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Review
. 2020 Dec 8;12(12):3684.
doi: 10.3390/cancers12123684.

Living with Metastatic Cancer: A Roadmap for Future Research

Danielle B Tometich  1 , Kelly A Hyland  2 , Hatem Soliman  3 , Heather S L Jim  1 , Laura Oswald  1
Affiliations
Review

Living with Metastatic Cancer: A Roadmap for Future Research

Danielle B Tometich et al. Cancers (Basel). .

Abstract

Living with metastatic cancer, or metavivorship, differs from cancer survivorship and has changed as novel treatments have increased survival time. The purpose of this narrative review is to describe factors that impact challenges in metavivorship within a conceptual framework to guide future research. This review focuses on the specific metavivorship outcomes of progressive disease, survival time, symptoms, distress, financial toxicity, and quality of life. We describe the predisposing, precipitating, and perpetuating (3P) model of metavivorship. Understanding the biological, psychological, and social 3P factors that contribute to the development and maintenance of challenges in metavivorship provides a roadmap for future research. Implications of this model include prevention by targeting predisposing factors, management of precipitating factors after onset of metastatic disease, and treatment of perpetuating factors to reduce symptoms and improve quality of life during the chronic phase of metavivorship. This can be accomplished through biopsychosocial screening efforts, monitoring of patient-reported outcomes, education and communication interventions, interdisciplinary symptom management, advance care planning, and behavioral interventions to cultivate psychological resilience.

Keywords: breast cancer; distress; melanoma; metastatic cancer; quality of life; survivorship; symptom management; symptoms.

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Conflict of interest statement

H.S.L.J. served as a consultant for RedHill BioPharma, Janssen Scientific Affairs, and Merck, and has received research funding from Pfizer and Kite Pharmaceuticals. The authors declare no additional conflict of interest. The funder had no role in the writing of the manuscript, or in the decision to publish.

Figures

Figure 1
Figure 1
The predisposing, precipitating, and perpetuating (3P) Model of Metavivorship. Predisposing factors may vary over time in their contribution to distressing symptoms and low quality of life. In the premorbid phase prior to diagnosis of metastatic or recurrent disease, predisposing factors are the sole contributor to risk for developing distressing symptoms. Precipitating factors begin in the acute phase, begin to decline in the early phase, but may vary throughout the chronic phase due to various treatments and disease monitoring. Perpetuating factors begin in the early phase and can sustain symptoms and affect quality of life throughout the chronic phase.
Figure 2
Figure 2
Biopsychosocial Predisposing, Precipitating, and Perpetuating (3P) Factors and Metavivorship Outcomes.
See this image and copyright information in PMC

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