The association between emotional distress prior to receiving immune checkpoint inhibitors and overall survival among patients with cancer: A population-based study.
Bibliographic record
Abstract
12106 Background: Immune checkpoint inhibitors (ICIs) are widely used across cancer care. Emerging evidence from smaller studies links pretreatment emotional distress (ED) to poorer outcomes in patients with melanoma and non-small cell lung cancer undergoing ICIs due to changes in inflammatory states but large-scale studies are lacking. We conducted a population-level retrospective cohort study to assess the impact of pre-treatment ED on overall survival (OS) across solid tumor patients treated with ICIs. Methods: Using population-level administrative data, a cohort of patients with cancer, age 18 years or older, who received at least one dose of an ICI between June 2012 to October 2018 in Ontario, Canada, were identified using systemic therapy databases. Databases were deterministically linked to obtain socio-demographic, clinical co-variates, pre-treatment ED levels, and overall survival. ED was defined as having the sum of the Edmonton Symptom Assessment Scale (ESAS) anxiety and depression score ≥ 4. Multivariable Cox proportional hazard models assessed the association between ED and OS, adjusted for age, sex, body mass index, history of autoimmune conditions, cancer centre facility level, comorbidity score, and hospitalization within 60 days prior to starting ICI. Results: Among the 3237 patients who received ICIs and completed the ESAS prior to ICI treatment, most were male (58%), median age 67 years (IQR 59-74), the median combined ESAS anxiety and depression score was 3 (IQR 0-7); 45% had pre-treatment ED. The majority had lung cancer (49%), melanoma (37%) or renal cancer (9%), and were either treated with nivolumab (42%), pembrolizumab (36%) or ipilimumab (19%). Median OS was 330 days. Pre-ICI treatment ED was associated with poorer OS (aHR = 1.23, 95% CI [1.12–1.34] P < 0.0001) and when analyzed as a continuous variable, a higher combined ESAS anxiety and depression score was associated with poorer OS (aHR = 1.02 per 1 unit increase, 95% CI [1.01-1.03] P < 0.0001). Pre-treatment ED was associated with poorer OS for both males (aHR males = 1.27, 95% CI [1.12–1.43] P = 0.0001) and females (aHR females = 1.18, 95% CI [1.03–1.36] P = 0.02). Among disease sites, ED was associated with reduced OS among patients with lung cancer (aHR = 1.33, 95% CI [1.17–1.51] P < 0.0001) and showed a similar but non-significant trend among patients with melanoma (aHR = 1.14, 95% CI [0.98–1.32] P = 0.09); while ED not significantly associated OS for patients with renal cancer (aHR = 0.98, P = 0.89). Similar results were observed across sexes and disease sites when evaluating the combined ESAS anxiety and depression score and OS. Conclusions: Among patients receiving ICIs, pretreatment ED is associated with poorer OS. These findings suggest the importance of screening for and addressing ED as a part of routine cancer care, which may potentially influence ICI treatment outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".