Immunotherapy Impact on Cancer Quality of Life: Review

Abstract

Immunotherapy, particularly immune checkpoint inhibitors (ICIs), profoundly impacts health-related quality of life (HRQoL) in cancer patients, delivering net benefits such as FACT-E score improvements (MD 2.7 points), pain reduction (MD -2.2), and fewer severe adverse events (OR 0.52) in PD-L1-high gastroesophageal cancers (GEC) per meta-analyses of 11 RCTs (n>9,200), alongside NSCLC first-line stabilization, while contrasting sharp declines affect 33% of hepatocellular carcinoma cases (nadir at 6 months) and frail elderly
NSCLC subgroups (EORTC physical functioning MD -8.2) due to immune-related adverse events (irAEs; transient symptom spikes +5-10 points), age >75, G8 frailty <14, and distress correlations (r=-0.62). Patient factors like PD-L1 ≥1% (interaction p=0.02) and therapy contrasts ICIs outperforming chemotherapy's fatigue/alopecia burdens yet paralleling targeted agents' rash profiles underscore recommendations for precision prioritization in fit GEC cohorts, routine PRO monitoring (EORTC QLQ-C30/FACT), proactive irAE management, and geriatric screening, addressing gaps in long-term (>2-year), combination, and non- Western data (e.g., QUALITOP) through biomarkers and AI predictions as ICIs anchor 30-40% of 2026 regimens for optimal survival-HRQoL balance.