Meta-Analysis of Quality of Life in Cancer Patients Treated With Immune Checkpoint Inhibitors

Brian D Gonzalez; Sarah L Eisel; Kristina E Bowles; Aasha I Hoogland; Brian W James; Brent J Small; Susan Sharpe; Kelly A Hyland; Hailey W Bulls; Shannon M Christy; Jori Mansfield; Ashley M Nelson; Raviteja Alla; Kelly Maharaj; Brittany Kennedy; Elizabeth Lafranchise; Noelle L Williams; Sarah Jennewein; Laura B Oswald; Michael A Postow; Adam P Dicker; Heather S L Jim

doi:10.1093/jnci/djab171

Meta-Analysis of Quality of Life in Cancer Patients Treated With Immune Checkpoint Inhibitors

J Natl Cancer Inst. 2022 Jun 13;114(6):808-818. doi: 10.1093/jnci/djab171.

Authors

Brian D Gonzalez¹, Sarah L Eisel², Kristina E Bowles³, Aasha I Hoogland¹, Brian W James⁴, Brent J Small⁵, Susan Sharpe⁶, Kelly A Hyland⁷, Hailey W Bulls⁸, Shannon M Christy⁹, Jori Mansfield⁴, Ashley M Nelson¹⁰, Raviteja Alla¹¹, Kelly Maharaj¹², Brittany Kennedy¹³, Elizabeth Lafranchise¹⁴, Noelle L Williams¹⁵, Sarah Jennewein¹⁶, Laura B Oswald¹⁷, Michael A Postow¹⁸, Adam P Dicker¹⁹, Heather S L Jim²⁰

Affiliations

¹ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
² Department of Health Outcomes and Behavior, Moffitt Cancer Center , Tampa, FL, USA.
³ Department of Health Outcomes and Behavior , Moffitt Cancer Center, Tampa, FL, USA.
⁴ Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
⁵ School of Aging Studies, University of South Florida, Tampa, FL, USA.
⁶ Moffitt Biomedical Library, Moffitt Cancer Center, Tampa, FL, USA.
⁷ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
⁸ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
⁹ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
¹⁰ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
¹¹ Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
¹² Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA .
¹³ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
¹⁴ Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
¹⁵ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
¹⁶ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL , USA.
¹⁷ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa , FL, USA.
¹⁸ Southeast Radiation Oncology Group, Levine Cancer Institute at Atrium Health, Charlotte, NC, USA.
¹⁹ Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
²⁰ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.

Abstract

Background: Trials of immune checkpoint inhibitors (ICIs) have published patient-reported quality of life (QOL), but the size and heterogeneity of this literature can make patient education difficult. This meta-analysis aimed to describe change in QOL and symptomatology in patients receiving ICIs for cancer.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases were searched through November 2019 for articles or abstracts of prospective, original studies reporting longitudinal QOL in adult cancer patients treated with ICIs. The prespecified primary outcomes were change in global QOL among patients treated with ICIs and difference in change since baseline in global QOL between patients treated with ICI vs non-ICI active treatment. Secondary outcomes included physical functioning and symptomatology. All statistical tests were 2-sided.

Results: Of 20 323 publications, 26 met inclusion criteria. Global QOL did not change over time in patients treated with ICIs (k = 26, n = 6974; P = .19). Larger improvements in global QOL was observed in patients receiving ICI vs non-ICI regimens (k = 16, ICI: n = 3588; non-ICI: n = 2948; P < .001). Physical functioning did not change in patients treated with ICIs (k = 14, n = 3169; P = .47); there were no differences in mean change between ICI vs non-ICI regimens (k = 11, n = 4630; P = .94). Regarding symptoms, appetite loss, insomnia, and pain severity decreased, but dyspnea severity increased in patients treated with ICIs (k = 14, n = 3243-3499; P < .001). Insomnia severity was higher in patients treated with ICIs than non-ICI regimens (k = 11, n = 4791; P < .001).

Conclusions: This study is among the first to quantitatively summarize QOL in patients treated with ICIs. Findings suggest ICI recipients report no change in global QOL and higher QOL than patients treated with non-ICI regimens.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural

MeSH terms

Adult
Antineoplastic Agents, Immunological* / therapeutic use
Humans
Immune Checkpoint Inhibitors
Neoplasms* / complications
Prospective Studies
Quality of Life
Sleep Initiation and Maintenance Disorders*

Substances

Antineoplastic Agents, Immunological
Immune Checkpoint Inhibitors

Abstract

Publication types

MeSH terms

Substances

Grants and funding