Adaptation and Implementation of Self-System Therapy for Older Adults with Advanced Lung Cancer: Pilot Trial Results
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2025-08-28
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Abstract
Background/Objectives: Advanced lung cancer is a highly distressing disease that negatively impacts older adults. Supportive care interventions designed for this population are scarce and often inaccessible due to competing demands and transportation access. We adapted and refined an evidence-based treatment, Self-System Therapy (SST), to address the unmet needs of older adults with advanced cancer. Methods: Guided by principles of implementation science, we conducted patient interviews, focus groups, and user testing to refine our new SST for the lung cancer (SST-LC) protocol. We then conducted a single-arm pilot trial (clinicaltrials.gov NCT04057196) for patients aged 65+ and above with Stage III or IV lung cancer (N = 30). Benchmarks for acceptability, feasibility, and preliminary changes in outcome measures were assessed. Results: Our study met the desired recruitment goals and demonstrated high treatment adherence rates (89%) and satisfaction rates (85%), indicating that SST-LC was feasible and well-received. Participants also showed reductions in distress and depression, and improvements in emotional and functional well-being from baseline to post-intervention, with effects mostly maintained at follow-up. Physical well-being, social well-being, and quality of life showed smaller, non-significant changes. Feedback from participants also suggested that SST enhanced their resilience and ability to cope with cancer-related challenges, but also indicated a preference for fewer sessions. Conclusions: SST for older adults living with advanced lung cancer is feasible and acceptable. Moreover, this supportive care intervention shows promise in addressing psychological distress, emotional well-being, and functional well-being in older adults. Future research will include testing the efficacy of SST in a larger randomized controlled trial.
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Scholars@Duke
Katherine Ramos
Laura S Porter
My research focuses on developing and evaluating behavioral interventions to help patients and their family members cope with the symptoms and psychological demands associated with chronic and life-limiting illness.
Timothy J. Strauman
Professor Strauman’s work is grounded in the premise that mental health and well-being are fundamentally shaped by self-regulation—how individuals pursue goals, respond to challenges, and adapt over time. His research integrates clinical psychology, affective neuroscience, and behavioral science to characterize the psychological and neurobiological systems that support self-regulation, and to understand how disruptions in these systems contribute to vulnerability to depression and related conditions.
Across a program of experimental, clinical, and neuroimaging research, his work has examined self-regulation as a multi-level system, including its cognitive and motivational mechanisms, its development through socialization, and its links to affective and immunological processes. This work has also informed the development and evaluation of novel interventions targeting self-regulatory dysfunction.
More recently, his work has focused on translating this science of self-regulation into scalable approaches to intervention and prevention. This includes the development of new models of treatment that target regulatory processes across disorders, as well as efforts to extend effective self-regulation skills beyond traditional clinical settings and into everyday contexts. This translational focus reflects a broader aim of building integrated, system-level approaches to mental health that can improve outcomes at population scale.
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