Checkpoint induced arthritis severely impacts QoL for patients with cancer
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Patients with immune checkpoint therapy-induced inflammatory arthritis report significant social, functional and emotional impacts, compared with cancer and other side effects, according to findings published in BMC Rheumatology.
“This was the first study to evaluate the patient experience of developing inflammatory arthritis as a result of cancer immunotherapy,” Laura C. Cappelli, MD, MHS, MS, of the Johns Hopkins School of Medicine, told Healio Rheumatology. “Patients must navigate complicated decisions about treatment for their arthritis and cancer with limited data which makes it a very difficult experience.”
To examine how patients experience immune checkpoint therapy-induced inflammatory arthritis, as well as potentially conflicting treatment decisions, Cappelli and colleagues conducted semi-structured interviews with 14 adults recruited from an ongoing, single-center longitudinal observational study of rheumatic side effects of checkpoint inhibitors. All participants had received immune checkpoint therapy and had been diagnosed by a rheumatologist with checkpoint-inhibitor-induced inflammatory arthritis.
The interview covered the experience of diagnosis, coping mechanisms, treatment and treatment decisions, as well as symptoms and impact, of checkpoint-inhibitor-induced inflammatory arthritis. Following the interviews, researchers used an iterative coding process to identify themes through inductive thematic analysis and consensus. They then developed an overarching conceptual framework from the qualitative analysis and identified care gaps reported by patients.
According to the researchers, participants’ answers provided the basis of five overarching themes. These themes were an awareness gap leading to a delayed diagnosis of inflammatory arthritis, descriptors of checkpoint therapy-induced inflammatory arthritis and its relationship to other adverse events, the emotional and quality-of-life impact of inflammatory arthritis, fear and decision-making, and contextual factors such as social support.
More specifically, the arthritis was a significantly morbid event for most participants, even compared with concomitant advanced-stage cancer. In addition, diagnosis and treatment decision-making were considered complicated and sometimes difficult to navigate. Fear regarding the return of their cancer influenced decision making. These fears were exacerbated by the lack of data and unanswered questions that could have otherwise allowed these fears to be addressed.
Additionally, patients with checkpoint-induced inflammatory arthritis reported less social and other support in managing and coping with their arthritis, compared with what they had received for cancer.
“Inflammatory arthritis due to ICIs has a significant impact on patients’ quality of life,” Cappelli said. “Patients in this clinical situation need more support from their social network and their doctors. More data is needed on the safety of treated ICI-induced inflammatory arthritis with immunosuppression so patients can make informed decisions. In addition, doctors should work together in a multidisciplinary fashion — oncologist, rheumatologist and other specialists — to take the best care of these patients.”
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