Small-cell lung cancer (SCLC) is an aggressive form of lung cancer that displays rapid proliferation and early metastatic potential. It accounts for approximately 15% of lung cancers and is strongly associated with tobacco carcinogens. Despite patients' initial response to systemic therapy, the majority develop early resistance and relapse. The outcomes of patients with metastatic SCLC are poor, prompting the need for new therapies. Over the past decade, the treatment landscape for NSCLC (non-small cell lung cancer) has significantly changed with the immergence of novel targeted therapies and immunotherapies. However, inroads of these therapies into SCLC have posed significant challenges due to its molecular and genomic heterogeneity. Despite the challenges of this disease, promising new first-in-class immunomodulatory agents have emerged and are currently undergoing extensive research. Herein, we review the current treatment paradigm of immunotherapy in SCLC and discuss future directions of this evolving field.
{"title":"Evolving Field of Immunotherapy: Pioneering New Paths in Small-Cell Lung Cancer.","authors":"Antonious Ziad Hazim, Konstantinos Leventakos, Vinicius Ernani","doi":"10.1200/OP-24-00862","DOIUrl":"https://doi.org/10.1200/OP-24-00862","url":null,"abstract":"<p><p>Small-cell lung cancer (SCLC) is an aggressive form of lung cancer that displays rapid proliferation and early metastatic potential. It accounts for approximately 15% of lung cancers and is strongly associated with tobacco carcinogens. Despite patients' initial response to systemic therapy, the majority develop early resistance and relapse. The outcomes of patients with metastatic SCLC are poor, prompting the need for new therapies. Over the past decade, the treatment landscape for NSCLC (non-small cell lung cancer) has significantly changed with the immergence of novel targeted therapies and immunotherapies. However, inroads of these therapies into SCLC have posed significant challenges due to its molecular and genomic heterogeneity. Despite the challenges of this disease, promising new first-in-class immunomodulatory agents have emerged and are currently undergoing extensive research. Herein, we review the current treatment paradigm of immunotherapy in SCLC and discuss future directions of this evolving field.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2400862"},"PeriodicalIF":4.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-08-05DOI: 10.1200/OP.24.00260
Aditi P Singh, Erin P Balogh, Robert W Carlson, Mary Margaret Huizinga, Bradley A Malin, Alexander Melamed, Neal J Meropol, Etta D Pisano, Robert A Winn, K Robin Yabroff, Lawrence N Shulman
Electronic health records (EHRs) are a significant advancement over paper records. However, the full potential of EHRs for improving care quality, patient outcomes, surveillance, and research in cancer care is yet to be realized. The organic evolution of EHRs has resulted in a number of unanticipated consequences including increased time spent by clinicians interfacing with the EHR for daily workflows. Patient access to clinicians and their records has been an important advancement in patient-centered care; however, this has brought to light additional gaps and challenges in EHRs meeting these needs. A significant challenge for EHR design and physician workflows is how best to meet the complex goals and priorities of various stakeholders including providers, researchers, patients, health systems, payors, and regulatory agencies. The National Cancer Policy Forum convened a 2022 workshop, "Innovations in Electronic Health Records for Oncology Care, Research and Surveillance," to address these challenges and to facilitate collaboration across all user groups with the goal of re-envisioning EHRs that will better support shared goals of improving patient outcomes and advancing cancer care and research without overburdening clinicians with administrative tasks. Here, we summarize the current EHR ecosystem as discussed at the workshop and highlight opportunities to improve EHR contributions to oncology evidence and care.
