Symptoms, symptom clusters and associated factors among Chinese cancer patients receiving immune checkpoint inhibitor therapy: a cross-sectional survey

Abstract

Purpose Immune checkpoint inhibitors (ICIs) have significant therapeutic effects in cancer patients. Although there are many studies on immune-related adverse events (irAEs), few studies have investigated such symptoms. The purpose of this study was to explore irAE symptoms and symptom clusters and analyse associated factors among Chinese cancer patients receiving ICI therapy. Methods A cross-sectional design was employed to investigate 216 Chinese cancer patients receiving ICI therapy. Participants were surveyed using the Eastern Cooperative Oncology Group Performance Score (ECOG PS) assessment, the ICI therapy symptom assessment scale, and demographic and disease characteristic questionnaires designed for this study. Exploratory factor analysis and multiple linear regression analysis were performed to analyse the data. Results The most common symptoms in patients with grade 1–2 symptom severity were fatigue (57.4%), itching (34.3%) and cough (33.3%) and with grade 3–4 symptom severity were rash (7.9%), joint pain (6.9%), muscle soreness (6.5%) and fatigue (6.5%). Four symptom clusters were identified: nonspecific, musculoskeletal, respiratory and cutaneous (the cumulative contribution to the variance was 52.963%). ECOG PS, disease course and sex were significantly associated with the nonspecific symptom cluster (Adj R2 = 14.8). ECOG PS and disease course were significantly associated with the respiratory symptom cluster (Adj R2 = 8.5). ECOG PS, disease course and education level were significantly associated with the musculoskeletal symptom cluster (Adj R2 = 20.2). Conclusions Cancer patients receiving ICI therapy experience various symptoms with apparent clustering. The factors associated with symptom clusters included sex, education level, ECOG PS and disease course. Our findings may provide a scientific basis for symptom assessment and management. Medical personnel should implement targeted strategies to promote symptom management in those receiving ICI therapy, improving patient outcomes and quality of life.