Exploring the meaning of “a good day” for individuals living with advanced cancer: A qualitative interview study.

249 Background: More people are living longer with stage IV cancer due to advances in cancer treatments. However, individuals living with advanced cancer must navigate dynamic treatment schedules, side effects, fear of progression, and uncertainty, resulting in unique day-to-day experiences that may be poorly understood by their health care team. The goal of this project was to better understand the activities, behaviors, and experiences that characterize a “good day” versus a “bad day” among individuals living with advanced cancer. Methods: Twenty participants with stage IV cancer were enrolled (mean 63 years old, range 41-75; 65% female; 65% White and 35% Black; mean 1.5 years since Stage IV diagnosis, range 9 days to 7.5 years). Participants completed semi-structured interviews which involved rating the quality of their day yesterday from 1-5 (1 = very bad and 5 = very good) and characterizing their experiences and activities during the day. Participants were also asked to describe a theoretical ‘very good day’ versus a ‘very bad day’ for them personally, as well as advice they would give to another patient with advanced cancer about how to make a day better. Interview transcripts were reviewed to identify common themes across participants. Results: Interviews revealed that “good days” were associated with feeling like oneself (feeling symptom-free, in control, like pre-cancer self), bringing oneself to engage in activities that bring personal wellness, feeling connected to others (spending quality time with others, helping others, feeling supported and understood by others), feeling accomplished (getting things done, reaching goals), and practicing positive thought patterns (gratitude, reframing success, letting go). On the other hand, loss of control, uncertainty/unpredictability, disruptive physical symptoms, negative experiences with health care, and inability to reach one’s goals were common on “bad days.” When asked what they felt most grateful for yesterday, some participants cited their support system, kids, and grandkids, but the majority of participants reported feeling most grateful for simply living another day, good or bad. Conclusions: Preliminary findings suggest that days on which individuals with advanced cancer are able to engage in activities that give them a sense of normalcy, control, self-identity, and connection to others are better than days without these activities. Findings also suggest that what defines a “good day” looks different between individuals with stage IV cancer. Understanding these individuals’ values and priorities may help care teams support people with advanced cancer to optimize their quality of life and functioning and navigate treatment decisions.