Clusters of symptoms associated with immune checkpoint inhibitor (ICI) therapy were associated with demographic characteristics and Eastern Cooperative Oncology Group Performance Score (ECOG PS), according to results of a cross-sectional study published in the European Journal of Oncology Nursing.

Patients with many malignancies are treated with ICIs, which are effective therapies but may cause immune-related adverse events (irAEs). In this study, 216 patients receiving ICI therapy were recruited at Tianjin’s Clinical Research Center for Cancer in China between 2001 and 2022. Patient demographic and clinical characteristics were associated with irAEs using a linear regression analysis.

The patients were mean age 53.61±15.57 years, 68.1% were men, 54.6% had lung cancer, 65.8% had stage IV disease, and the median number of ICI cycles was 6.00 (IQR, 3.00-10.75).

Continue Reading

The most common irAEs included fatigue (63.9%), itching (40.3%), cough (37.0%), and nausea (34.2%).

In a cluster analysis, 4 distinct clusters were observed. Cluster 1 included nonspecific symptoms, explained variance 18.216%; cluster 2 included musculoskeletal symptoms, explained variance, 17.978%; cluster 3 included cutaneous symptoms, explained variance, 14.745%; and cluster 4 included respiratory symptoms, explained variance, 13.131%.

The nonspecific symptom cluster was predicted by gender (B, 1.139; P =.000), ECOG PS (B, 0.421; P =.012), and disease course (B, −0.534; P =.001). Predictors for the musculoskeletal symptom cluster included ECOG PS (B, 1.098; P =.000), education (B, 0.683; P =.003), and disease course (B, −0.452; P =.001). The respiratory symptom cluster associated with ECOG PS (B, 0.427; P =.000) and disease course (B, −0.214; P =.041).

The major limitation of this study was that the cross-sectional design did not allow for causal relationships to be evaluated.

These data indicated that patient characteristics, such as gender and educational level, in addition to disease features were predictors for irAE clusters in patients treated with ICIs.


Feng LN, He J, Feng LX, Li Y, Li J, Chen C. Symptoms, symptom clusters and associated factors among cancer patients receiving immune checkpoint inhibitor therapy: A cross-sectional survey.Eur J Oncol Nurs. Published online February 10, 2023. doi:10.1016/j.ejon.2023.102288