central hypothesis will be tested through two specific aims: 1) Test the efficacy of Pathways against enhanced usual care; and 2) Evaluate goal interference and goal adjustment as mediators of intervention effects. Because ALC disproportionately affects rural, older underserved populations who have been underrepresented in psychosocial intervention trials, Aim 3 will use mixed-methods to evaluate the reach and effectiveness of the Pathways intervention among these subgroups. To accomplish these aims, 234 patients undergoing treatment for ALC at the University of Kentucky Markey Cancer Center will be randomized to Pathways or enhanced usual care, with outcomes collected, pre, post, and at follow-up. The research proposed in this application is innovative because it is testing a novel intervention with respect to intervention focus and intervention delivery at the point of ALC care. The proposed research is significant because it will determine the efficacy of an intervention that is responsive to patients’ needs in the current medical landscape for ALC and has high potential for broad dissemination into routine ALC care in both high- and low-resourced settings. Once efficacy is demonstrated, the effectiveness of the intervention will be tested in both academic and community oncology practices with other advanced cancer patient populations, significantly advancing psychosocial and palliative care in this new treatment era and ultimately having a large impact on the over 600,000 people living with advanced cancer in the U.S.

PROJECT NARRATIVE The proposed research is relevant to public health because it proposes to test a new psychosocial intervention that addresses a critical intervention gap in current psychosocial care for patients living with advanced lung cancer, the most common advanced cancer associated with high rates of psychological distress and poor quality of life, and which disproportionately affects rural, socioeconomically disadvantaged adults. Because the intervention was designed with patient needs and clinical practice in mind, it could easily be implemented in routine advanced cancer care in both academic and community oncology settings and could be exported for use among the over 600,000 people living with advanced cancer in the U.S. Thus, the proposed research will support the National Cancer Institute’s mission of reducing the burden of cancer through high quality cancer care.