{"title":"Re-Envisioning Electronic Health Records to Optimize Patient-Centered Cancer Care, Quality, Surveillance, and Research.","authors":"Aditi P Singh, Erin P Balogh, Robert W Carlson, Mary Margaret Huizinga, Bradley A Malin, Alexander Melamed, Neal J Meropol, Etta D Pisano, Robert A Winn, K Robin Yabroff, Lawrence N Shulman","doi":"10.1200/OP.24.00260","DOIUrl":"10.1200/OP.24.00260","url":null,"abstract":"<p><p>Electronic health records (EHRs) are a significant advancement over paper records. However, the full potential of EHRs for improving care quality, patient outcomes, surveillance, and research in cancer care is yet to be realized. The organic evolution of EHRs has resulted in a number of unanticipated consequences including increased time spent by clinicians interfacing with the EHR for daily workflows. Patient access to clinicians and their records has been an important advancement in patient-centered care; however, this has brought to light additional gaps and challenges in EHRs meeting these needs. A significant challenge for EHR design and physician workflows is how best to meet the complex goals and priorities of various stakeholders including providers, researchers, patients, health systems, payors, and regulatory agencies. The National Cancer Policy Forum convened a 2022 workshop, \"Innovations in Electronic Health Records for Oncology Care, Research and Surveillance,\" to address these challenges and to facilitate collaboration across all user groups with the goal of re-envisioning EHRs that will better support shared goals of improving patient outcomes and advancing cancer care and research without overburdening clinicians with administrative tasks. Here, we summarize the current EHR ecosystem as discussed at the workshop and highlight opportunities to improve EHR contributions to oncology evidence and care.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"128-135"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-08-21DOI: 10.1200/OP.23.00830
Nerea Lopetegui-Lia, Revati Varma, Jame Abraham, Erin Roesch
Metastatic breast cancer (mBC) remains an incurable disease, and most patients will experience disease progression during their treatment course. Although endocrine therapy remains the mainstay of treatment for hormone receptor-positive/human epidermal growth factor receptor 2-negative mBC, significant progress has been and continues to be made in the treatment of this BC subtype. The discovery of molecular markers, mutations in key cellular pathways, and genomic signatures have led to the development of novel and targeted agents, such as antibody-drug conjugates, oral selective estrogen receptor downregulators, and inhibitors of the PI3K/AKT/mTOR pathway. This has resulted in significant improvements in the survival and quality of life of patients. With the increasing number of treatment options for patients, appropriate drug sequencing remains a challenge. Treatment discussions should involve patient-physician shared decision making, with consideration of genomic data, previous lines of therapy, side effect profiles, and clinical trial enrollment.
转移性乳腺癌(mBC)仍然是一种无法治愈的疾病,大多数患者在治疗过程中会出现疾病进展。尽管内分泌治疗仍是激素受体阳性/人表皮生长因子受体 2 阴性 mBC 的主要治疗方法,但在治疗这一 BC 亚型方面已经取得了重大进展,并将继续取得进展。分子标记物、关键细胞通路突变和基因组特征的发现促进了新型靶向药物的开发,如抗体药物共轭物、口服选择性雌激素受体下调剂和 PI3K/AKT/mTOR 通路抑制剂。这大大提高了患者的生存率和生活质量。随着患者可选择的治疗方案越来越多,适当的药物排序仍然是一项挑战。在讨论治疗方案时,患者和医生应共同做出决定,并考虑基因组数据、既往治疗方案、副作用以及临床试验注册情况。
{"title":"Current and Novel Treatment Options in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer.","authors":"Nerea Lopetegui-Lia, Revati Varma, Jame Abraham, Erin Roesch","doi":"10.1200/OP.23.00830","DOIUrl":"10.1200/OP.23.00830","url":null,"abstract":"<p><p>Metastatic breast cancer (mBC) remains an incurable disease, and most patients will experience disease progression during their treatment course. Although endocrine therapy remains the mainstay of treatment for hormone receptor-positive/human epidermal growth factor receptor 2-negative mBC, significant progress has been and continues to be made in the treatment of this BC subtype. The discovery of molecular markers, mutations in key cellular pathways, and genomic signatures have led to the development of novel and targeted agents, such as antibody-drug conjugates, oral selective estrogen receptor downregulators, and inhibitors of the PI3K/AKT/mTOR pathway. This has resulted in significant improvements in the survival and quality of life of patients. With the increasing number of treatment options for patients, appropriate drug sequencing remains a challenge. Treatment discussions should involve patient-physician shared decision making, with consideration of genomic data, previous lines of therapy, side effect profiles, and clinical trial enrollment.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"145-154"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-10DOI: 10.1200/OP-24-00683
Irene Kuter
The electronic health record has affected how physicians document patient care, and presents challenges.
