Quality of life, neurocognitive functioning, psychological issues, sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatment
Background 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...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-03-01
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| Series: | Journal for ImmunoTherapy of Cancer |
| Online Access: | https://jitc.bmj.com/content/13/3/e011168.full |
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| author | Melanie M van der Klauw T Jeroen N Hiltermann Mathilde Jalving Emoke Racz Sjoukje Oosting Anna K L Reyners Wellington Candido Annemarie Cecile Eggen Ingeborg Bosma Reinate D Horinga Kelly C van Heuvelen Janine Nuver |
| author_facet | Melanie M van der Klauw T Jeroen N Hiltermann Mathilde Jalving Emoke Racz Sjoukje Oosting Anna K L Reyners Wellington Candido Annemarie Cecile Eggen Ingeborg Bosma Reinate D Horinga Kelly C van Heuvelen Janine Nuver |
| author_sort | Melanie M van der Klauw |
| collection | DOAJ |
| description | Background 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.Methods 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.Results 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.Conclusions 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. |
| format | Article |
| id | doaj-art-2c31397fbf454541b49f96d165541911 |
| institution | DOAJ |
| issn | 2051-1426 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj-art-2c31397fbf454541b49f96d1655419112025-08-20T03:10:03ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262025-03-0113310.1136/jitc-2024-011168Quality of life, neurocognitive functioning, psychological issues, sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatmentMelanie M van der Klauw0T Jeroen N Hiltermann1Mathilde Jalving2Emoke Racz3Sjoukje Oosting4Anna K L Reyners5Wellington Candido6Annemarie Cecile Eggen7Ingeborg Bosma8Reinate D Horinga9Kelly C van Heuvelen10Janine Nuver117 Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands2 University of Groningen, Groningen, The Netherlands1 Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands2 University of Groningen, Groningen, The Netherlands1 Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands1 Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands1 Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands3 Department of Internal Medicine, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands2 University of Groningen, Groningen, The Netherlands1 Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands1 Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands1 Medical Oncology, University Medical Center Groningen, Groningen, The NetherlandsBackground 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.Methods 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.Results 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.Conclusions 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.https://jitc.bmj.com/content/13/3/e011168.full |
| spellingShingle | Melanie M van der Klauw T Jeroen N Hiltermann Mathilde Jalving Emoke Racz Sjoukje Oosting Anna K L Reyners Wellington Candido Annemarie Cecile Eggen Ingeborg Bosma Reinate D Horinga Kelly C van Heuvelen Janine Nuver Quality of life, neurocognitive functioning, psychological issues, sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatment Journal for ImmunoTherapy of Cancer |
| title | Quality of life, neurocognitive functioning, psychological issues, sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatment |
| title_full | Quality of life, neurocognitive functioning, psychological issues, sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatment |
| title_fullStr | Quality of life, neurocognitive functioning, psychological issues, sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatment |
| title_full_unstemmed | Quality of life, neurocognitive functioning, psychological issues, sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatment |
| title_short | Quality of life, neurocognitive functioning, psychological issues, sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatment |
| title_sort | quality of life neurocognitive functioning psychological issues sexuality and comorbidity more than 2 years after commencing immune checkpoint inhibitor treatment |
| url | https://jitc.bmj.com/content/13/3/e011168.full |
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