BREAKING research demonstrates that some effective cancer treatments improve quality of life. Specifically, patients with blood cancers experienced a significant improvement in their self-reported wellbeing 6 months after receiving chimeric antigen receptor T-cell (CAR-T) therapy. Developed by harvesting a patient’s own T-cells before engineering them to target proteins on the surface of cancer cells, CAR-T cell therapy has transformed cancer treatment. However, few studies have looked at the impact of the treatment on patient quality of life.
The study enrolled 103 blood cancer patients diagnosed between April 2019 and November 2021, aged between 23 and 90. Of these, 71% were diagnosed with lymphoma, 28% with myeloma, and 1% with B-cell acute lymphoblastic leukaemia. Patients eligible to receive CAR-T therapy were administered tisagenlecleucel (34%), lisocabtagene maraleucel (16%), axicabtagene ciloleucel (13%), and idecabtaene vicleucel (12%). Several self-reported questionnaires were used to measure quality of life prior to treatment, and 1 week, 1 month, 3 months, and 6 months following CAR-T cell infusion.
Functional Assessment of Cancer Therapy-General (FACT-G), a 27-item questionnaire, measures quality of life on four different subscales: physical, functional, emotional and social. Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS), which is designed to measure anxiety and depression symptoms. Finally, major depressive symptoms were measured using PHQ-9, while post-traumatic stress disorder symptoms were assessed using the Post-Traumatic Stress Checklist. Physical symptoms were recorded using the Edmonton Symptom Assessment System which investigates fatigue, pain, appetite, nausea, drowsiness, dyspnea, insomnia, and trouble swallowing over 24 hours.
The majority of patients achieved remission (76%), while 38% did not survive the length of follow-up, and 33% experienced immune effector cell-associated neurotoxicity syndrome, a common side effect. Regarding quality of life, the majority of participants experienced an initial decline in quality of life 1 week after therapy, with the median score decreasing from 77.9 to 70.1. However, reported quality of life then significantly increased by 6 months post-treatment (median: 83.7), along with an improvement in physical symptom burden and anxiety. Therefore, the majority of participants experienced an improvement to their quality of life following CAR-T cell therapy. However, roughly 20% of patients reported persistent physical and psychological symptoms, which were at times detrimental to quality of life.
Connor Johnson, Massachusetts General Hospital, Boston, Massachusetts, USA, explained that it is important to recognise the burden associated with CAR-T cells in order to maximise the effectiveness of the therapy, and to improve the care of patients. Despite the significant increase in quality of life among a number of patients with an array of blood cancer diagnoses, Johnson commented: “We also identify a distinct subset of patients who have persistent physical and psychological symptom burden, even at the 6-month post-CAR-T time point. And I hope that these findings lead to additional interventions, with a goal of improving the overall quality of life trajectory of all patients.”