Patient and Caregiver Experience With the Hope and Prognostic Uncertainty of Immunotherapy: A Qualitative Study.

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.

Learning About and Living With Toxicity: A Qualitative Study of Patients Receiving Immune Checkpoint Inhibitors For Melanoma or Lung Cancer and Their Caregivers.

Background/Objective: Immune checkpoint inhibitors (ICIs) have revolutionized treatment for melanoma and lung cancer and are in widespread use. This study aims to describe how patients and caregivers learn about ICI toxicities and their perceptions and experiences of toxicity. Methods: We conducted a qualitative study of 42 patients with advanced non-small cell lung cancer (NSCLC; n = 16) or melanoma (n = 26) who were initiating or discontinuing an ICI and their caregivers (n = 9). We conducted in-depth interviews to explore patients' and caregivers' experiences learning about and living with ICI side effects. We audio-recorded the first oncology visit after enrollment. We used a framework approach to code interview and visit transcripts and synthesized codes into themes. Results: The median age of patients was 67; 68% were male. Themes of participant interviews and clinician-patient dialogue included: i) Patients initiating an ICI received extensive information about side effects, which some patients found overwhelming or scary and difficult to absorb; ii) Patients who were deterred by fear of toxicity ultimately proceeded with treatment because of oncologist encouragement or the sense of no alternative; iii) participants found hope in the association between toxicity and ICI efficacy; iv) caregivers helped patients navigate the deluge of information and uncertainty related to ICIs. Participants suggested ways to improve ICI side effect education, such as incorporating patient stories. Conclusion: Patients perceived that ICI toxicity counseling was overwhelming yet were encouraged by oncologists' reassurance that serious side effects were manageable and by the framing of toxicity as a sign of efficacy. We identified opportunities to improve communication of ICI risks and benefits.

Home away from home: international students' experiences during the COVID-19 pandemic and the role of US higher education.

Introduction: This study focuses on the impact of the COVID-19 pandemic on international students' overall experiences. Method: We interviewed 22 international students from 11 countries and 17 universities in the US who participated in a large longitudinal study that aims to understand the physical and emotional wellbeing of young adults during the COVID-19 pandemic. Guided by Bronfenbrenner's ecological model, the findings suggested that students were impacted by the COVID-19 pandemic at interpersonal, institutional, political, and personal levels. Results: The results showed that the pandemic exacerbated existing stressors such as the lack of social support from family, various visa regulations, competitive and limited job opportunities, discrimination and xenophobia, particularly toward students from Asia, and financial burdens. Additionally, the findings highlighted students' perceived loss of the "American dream" and the uneven return on investment due to the pandemic. Discussion: This study reveals the importance of US higher education institutions in supporting international students during the pandemic, particularly in terms of their sense of belonging. Recommendations for institutions drawn from the findings are proposed to better support international students during times of COVID-19 and beyond.

An Undergraduate Laboratory Series Using C. elegans That Prepares Students for Independent Inquiry.

Undergraduate neuroscience laboratories provide valuable opportunities for students to learn about neurobiological systems through active learning. Caenorhabditis elegans (C. elegans) is a valuable model for teaching students how to use a reductionist approach to neuroscientific inquiry. This series of lab modules trains students to utilize foundational laboratory techniques such as worm handling and maintenance, fluorescence imaging, behavioral assays, and Western blot. Upon completing this series of laboratory exercises, students are well prepared to engage in independent research projects using these research techniques. As supported by student survey results, this series of C. elegans laboratory exercises leads to the development of essential research skills, which students may be able to apply to a wide range of future scientific endeavors.

Psychological Distress and Heavy Alcohol Consumption Among U.S. Young Women During the COVID-19 Pandemic.

