No abstract

Objective Over the past 20 years, immunotherapy and targeted therapy (TT) have been extending the life expectancy and providing hope for a growing number of patients with advanced and metastatic cancer. However, the efficacy, side effects, and overall prognosis of these treatments are highly unpredictable. Recent research suggests that these patients may be experiencing significant uncertainty which impacts their functioning. This study reviewed the literature on the experiences of uncertainty for individuals with advanced or metastatic cancer patients who are receiving immunotherapy or TT. Method A systematic literature review was conducted. Data was extracted from studies by pairs of reviewers. Literature quality was appraised using the Critical Appraisal Skills Program checklist. Following data extraction, thematic synthesis was used to summarize findings across studies and generate overarching themes. Results Fifteen qualitative studies were included. Findings highlighted impacts of various sources of uncertainty (financial, emotional, social), unmet needs related to uncertainty (practical, informational, communication), and recommendations for the management of uncertainty. Clinical implications and study limitations were indicated. Conclusions Findings were situated within Mishel's Uncertainty in Illness Theory and the literature on supportive care for advanced cancer populations. Recommendations related to improving healthcare provider communication and balancing hope and expectations for treatment outcomes were highlighted. Further research is needed to investigate experiences of uncertainty in this population. Tailored interventions for uncertainty may be warranted.

� Several fear of cancer recurrence (FCR) interventions have demonstrated their efficacy but are not yet implemented in routine clinical care. � Clinicians have expressed an interest in receiving FCR training, but access and availability are limited.� This paper reports on the evaluation of a 5h workshop over 2 days on the Fear Of Recurrence Therapy (FORT) intervention.� 40 international psychosocial oncology clinicians were provided the workshop at no cost. Evaluation measures included feedback on the workshop, and preliminary outcome measures of their knowledge, self-efficacy, usage, and implementation barriers/enablers. � Majority of participants utilized some or most of the FORT intervention. Results from the training indicate that it was effective, feasible and acceptable.