Managing Cancer and Living Meaningfully (CALM) for Patients With Metastatic Cancer and Treatment Response

BACKGROUND: Immunotherapy and targeted therapy can yield durable responses in metastatic cancer but introduce prognostic uncertainty and distress resembling that of patients with a limited life expectancy. Managing Cancer and Living Meaningfully (CALM) is a brief, flexible psychotherapy designed for advanced-stage patients and may also benefit treatment responders. AIMS: To qualitatively assess how patients with metastatic lung cancer or melanoma experience life after responding to immunotherapy or targeted therapy, and to capture their perspectives on receiving CALM psychotherapy. METHODS: Twenty-two patients with metastatic lung cancer or melanoma and a confirmed therapy response began CALM as part of a larger study in the Netherlands. One year later, 20 were alive; 17 agreed to a semi-structured interview. Two researchers independently conducted thematic analysis of the transcripts. RESULTS: Four themes described becoming a responder: a twilight zone between health and illness, living in ongoing uncertainty, struggling to adapt, and a shift over time. Five themes emerged on CALM: a safe place to process cancer, resolving relational strain, navigating illness, being seen as a whole person, and an invitation to discuss mortality. Most participants found CALM helpful. They valued the invitation to address mortality, but felt ambivalent, acknowledging its importance yet lacking urgency unless progression loomed. CONCLUSIONS: Treatment responders face a shifting identity and enduring uncertainty as they adjust to life after a response. CALM can offer a support framework for those who struggle to establish a new equilibrium. Nonetheless, addressing mortality remains challenging when the timing of disease progression is unpredictable.