INTRODUCTION: The predictors of heavy drinking among U.S. young women during the COVID-19 pandemic are not well-examined. This study aims to determine the prospective relationship between COVID-19 psychological distress and heavy alcohol use among U.S. young adult women. DESIGN: This study used the COVID-19 Adult Resilience Experiences Study (CARES) data collected from April 13, 2020, to August 31, 2020 (T1) and September 21, 2020, to March 15, 2021 (T2). Among the young adults (ages 18-30) who participated in both surveys, a total of 684 identified as women (including transgender women) and were included in the analysis. Three or more drinks as a typical intake were defined as heavy drinking. Psychological distress in T1 was measured using scores for financial stress, COVID-19-related worry, and COVID-19-related grief. A series of logistic regression analyses were performed to identify risk factors associated with young women's heavy drinking during the pandemic. RESULTS: Twenty-two and one-half percent of young women reported heavy drinking in a typical intake. After controlling for covariates, women who reported high levels of COVID-19-related grief were more likely to report heavy drinking (odds ratio, 1.06; 95% confidence interval [CI], 1.01-1.13; p < .05). Those with high levels of COVID-19-related worry were less likely to report drinking heavily (odds ratio, 0.90; 95% confidence interval, 0.85-0.97; p < .01). CONCLUSIONS: Those who suffer from a deeper sense of COVID-19-related grief are particularly at risk of heavy drinking and should be targeted for outreach and clinical intervention. Further research is necessary to determine the long-term impacts of the pandemic on heavy drinking among young women and should include a more comprehensive assessment of psychological distress.

Prognostic communication about lung cancer in the precision oncology era: A multiple-perspective qualitative study.

BACKGROUND: Although most patients with cancer prefer to know their prognosis, prognostic communication between oncologists and patients is often insufficient. Targeted therapies for lung cancer improve survival yet are not curative and produce variable responses. This study sought to describe how oncologists communicate about prognosis with patients receiving targeted therapies for lung cancer. METHODS: This qualitative study included 39 patients with advanced lung cancer with targetable mutations, 14 caregivers, and 10 oncologists. Semistructured interviews with patients and caregivers and focus groups or interviews with oncologists were conducted to explore their experiences with prognostic communication. One oncology follow-up visit was audio-recorded per patient. A framework approach was used to analyze interview transcripts, and a content analysis of patient-oncologist dialogue was conducted. Themes were identified within each source and then integrated across sources to create a multidimensional description of prognostic communication. RESULTS: Six themes in prognostic communication were identified: Patients with targetable mutations develop a distinct identity in the lung cancer community that affects their information-seeking and self-advocacy; oncologists set high expectations for targeted therapy; the uncertain availability of new therapies complicates prognostic discussions; patients and caregivers have variable information preferences; patients raise questions about progression by asking about physical symptoms or scan results; and patients' expectations of targeted therapy influence their medical decision-making. CONCLUSIONS: Optimistic patient-oncologist communication shapes the expectations of patients receiving targeted therapy for lung cancer and affects their decision-making. Further research and clinical guidance are needed to help oncologists to communicate uncertain outcomes effectively.

A Balancing Act: The Immune System Supports Neurodegeneration and Neurogenesis.

Decapod crustaceans, like mammals, retain the ability to make new neurons throughout life. In mammals, immune cells are closely associated with stem cells that generate adult-born neurons. In crayfish, evidence suggests that immune cells (hemocytes) originating in the immune system travel to neurogenic regions and transform into neural progenitor cells. This nontraditional immune activity takes place continuously under normal physiological conditions, but little is known under pathological conditions (neurodegeneration). In this study, the immune system and its relationship with neurogenesis were investigated during neurodegeneration (unilateral antennular ablation) in adult crayfish. Our experiments show that after ablation (1) Proliferating cells decrease in neurogenic areas of the adult crayfish brain; (2) The immune response, but not neurogenesis, is ablation-side dependent; (3) Inducible nitric oxide synthase (iNOS) plays a crucial role in the neurogenic niche containing neural progenitors during the immune response; (4) Brain areas targeted by antennular projections respond acutely (15 min) to the lesion, increasing the number of local immune cells; (5) Immune cells are recruited to the area surrounding the ipsilateral neurogenic niche; and (6) The vasculature in the niche responds acutely by dilation and possibly also neovascularization. We conclude that immune cells are important in both neurodegeneration and neurogenesis by contributing in physiological conditions to the maintenance of the number of neural precursor cells in the neurogenic niche (neurogenesis), and in pathological conditions (neurodegeneration) by coordinating NO release and vascular responses associated with the neurogenic niche. Our data suggest that neural damage and recovery participate in a balance between these competing immune cell roles.