电子病历影响了医生记录病人护理的方式,也带来了挑战。
{"title":"Medical Record-Keeping Then and Now.","authors":"Irene Kuter","doi":"10.1200/OP-24-00683","DOIUrl":"10.1200/OP-24-00683","url":null,"abstract":"<p><p>The electronic health record has affected how physicians document patient care, and presents challenges.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"111-113"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-07-25DOI: 10.1200/OP.23.00813
Jonathan Sussman, Joshua O Cerasuolo, Gregory R Pond, Daryl Bainbridge, Hsien Seow
Purpose: Many cancer survivors have ongoing follow-up with their oncologist(s), despite evidence that this care can be competently managed by primary care and transitioning well survivors could relieve growing pressure on cancer care systems. We analyzed population-based administrative data from Ontario, Canada, to examine rates of transition to primary care-led follow-up care during the survivorship phase, including clinical and demographic predictors associated with being transitioned.
Methods: We conducted a retrospective cohort study to describe the patterns of survivorship follow-up care among all patients with breast cancer in Ontario from 2006 to 2016. Data were derived from the Ontario Cancer Registry and other linked data sets. We defined the survivorship phase of care beginning at 2 years after initial diagnosis. Logistic regression was used to explore factors potentially prognostic of no oncology visits in each of the years after survivorship.
Results: Our survivorship cohort was composed of 71,719 patients with breast cancer, 42% of whom were considered to have transitioned from oncology to primary care 2 years after diagnosis. Although the number of patients having oncology visits diminished over time, a quarter of the cohort continued being seen in year 5 of survivorship. Regression analysis found older age, early cancer stage, living farther from a cancer center, not receiving radiation or chemotherapy, and high well-being to be associated with transitioning to primary care.
Conclusion: Our findings contribute to the development of low-risk profiles among survivors to inform optimal transition from oncology to primary care. Further research examining qualitative perspectives from oncologists, cancer survivors, and primary care is also required to illuminate other sentinel factors to be considered when transitioning during follow-up.
{"title":"Patterns of Survivorship Follow-Up Care Among Patients With Breast Cancer: A Retrospective Population-Based Cohort Study in Ontario, Canada, Between 2006 and 2016.","authors":"Jonathan Sussman, Joshua O Cerasuolo, Gregory R Pond, Daryl Bainbridge, Hsien Seow","doi":"10.1200/OP.23.00813","DOIUrl":"10.1200/OP.23.00813","url":null,"abstract":"<p><strong>Purpose: </strong>Many cancer survivors have ongoing follow-up with their oncologist(s), despite evidence that this care can be competently managed by primary care and transitioning well survivors could relieve growing pressure on cancer care systems. We analyzed population-based administrative data from Ontario, Canada, to examine rates of transition to primary care-led follow-up care during the survivorship phase, including clinical and demographic predictors associated with being transitioned.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study to describe the patterns of survivorship follow-up care among all patients with breast cancer in Ontario from 2006 to 2016. Data were derived from the Ontario Cancer Registry and other linked data sets. We defined the survivorship phase of care beginning at 2 years after initial diagnosis. Logistic regression was used to explore factors potentially prognostic of no oncology visits in each of the years after survivorship.</p><p><strong>Results: </strong>Our survivorship cohort was composed of 71,719 patients with breast cancer, 42% of whom were considered to have transitioned from oncology to primary care 2 years after diagnosis. Although the number of patients having oncology visits diminished over time, a quarter of the cohort continued being seen in year 5 of survivorship. Regression analysis found older age, early cancer stage, living farther from a cancer center, not receiving radiation or chemotherapy, and high well-being to be associated with transitioning to primary care.</p><p><strong>Conclusion: </strong>Our findings contribute to the development of low-risk profiles among survivors to inform optimal transition from oncology to primary care. Further research examining qualitative perspectives from oncologists, cancer survivors, and primary care is also required to illuminate other sentinel factors to be considered when transitioning during follow-up.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"188-198"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-07-30DOI: 10.1200/OP.24.00390
Ramy Sedhom, Thomas J Smith, J Brian Cassel, Sarina R Isenberg
@ramsedhom and colleagues highlight the opportunity of palliative care to bend the cost (and value) curve in cancer. Enhanced, early, and expanded access to PC offers benefits to inpatients with cancer and cost savings to health systems and payors.
