ABSTRACT
Background
Immune-checkpoint Inhibitors (ICIs) are increasingly used in advanced cancers and can be associated with immune-related adverse events (irAEs).
Aims
This study examined the association between anxiety and depression, irAEs, and overall survival in a national cohort of ICI-treated cancer survivors.
Methods
This retrospective cohort study used data from 8671 2-year survivors following ICI treatment with advanced melanoma, lung, colorectal, head and neck, and bladder cancers from a nationwide de-identified electronic health record-derived database. Bivariate tests, Kaplan-Meier curves, and multivariable logistic regressions were conducted using R.
Results
The majority (79%, N = 6820) did not have irAEs, anxiety, or depression. The landmark analysis observed that accounting for covariates, irAEs were associated with anxiety or depression (aOR: 1.70, 95% CI: 1.41, 2.06, p < 0.001) in the first 2 years after ICIs. Female sex (aOR: 1.46, 95% CI: 1.24, 1.73, p < 0.001), poorer functional status (ECOG = 2: 1.47, 95% CI: 1.06, 2.04, p = 0.022), Medicaid coverage (aOR: 1.54, 95% CI: 1.08, 2.18, p = 0.016), and being seen in an academic practice setting (aOR: 3.62, 95% CI: 3.02, 4.35, p < 0.001) were associated with greater odds of anxiety/depression diagnoses compared with male sex, ECOG = 0, Medicare, and community practice settings. Non-white survivors who experienced an irAE had lower odds of experiencing anxiety/depression (aOR: 0.58, 95% CI: 0.45, 0.46, p < 0.001) compared with White survivors.
Conclusions
Few studies have examined the relationship between anxiety and depression and irAEs in a national sample. Findings have implications for survivorship quality of life and integrated mental health care delivery.