Anxiety, depression, and quality of life in metastatic cancer patients receiving immune checkpoint inhibitors: A 2-center cross-sectional study
Medicine (United States), vol.105, no.24, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 105 Issue: 24
- Publication Date: 2026
- Doi Number: 10.1097/md.0000000000049285
- Journal Name: Medicine (United States)
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, EMBASE, MEDLINE, Directory of Open Access Journals
- Keywords: anxiety, cancer, depression, immunotherapy, quality of life
- Hacettepe University Affiliated: Yes
Abstract
Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, but their psychological impact remains underexplored. This study evaluated the relationship between emotional distress and quality of life (QoL) among patients undergoing ICI therapy. In this 2-center cross-sectional study, 200 adults with metastatic solid tumors who had received ≥3 ICI cycles were assessed using the Turkish version of the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Patients were categorized into high and low QoL groups according to the median global SF-36 score, with a cutoff value of 60.5. Correlation analyses and multivariate logistic regression were used to identify factors associated with poor QoL. The median age was 61 years; 73% were male, and 60.5% had Eastern Cooperative Oncology Group 1 to 2. Fifty-two percent of patients had low QoL. HADS-anxiety subscale (HADS-A) and HADS-depression subscale (HADS-D) scores were higher in the low QoL group (11 vs 8; 8 vs 6; both P < .001). Both subscales showed significant negative correlations with all SF-36 domains. In multivariate analysis, Eastern Cooperative Oncology Group ≥ 1 (odds ratio [OR]: 5.92, 95% confidence interval [CI]: 2.61–13.40, P < .001), age ≥ 60 (OR: 2.98, 95% CI: 1.35–6.57, P = .007), ≥2 metastatic sites (OR: 3.62, 95% CI: 1.64–7.98, P = .001), second-line or later therapy (OR: 3.11, 95% CI: 1.23–7.82, P = .016), HADS-A (OR: 3.74, 95% CI: 1.70–8.18, P < .001), and HADS-D (OR: 5.03, 95% CI: 2.32–11.34, P < .001) independently predicted poor QoL. Anxiety and depression are common among ICI-treated patients and independently predict poorer QoL, regardless of clinical factors. Routine psychosocial assessment and early supportive interventions should be integrated into comprehensive immunotherapy care.