Embedded Palliative Care in Managing Symptoms in Participants With Recurrent Stage III-IV Thoracic Malignancies and Their Caregivers

Inclusion Criteria:

* Patients with advanced or metastatic cancer of the chest (lung, thymus, or pleura): stage III or IV, recurrent disease
* Patients will receive therapy (chemotherapy, immunotherapy, targeted therapy or radiation therapy) at The Ohio State University
* New patients (defined as patients who have received no therapy for metastatic disease or have started treatment for metastatic disease within the last 30 days) or established patients with advanced cancer receiving anti-cancer therapy, no limit on prior therapies
* Patient and caregiver must be able to read and understand consent form
* Patients must designate a willing caregiver to participate although caregiver consent is not required for patient participation

Exclusion Criteria:

* Patients who are already enrolled or have been previously enrolled in palliative care or hospice services as an outpatient. Inpatient palliative care consultation prior to enrollment is permitted
* Patients who do not qualify for active anti-cancer therapy and opt to enroll in hospice services prior to study enrollment
* Patients who are unable to read or understand consent form
* Patients receiving primary systemic treatment outside of Ohio State. Outside radiation therapy is permitted