Study On The Current Status And Influencing Factors Of Symptom Burden In Patients With Lung Cancer Treated With Immune Checkpoint Inhibitor

Purpose Guided by the Theory of Unpleasant Symptoms(TOUS),this study investigated the current status of symptom burden in lung cancer patients treated with immune checkpoint inhibitors(ICIs),analyzed the factors influencing their symptom burden,and provided an empirical basis for clinical healthcare professionals to carry out precise symptom management.Method A cross-sectional survey was carried out in departments of oncology and respiratory of a tertiary hospital in Zhejiang Province betweenfrom August 2022 to February 2023.A total of158 lung cancer patients treated with ICIs were selected using a convenient sampling method.Data were collected with the General Information Questionnaire,Oncology Patient Symptom Self-Rating Scale,Hospital Anxiety and Depression Scale(HADS),Medical Coping Modes Questionnaire(MCMQ),and Patient Reported Outcome Social Relationship Short Form.SPSS 26.0 was used for data analysis.Differences in symptom burden among patients with different demographic and disease characteristics was compared by t-test or ANOVA;Spearman correlation analysis was used for the correlation between anxiety,depression and symptom burden;Pearson correlation was used for the correlation between the dimensions of coping style,social support and symptom burden.Multiple linear regression analysis was used to include statistically significant variables in the univariate analysis into the regression equation to explore the factors influencing symptom burden.Results1.Patients with lung cancer treated with ICIs experienced a mean of(8.73 ± 3.71)symptoms,with the most common symptoms including fatigue(weakness)(88%),muscle weakness(65.2%),cough(58.2%),decreased appetite(50.6%)and anxiety(50%).The overall symptom burden score was(0.54 ± 0.30),with the higher scoring symptoms being:fatigue(weakness),muscle weakness,loss of appetite,cough,difficulty sleeping,pain(whole body/head/muscles/joints/chest/eyes/extremities/abdomen)and itchy skin.The lowest symptom burden score among the different ICIs treatment regimens was(0.42 ±0.26)for patients on monotherapy and the highest symptom burden score was(0.60±0.32)for patients on combination chemotherapy.2.The results of univariate analysis showed differences in the level of symptom burden among patients with different age,BMI,monthly household income,EOCG-PS score,whether tumor metastasis,and whether chemotherapy was synchronized(P<0.05).The results of correlation analysis showed that anxiety,depression,and yielding coping were positively correlated with symptom burden,and avoidance coping was negatively correlated with symptom burden(P<0.05).3.The results of multiple linear regression results revealed that the factors influencing patients’ symptom burden in lung cancer treated with ICIs included monthly household income(β=-0.130,P=0.046),EOCG-PS score(β=0.284,P<0.001),tumor metastasis(β=0.172,P=0.006),synchronous chemotherapy(β=0.202,P=0.001),avoidance coping(β=-0.136,P=0.050)and depression(β=0.270,P=0.001),which could explain 42.6% of the variance in symptom burden.Conclusion1.1.Symptom burden of patients with lung cancer treated with ICIs is at a mild to moderate level,and patients tolerate treatment with ICIs well.2.The symptoms of lung cancer patients treated with ICIs have unique pattern of occurrence.The symptom characteristics of lung cancer patients treated with different ICIs treatment regimens varies,with the combination of chemotherapy increasing the symptom burden of lung cancer patients,their symptom monitoring should be strengthened,especially for ICIs treatment-related skin,nerve,skeletal muscle and other discomfort symptoms.3.Monthly household income,EOCG-PS score,tumor metastasis,concurrent chemotherapy,depression and avoidance coping are factors influencing the symptom burden of patients with lung cancer treated with ICIs.4.Health care providers should pay attention to lung cancer patients with low family income,low physical status,tumor metastasis,synchronous chemotherapy,and changes in patients’ psychological status.Furthermore,provide ICIs-ir AEs professional guidance to patients and their families to help patients reduce negative emotions and adopt positive coping strategies to reduce symptom burden.