Background The use of biological and precision medicines for cancer has exploded in recent years. These treatments differ to traditional cytotoxic chemotherapy and radiotherapy, in that they prevent malignant cell replication at the molecular level, rather than attacking all cells in the hope of also targeting the cancer. As a result people with advanced cancer are living longer. This, in turn, has changed the narrative around advanced cancer from near certain death in a relatively short time span, to that of a chronic condition of which some patients live for years. We explored the changing experience of cancer patients as a result of these treatments, and how that has impacted adjusting to their new way of life with cancer.

Methods Semi-structured interviews were conducted with both people with advanced cancer being treated with biological and precision medicine (n=31) and healthcare professionals involved in treating these patients (n=22), across six tumour groups: breast(female); malignant melanoma; lung; colorectal; renal and ovarian. Interviews were audio-recorded and transcribed verbatim. Framework analysis, using a framework based on domains of unmet need (physical, psychological, information, social, activities of daily living, healthcare, spiritual, sexual, economic, autonomy and role) was used, supplemented with inductive thematic analysis, for emerging themes.

Results The data suggest patients being treated with biological and precision therapies, have significant unmet needs. These not only encompass the side-effects of treatment and its consequences (e.g., extreme nausea adversely impacts everyday life), patients also often do not ‘look like’ a cancer patient. This has revealed implications for adjusting to their ‘new normal’ and shifted the illness identity of cancer patients.

Conclusion This research adds to the limited available research on experiences receiving biological and precision therapies. The findings reveal important issues about the experiences of what is a toxic treatment, despite its potential clinical benefits. These perspectives are of great importance when considering the growth of biological and precision therapies, and the expanding use beyond metastatic disease. They come with consequences that can forever change the lives of people receiving them. Implications for identifying as a patient (or not) and getting the recognition (or not) that comes with having a very serious advanced diagnosis is concerning, especially when we remember that these treatments are still toxic treatments, with very significant, often debilitating, side effects.