Accepting Immunotherapy After Multiline Treatment Failure: An Exploration of the Anxiety and Depression in Patients with Advanced Cancer Experience

Abstract

Background: Tumor immunotherapy is a promising therapeutic strategy for patients with advanced cancers, and some tumors have profound and durable tumor regression. However, immunotherapy is still in the clinical trial stage with elusive long-term effects and complications as a new strategy. It is unclear whether patients possess an accurate understanding of the clinical benefits associated with these agents. Objective: To investigate the anxiety and depression of patients with advanced cancer who received immunotherapy using programmed death-1 or programmed death-ligand 1 after multiline treatment failure, explore the influencing factors, and provide a reference for clinical medical staff and psychological support for patients. Methods: The Hospital Anxiety and Depression Scale was used to calculate the anxiety and depression scores before and after 1, 2, and 3 courses of treatment, respectively. The patients with anxiety and depression were counted. Purposive sampling was used to conduct face-toface semi-structured interviews with 21 patients to find out the reasons. The obtained data were analyzed and collated using Colaizzi's phenomenological method. Results: One hundred and twenty-six patients with advanced cancers were included in the study. Before and after 1, 2 and 3 courses of treatment, 18.26%, 23.0%, 50% and 54% of patients suffered from anxiety and depression, respectively. The proportion of patients with anxiety and depression during immunotherapy kept increasing, mainly due to therapeutic efficacy below expectation, lack of timely information after treatment, lack of awareness of treatment and drugs, and lack of family and social support. Conclusion: Patients with advanced tumors after multiline treatment failure are susceptible to anxiety and depression during immunotherapy. It is necessary to test the emotional state of patients in time and carry out early intervention. Nursing staffs and medical staffs should adopt personalized measures to meet the psychological needs of patients.

Association between preoperative anxiety states and postoperative complications in patients with esophageal cancer and COPD: a retrospective cohort study

“…Approximately one-fifth of patients in previous studies were found to have anxiety, while the proportion of anxiety in esophageal cancer patients found in previous studies was even higher, accounting for as much as one-fourth or more [ 32 , 33 ]. One possible reason for this difference is that our study did not include late-stage patients who were no longer eligible for surgery, while late-stage cancer patients often have a shorter survival time, more obvious symptoms, and are more likely to experience anxiety [ 34 – 36 ]. Another possible reason is that different cultural backgrounds may lead to differences in the perception of emotional states.…”

Experience of patients considering or using checkpoint inhibitors in cancer treatment: a systematic review of qualitative research

“… 16 While our review did not identify any evidence that checkpoint inhibitors impacted mental health, a recent study reported that patients with multi-line treatment failure are susceptible to anxiety and depression during immunotherapy because of emotional vulnerability due to stressors such as long-term suffering, high financial burden, and low self-healing expectations. 74 Future qualitative studies of immunotherapy should examine the impact of receiving immunotherapy both on physical function and mental health, as important components of patient QoL.…”

Patients' experiences of cancer immunotherapy with immune checkpoint inhibitors: A systematic review and thematic synthesis

“…The Dr (medical oncologist) came in, and he asked if everything (about immunotherapy) had been explained to us and were we aware of all the side effects, we ran through it all again … they gave us some paperwork to read as well. (Livingstone et al, To bridge perceived knowledge gaps, some individuals sought further information about ICIs and irAEs from the internet, friends, family and peer support groups (Hou et al, 2023;Jamieson et al, 2020;Livingstone et al, 2021;Park et al, 2020;Xie et al, 2022). Some individuals; however, found peer support groups were often inadequate (Park et al, 2020).…”

“…(Hou et al, 2023, p. 497-498) ICIs were generally perceived as less toxic than chemotherapy with some individuals reporting feeling well between treatments (Levy et al, 2019) and being able to resume activities relatively quickly following treatment (Bharmal et al, 2018;Cheung et al, 2019;Park et al, 2020;Shuk et al, 2017). Lambert et al, 2020;Milne et al, 2020;Park et al, 2020;Shuk et al, 2017;Xie et al, 2022).…”

“…So it's a kind of a double-edged sword that, to be on it and to be so well is fabulous, but the other side, you know, in the back of your head was a little, every now and then a little voice says, "Aha, but when it finishes…" (Jamieson et al, 2020, p. 9) Psychological distress arising from layers of uncertainty about the future and life expectancy, treatment effectiveness and irAEs was prominent. Individuals articulated anxieties around ICIs effectiveness and duration of response (Hou et al, 2023;Jamieson et al, 2020;Levy et al, 2019;Livingstone et al, 2021;Milne et al, 2020;Park et al, 2020;Shuk et al, 2017;Xie et al, 2022). (Shuk et al, 2017(Shuk et al, , p. 2162(Shuk et al, -2163 Many experienced anxiety immediately before routine interval surveillance imaging and while awaiting results (Hou et al, 2023;Jamieson et al, 2020;Lai-Kwon et al, 2021;Levy et al, 2019;Shuk et al, 2017;Zwanenburg et al, 2022).…”