Symptom Experience of Lung Cancer Patients Treated With Immunotherapy Combined with Chemotherapy: A Longitudinal Study

Abstract

The study aims to determine the incidence, frequency, severity, and distress of symptoms in lung cancer patients during the treatments with immune checkpoint inhibitors（ICIs） combined with chemotherapy, evaluating the characteristic of symptoms over time. This study used convenience sampling to select lung cancer patients who initially received a combination of ICIs and chemotherapy drugs in tertiary hospitals in Beijing from October 2023 to January 2025. The study instrumentsincluded a self-designed patient general information questionnaire and a Chinese version of the Memory Symptoms Assessment Scale (MSAS-Ch). Patients’ general information was collected before treatment, and symptom follow-up began on day 8 after the first treatment (T1), continuing until day 8 after the sixth treatment (T6). During this period, the incidence, frequency, severity, and distress level of symptoms were recorded. A total of 402 patients were initially included in the baseline measurements, with 43 dropouts, data from 354 patients was analyzed finally. 17 symptoms were extracted as the top ten most frequent occurrences during treatment. Fatigue, drowsiness, loss of appetite, altered taste, and nausea had an incidence >30% and consistently ranked in the top ten. A total of 15 symptoms scored ≥3 points (indicating "frequent" or "persistent") throughout the entire cycle. Fatigue, drowsiness, loss of appetite, and pain remained relatively frequent. In the T5, loss of appetite was the most frequent symptom (26.55%), while in the T6, pain was the most frequent (35.88%). Sixteen symptoms were rated as severe (≥3 points, indicating "serious" or "very serious"). Drowsiness and loss of appetite were consistently rated as more severe. In the assessment of the top ten symptoms rated as significant (≥3 points, indicating "moderately" or "severely"), only drowsiness persisted across all six cycles. The most prominent symptom was fatigue from T1 to T4 and T6 periods (37.29% to 50.85%). In the T5 period, hair loss (24.85%) and pain (23.45%) were the most distressing symptoms. Lung cancer patients exhibit various symptoms after receiving immunotherapy combined with chemotherapy. Over time, the incidence of perceived symptoms such as "fatigue and drowsiness" is higher than that of dietary-related symptoms like "loss of appetite and altered taste." These symptoms are most frequent, extremely severe, and cause significant distress. Health care providers can intervene during treatment to improve the patient's symptom experience by addressing symptoms that occur frequently or frequently, are more severe in perception, and are more troubling to the patient.