Candido Wellington, Eggen Annemarie Cecile, Jalving Mathilde, Bosma Ingeborg, Horinga Reinate D, van Heuvelen Kelly C, Hiltermann T Jeroen N, Oosting Sjoukje, Racz Emoke, van der Klauw Melanie M, Reyners Anna K L, Nuver Janine
Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands.
University of Groningen, Groningen, The Netherlands.
J Immunother Cancer. 2025 Mar 28;13(3):e011168. doi: 10.1136/jitc-2024-011168.
Increasing numbers of patients diagnosed with advanced cancer survive long-term after treatment with immune checkpoint inhibitors (ICIs). To design adequate interventions for these survivors, knowledge regarding quality of life (QOL) and its association with long-term and late effects of ICI treatment is required. Therefore, this study aimed to evaluate QOL, neurocognitive function, psychological issues, sexuality, and comorbidities in patients surviving at least 2 years after commencing ICI treatment.
We performed a cross-sectional study in patients with stage III-IV melanoma, non-small cell lung cancer (NSCLC), urothelial cell carcinoma (UCC), or renal cell carcinoma (RCC) who survived at least 2 years after the start of ICIs. We assessed QOL, neurocognitive function, psychological issues, sexual function and comorbidity in survivors. Additionally, we evaluated QOL of informal caregivers.
132 survivors (70 melanoma, 50 NSCLC, 12 UCC or RCC) and 80 caregivers were included. Median age was 65 years (range 30-85) and 50 survivors were women (38%). Median time since start and cessation of ICI treatment was 33 (range 21-91) and 18 (range 0-68) months, respectively. Average survivor QOL was comparable to the reference population, but 37 (28%) survivors had poor QOL. Depression and anxiety were negatively correlated with all QOL domains. Although immune-related adverse events were common, there was no association with lower QOL. Caregiver and survivor QOL were only weakly related. Neurocognitive concerns and formally tested neurocognitive impairment were present in 22 (17%) and 13 (15%) survivors, respectively, and were not associated with a diagnosis of brain metastases. Men had a high prevalence of erectile dysfunction and low sexual satisfaction. Half of the survivors met the criteria for the metabolic syndrome.
At least 2 years after the start of ICI treatment, one-quarter of cancer survivors had a clinically relevant lower QOL. This was associated with symptoms of depression and anxiety, but not with immune-related adverse events. Sexual issues and metabolic syndrome are prevalent. Survivorship care should address these issues in this population.
越来越多被诊断为晚期癌症的患者在接受免疫检查点抑制剂（ICI）治疗后长期存活。为了针对这些幸存者设计适当的干预措施，需要了解生活质量（QOL）及其与ICI治疗的长期和晚期影响之间的关联。因此，本研究旨在评估开始ICI治疗后至少存活2年的患者的生活质量、神经认知功能、心理问题、性功能和合并症。
我们对III-IV期黑色素瘤、非小细胞肺癌（NSCLC）、尿路上皮细胞癌（UCC）或肾细胞癌（RCC）患者进行了一项横断面研究，这些患者在开始ICI治疗后至少存活2年。我们评估了幸存者的生活质量、神经认知功能、心理问题、性功能和合并症。此外，我们还评估了非正式照料者的生活质量。
纳入了132名幸存者（70名黑色素瘤患者、50名NSCLC患者、12名UCC或RCC患者）和80名照料者。中位年龄为65岁（范围30-85岁），50名幸存者为女性（38%）。自开始和停止ICI治疗的中位时间分别为33个月（范围21-91个月）和18个月（范围0-68个月）。幸存者的平均生活质量与参考人群相当，但37名（28%）幸存者的生活质量较差。抑郁和焦虑与所有生活质量领域均呈负相关。尽管免疫相关不良事件很常见，但与较低的生活质量无关。照料者和幸存者的生活质量仅呈弱相关。分别有22名（17%）和13名（15%）幸存者存在神经认知问题和经正式测试的神经认知障碍，且与脑转移诊断无关。男性勃起功能障碍患病率高，性满意度低。一半的幸存者符合代谢综合征的标准。
在开始ICI治疗至少2年后，四分之一的癌症幸存者的生活质量在临床上较低。这与抑郁和焦虑症状相关，但与免疫相关不良事件无关。性问题和代谢综合征很普遍。幸存者护理应针对该人群解决这些问题。
