Lung cancer remains one of the leading causes of cancer-related deaths worldwide, with advanced-stage cases often requiring intensive treatment. In recent years, immune checkpoint inhibitors (ICIs) have transformed the landscape of lung cancer therapy, offering new hope to patients. However, while these treatments have improved survival rates, their impact on patients’ quality of life (QoL) remains a critical question.
Immunotherapy, compared to conventional systemic treatments like chemotherapy and radiotherapy, has lower risk of toxicities, better symptom control, longer time until QoL deterioration. However, these findings have been largely based on clinical trials, which often exclude patients with poor performance status, multiple comorbidities, or other cancers. Moreover, existing studies have short follow-up durations (typically less than one year), limiting our understanding of long-term QoL trajectories in real-world settings.
A recent study led by researchers at the London School of Hygiene & Tropical Medicine (LSHTM) provides real-world evidence on how QoL changes over 18 months in patients with advanced lung cancer receiving different ICI-based treatments.
The study tracked 420 patients in the Netherlands, using validated questionnaires to assess QoL changes. Statistical models analysed global QoL variations from the start of immunotherapy up to 18 months, comparing different treatment regimens.
First-line immuno-monotherapy with palliative intent led to a small improvement in QoL within six months, stabilising thereafter. First-line immuno-chemotherapy with palliative intent resulted in a small QoL improvement over 12 months, with no significant changes afterward. Second/further-line immunotherapy with palliative intent and curative-intent chemo-radiotherapy followed by Durvalumab did not significantly alter QoL. Patients with pre-existing cardiovascular disease (CVD) or poor performance status had lower QoL scores but experienced no major changes in trajectory.
The findings revealed that patient experiences with ICIs varied significantly by cancer treatment regimens based on drug intensity, line and intent of immunotherapy. These differences highlight the need for a more personalised approach to cancer care, recognising the practical implications of different treatment regimens.
Dr Ananya Malhotra, the lead author of the paper said: “With ICIs becoming a standard treatment for advanced lung cancer, understanding their long-term impact on patient well-being is crucial. This study explores how immunotherapy impacts the quality of life in advanced lung cancer patients, guiding personalised cancer care beyond survival benefits alone.”
However, the study acknowledges limitations, including potential selection bias due to its observational nature and missing data from patients lost to follow-up. Additionally, average changes in QoL by cancer treatment regimens were studied rather than individual patient trajectories, so caution is needed when applying these findings to patient-level care in clinical settings.
These results reinforce the importance of integrating QoL assessments into routine cancer care, ensuring that treatment decisions prioritise both longevity and quality of life.