{"title":"What Is the Value of Palliative Care for Inpatients With Cancer?","authors":"Ramy Sedhom, Thomas J Smith, J Brian Cassel, Sarina R Isenberg","doi":"10.1200/OP.24.00390","DOIUrl":"10.1200/OP.24.00390","url":null,"abstract":"<p><p>@ramsedhom and colleagues highlight the opportunity of palliative care to bend the cost (and value) curve in cancer. Enhanced, early, and expanded access to PC offers benefits to inpatients with cancer and cost savings to health systems and payors.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"114-117"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-03DOI: 10.1200/OP-24-00923
Bani Tamraz, Alan P Venook
{"title":"Reply to: \"Give Patients the Choice to Test for DPD Deficiency Before Fluoropyrimidine Chemotherapy,\" \"Large-Scale DPD Testing Should Be More Than an Option,\" and \"A Big Problem With a Feasible Solution, Not a Small Problem With a Complex Solution\".","authors":"Bani Tamraz, Alan P Venook","doi":"10.1200/OP-24-00923","DOIUrl":"10.1200/OP-24-00923","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"265-266"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-03DOI: 10.1200/OP.24.00443
Ken Surprenant, Lindsay Murray, Karen Merritt, Maria Hopkins, Joanne McIntyre
Patients, not physicians, should decide if DPYD screening is right for them before FU/Xeloda chemotherapy.
在FU/希罗达化疗前,患者(而不是医生)应该决定DPYD筛查是否适合他们。
{"title":"Give Patients the Choice to Test for DPD Deficiency Before Fluoropyrimidine Chemotherapy.","authors":"Ken Surprenant, Lindsay Murray, Karen Merritt, Maria Hopkins, Joanne McIntyre","doi":"10.1200/OP.24.00443","DOIUrl":"10.1200/OP.24.00443","url":null,"abstract":"<p><p>Patients, not physicians, should decide if DPYD screening is right for them before FU/Xeloda chemotherapy.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"264-265"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-07-22DOI: 10.1200/OP.24.00299
Mary C Boulanger, Ayo S Falade, Kelly Hsu, Robert K Sommer, Ashley Zhou, Roshni Sarathy, Donald Lawrence, Ryan J Sullivan, Lara Traeger, Joseph A Greer, Jennifer S Temel, Laura A Petrillo
Purpose: Immunotherapy has improved survival for patients with melanoma and non-small cell lung cancer (NSCLC). Yet, as responses vary widely, immunotherapy also introduces challenges in prognostic communication. In this study, we sought to explore how patients and caregivers learned about the goal of immunotherapy and their experience of living with uncertainty.
Materials and methods: We conducted a qualitative study of patients with stage III or IV melanoma or stage IV NSCLC within 12 weeks of initiating or 12 months of discontinuing immunotherapy, and their caregivers. We conducted in-depth interviews with participants to explore how they learned about immunotherapy from oncology clinicians and how they experienced uncertainty. We used a framework approach to analyze interview transcripts and synthesized concepts into themes.
Results: Forty-two patients and 10 caregivers participated; median age was 67 years and most were male (68%), white (95%), married (61%), and had melanoma (62%). We identified four themes: (1) the oncology team shaped participants' hopeful expectations of immunotherapy, including as a potential cure among those with melanoma; (2) distress related to prognostic uncertainty particularly affected patients who experienced toxicity or progressive disease; (3) patients who did not have long-term responses experienced overwhelming disappointment; and (4) some patients and caregivers had conflicting preferences for prognostic information. Participants provided suggestions to improve education and underscored unmet psychosocial needs.
Conclusion: Patients and caregivers held optimistic expectations of immunotherapy, which resulted in heightened disappointment among the subset with progression or toxicity. Clinicians should elicit information preferences of both patients and caregivers, as these may be disparate. Our results highlight the need to optimize prognostic communication and support for living with uncertainty among patients receiving immunotherapy.
