Impact of Baseline Nutritional Status, Psychological Health, Fatigue, and Insomnia on Outcomes of Immune Checkpoint Inhibitors in Advanced Non-Small Cell Lung Cancer: A Retrospective Cohort Study.

Abstract

This study investigated the impact of pretreatment nutritional status, psychological health, fatigue, and insomnia on outcomes of immune checkpoint inhibitors (ICIs) monotherapy in patients with advanced non-small cell lung cancer (NSCLC). A total of 80 patients with stage IV NSCLC were enrolled. Baseline assessments included the Controlling Nutritional Status (CONUT) score, Herth Hope Index (HHI), Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and Athens Insomnia Scale (AIS). Response to ICImonotherapy, along with progression-free survival (PFS) and overall survival (OS), was evaluated at week eight and through subsequent survival analyses. At week eight, partial response (PR), stable disease (SD), and progressive disease (PD) were observed in 31.8%, 33.0%, and 35.2% of patients, respectively. PD patients had significantly higher pretreatment CONUT scores, greater anxiety and depression, and more severe fatigue and insomnia than PR patients. Low nutritional risk was associated with improved OS and PFS. Higher HHI scores and lower HADS-A/D, BFI, and AIS scores correlated with better survival outcomes. In multivariate analysis, anxiety was independently associated with PFS, and depression and fatigue independently predicted OS. Pretreatment nutritional status, psychological health, fatigue, and insomnia significantly influence immunotherapy response and survival in advanced NSCLC. These findings underscore the clinical importance of comprehensive baseline assessments to identify high-risk patients who may benefit from targeted interventions before initiating immunotherapy. Addressing nutritional deficits, psychological distress, fatigue, and insomnia early could potentially enhance treatment response and improve survival outcomes, offering valuable insights for personalized cancer care strategies.