| Background and purpose: Lung cancer has become the main cause of cancer-related morbidity and mortality worldwide.The 2-year survival rate for patients with non-small-cell lung cancer（NSCLC）increased by 8% from diagnosis in 2015-2016 compared with diagnosis in 2009-2010,with absolute increases of 5% to 6% for every stage of diagnosis.Studies have found that compared with patients with other types of cancer,lung cancer patients have significantly greater psychological distress.Psychological distress is an unpleasant emotional experience that is affected by many factors,including psychological factors（cognition,behavior,emotion）,social factors and spiritual factors.It is a broad term that mainly manifests itself as anxiety,stress,worry,panic and fear.Some studies have shown that due to the particular characteristics of lung cancer,psychological distress has become an important factor affecting the quality of life of lung cancer patients.Immunotherapy is one of the most important treatments for advanced NSCLC.Immunotherapy can increase the survival of patients with advanced NSCLC,and the number of advanced NSCLC survivors is increasing.The duration of response is the greatest advantage of immunotherapy,which can last for years once a response is obtained,and it can change the trajectory of the disease,even if the disease merely remains stable.However,most patients who receive immunotherapy experience psychological distress.Currently,the psychological distress experienced by advanced NSCLC patients has received increasing attention.Psychological distress is one of the most important factors affecting the quality of life of advanced NSCLC patients.Previous studies have found that the combination of anxiety,depression and other emotional factors during immunotherapy for advanced NSCLC is closely related to quality of life.However,the effect of psychological distress on the efficacy of immunotherapy in these lung cancer patients remains unclear.The purpose of this study was to evaluate the relationships between psychological distress and immunotherapy efficacy,adverse reactions and quality of life scores in patients with advanced non-small cell lung cancer（NSCLC）.Method: A total of 104 NSCLC patients who received 4-6 cycles of standard immunotherapy were enrolled and evaluated with the Distress Thermometer（DT）and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire（EORTC QLQ-C30）.The aim was to analyze the correlation between psychological distress and quality of life and to analyze whether psychological distress affects the efficacy of and adverse reactions to immunotherapy.Results: The objective response rate（ORR）and disease control rate（DCR）of the psychological distress group were 6% and 50%,respectively,and those of the no psychological distress group were 18.5% and 83.3%,respectively.The differences were statistically significant（χ2 = 14.131,P<0.05）.The progression-free survival（PFS）of advanced NSCLC patients who received comprehensive immunotherapy and had no psychological distress was significantly better than that of the psychological distress group（HR,0.338;95% CI,0.192-0.592;P<0.05）.The PFS of advanced NSCLC patients who received immunotherapy combined with chemotherapy in the no psychological distress group was significantly better than that in the psychological distress group（HR,0.458;95% CI,0.296-0.709;P<0.05）.After immunotherapy,the summary score for quality of life in the psychological distress group was 74.47±10.81 points,and the summary score for quality of life in the group without psychological distress was 90.88 ± 6.10 points;the difference between the groups was significant（t=-9.431,P=0.000<0.05）.There was a significant negative correlation between psychological distress and quality of life in 104 patients.Conclusions: Psychological distress in patients with advanced NSCLC is one of the factors affecting the efficacy of immunotherapy,and psychological distress is negatively correlated with quality of life during immunotherapy. |
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