目的:免疫疗法提高了黑色素瘤和非小细胞肺癌(NSCLC)患者的生存率。然而,由于反应差异很大,免疫疗法也给预后交流带来了挑战。在这项研究中,我们试图探讨患者和护理人员如何了解免疫疗法的目标以及他们在不确定情况下的生活体验:我们对开始免疫治疗 12 周内或停止免疫治疗 12 个月内的 III 期或 IV 期黑色素瘤或 IV 期 NSCLC 患者及其护理人员进行了定性研究。我们对参与者进行了深入访谈,探讨他们是如何从肿瘤临床医生那里了解免疫疗法的,以及他们是如何经历不确定性的。我们采用框架法分析访谈记录,并将概念归纳为主题:42名患者和10名护理人员参加了访谈;年龄中位数为67岁,大多数患者为男性(68%)、白人(95%)、已婚(61%)和黑色素瘤患者(62%)。我们确定了四个主题:(1)肿瘤团队塑造了参与者对免疫疗法的希望,包括将其作为黑色素瘤患者的一种潜在治愈方法;(2)与预后不确定性相关的痛苦尤其影响到出现毒性或疾病进展的患者;(3)没有长期反应的患者经历了难以承受的失望;以及(4)一些患者和护理人员对预后信息的偏好相互矛盾。参与者提出了改进教育的建议,并强调了尚未满足的社会心理需求:结论:患者和护理人员对免疫疗法抱有乐观的期望,结果导致病情恶化或出现毒性反应的患者更加失望。临床医生应了解患者和护理人员的信息偏好,因为他们的偏好可能各不相同。我们的研究结果突出表明,有必要优化预后沟通,并为接受免疫疗法的患者提供生活不确定性方面的支持。
{"title":"Patient and Caregiver Experience With the Hope and Prognostic Uncertainty of Immunotherapy: A Qualitative Study.","authors":"Mary C Boulanger, Ayo S Falade, Kelly Hsu, Robert K Sommer, Ashley Zhou, Roshni Sarathy, Donald Lawrence, Ryan J Sullivan, Lara Traeger, Joseph A Greer, Jennifer S Temel, Laura A Petrillo","doi":"10.1200/OP.24.00299","DOIUrl":"10.1200/OP.24.00299","url":null,"abstract":"<p><strong>Purpose: </strong>Immunotherapy has improved survival for patients with melanoma and non-small cell lung cancer (NSCLC). Yet, as responses vary widely, immunotherapy also introduces challenges in prognostic communication. In this study, we sought to explore how patients and caregivers learned about the goal of immunotherapy and their experience of living with uncertainty.</p><p><strong>Materials and methods: </strong>We conducted a qualitative study of patients with stage III or IV melanoma or stage IV NSCLC within 12 weeks of initiating or 12 months of discontinuing immunotherapy, and their caregivers. We conducted in-depth interviews with participants to explore how they learned about immunotherapy from oncology clinicians and how they experienced uncertainty. We used a framework approach to analyze interview transcripts and synthesized concepts into themes.</p><p><strong>Results: </strong>Forty-two patients and 10 caregivers participated; median age was 67 years and most were male (68%), white (95%), married (61%), and had melanoma (62%). We identified four themes: (1) the oncology team shaped participants' hopeful expectations of immunotherapy, including as a potential cure among those with melanoma; (2) distress related to prognostic uncertainty particularly affected patients who experienced toxicity or progressive disease; (3) patients who did not have long-term responses experienced overwhelming disappointment; and (4) some patients and caregivers had conflicting preferences for prognostic information. Participants provided suggestions to improve education and underscored unmet psychosocial needs.</p><p><strong>Conclusion: </strong>Patients and caregivers held optimistic expectations of immunotherapy, which resulted in heightened disappointment among the subset with progression or toxicity. Clinicians should elicit information preferences of both patients and caregivers, as these may be disparate. Our results highlight the need to optimize prognostic communication and support for living with uncertainty among patients receiving immunotherapy.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"178-187"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}