Department of Medical Oncology (J.J.K., E.G.V., A.M.K, R.J.V., E.H.T., P.O.W., K.P.S.), University Medical Center Utrecht, University Utrecht, The Netherlands.
Center of Expertise in Palliative Care (F.H.B., S.C.T.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands.
J Pain Symptom Manage. 2022 Jun;63(6):997-1005. doi: 10.1016/j.jpainsymman.2022.02.013. Epub 2022 Feb 20.
While praised for inducing durable anti-tumour responses, immune checkpoint inhibitors (ICI) also cause immune-related adverse events (irAEs) that can vary in severity and affect health-related quality of life (HRQL).
This study was performed to provide insight into the course of symptoms and the influence of irAEs on HRQL measured with the treatment-specific Utrecht Symptom Diary Immunotherapy (USD-I).
In this observational cohort study, melanoma or non-small lung cancer (NSCLC) patients treated with PD(L)1-inhibitors between February 2016 and December 2018 were included. Data on symptoms, wellbeing and influence of side effects on HRQL were obtained using the patient-scored, treatment-specific USD-I, which was completed as part of routine care. Patients scored symptom intensity on a 0-10 numeric rating scale (NRS); NRS≥3 considered clinically relevant.
A total of 162 melanoma (55%) or NSCLC (45%) patients completed 1493 USDs (median seven per patient). Most common patient-reported clinically relevant symptoms were: inactivity, fatigue, pain, cough and sleeping problems. Symptom prevalence decreased during treatment. Patients generally reported a low influence of side effects on HRQL. A higher number of clinically relevant symptoms at a certain time point correlated with poorer wellbeing.
These data illustrate that ICI-treatment is generally well tolerated. However, especially the number of clinically relevant symptoms can impact patients wellbeing. Systematic use of an ICI-tailored PROM could create a window to discuss symptoms in a structured way which may promote personalized care during treatment.
免疫检查点抑制剂（ICI）虽然因其能诱导持久的抗肿瘤反应而受到赞誉，但也会引起免疫相关不良反应（irAE），其严重程度不一，影响健康相关生活质量（HRQL）。
本研究旨在深入了解症状的发生过程以及 irAE 对使用特异性免疫治疗 Utrecht 症状日记（USD-I）评估的 HRQL 的影响。
在这项观察性队列研究中，纳入了 2016 年 2 月至 2018 年 12 月期间接受 PD（L）1 抑制剂治疗的黑色素瘤或非小细胞肺癌（NSCLC）患者。使用患者自评、特异性免疫治疗 USD-I 获得症状、幸福感以及副作用对 HRQL 影响的数据，该问卷作为常规护理的一部分完成。患者对症状强度进行 0-10 数字评分量表（NRS）评分；NRS≥3 认为具有临床相关性。
共有 162 例黑色素瘤（55%）或 NSCLC（45%）患者完成了 1493 份 USD（每名患者中位数为 7 份）。最常见的患者报告具有临床相关性的症状为：活动受限、疲劳、疼痛、咳嗽和睡眠问题。治疗期间症状的发生率下降。患者普遍报告副作用对 HRQL 的影响较小。在某个时间点报告的具有临床相关性的症状数量越多，幸福感越差。
这些数据表明，ICI 治疗通常具有良好的耐受性。然而，尤其是具有临床相关性的症状数量可能会影响患者的幸福感。系统使用特定于 ICI 的 PROM 可以为有针对性地讨论症状提供一个机会，从而在治疗期间促进个性化护理。
