Quality of life and care experience in durable responders to immune checkpoint inhibitors for advanced or metastatic NSCLC or melanoma

Abstract

Background Immune checkpoint inhibitors (ICIs) have transformed outcomes for advanced/metastatic melanoma and non-small-cell lung cancer (NSCLC), allowing for a growing population of ICI durable responders (ICI-DR). Despite improved survival, ICI-DR patients may face persistent health-related quality of life (HRQoL) challenges and these are poorly documented. The QUALICI study aimed to describe HRQoL and factors associated with better HRQoL outcomes, patients' experience, and expectations toward HRQoL in ICI-DR patients with advanced/metastatic NSCLC or melanoma. Patients and methods QUALICI was a multicenter, cross-sectional study conducted in 16 French hospitals. All ICI-DR adults (≥2 years since ICI initiation, no subsequent cancer therapy) were screened and randomly selected to participate and complete questionnaires assessing HRQoL (EuroQol 5 Dimensions 5 Levels [EQ-5D-5L]), social difficulties [Social Difficulties Inventory (SDI)], fatigue (Chalder Fatigue Scale), and care experience. Results A total of 234 patients (117 with NSCLC and 117 with melanoma) completed the questionnaires. Most patients (62.0% with NSCLC and 69.7% with melanoma) reported no/slight problems on the five EQ-5D-5L dimensions. Mean ± standard deviation (SD) visual analog scale scores were 67.0 ± 19.3 in the NSCLC group and 74.8 ± 19 in the melanoma group, with higher scores in younger and professionally active patients. Most patients (78.9% with NSCLC and 95.3% with melanoma) had moderate-to-severe fatigue and social difficulties were more pronounced in patients with NSCLC (mean ± SD SDI score: NSCLC 10.4 ± 8.5, melanoma 5.9 ± 6.6). Patients with moderate-to-severe problems on EQ-5D-5L had poorer perceived general health, increased fatigue, and more social difficulties in both groups. Two-thirds of patients had discussed quality of life issues with health care professionals yet 22.2% felt unable to fully express concerns. Conclusion Most ICI-DR patients reported satisfactory HRQoL but heterogeneity and communication gaps support the need for patient-centered survivorship care.