Longitudinal Patient-Reported Outcomes in Patients Receiving Chimeric Antigen Receptor (CAR) T-Cell Therapy

Johnson, Patrick Connor; Dhawale, Tejaswini; Lavoie, Mitchell W.; Karpinski, Kyle; Markovitz, Netana H.; Hennessey, Kathleen; Frigault, Matthew J.; El‐Jawahri, Areej

doi:10.1182/blood-2022-163194

Cited by 3 publications

(11 citation statements)

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“…115 Indeed, long-term survivors of CAR-T cell therapy have overall comparable self-reported measures of mental health, fatigue, and social function as the general population. 41 Nevertheless, anxiety, depression, and other stressors continue to afflict a substantial proportion of long-term survivors, 41,106 underscoring the importance of screening and support for mental health disorders as part of routine care. Efforts are ongoing to develop and validate instruments to better characterize symptom burden, quality of life, and other patient-reported outcomes following CAR-T cell therapy.…”

Section: Psychosocial Effectsmentioning

confidence: 99%

“…Qualitative research studies have revealed a significant burden of psychologic distress among CAR-T cell recipients, including frequent symptoms of anxiety, depression, and post-traumatic stress disorder. 41,44,[104][105][106] Patients undergoing CAR-T cell therapy may experience a sense of loss, isolation, and frustration during repeated cycles of treatment and relapse, along with fear of recurrence and difficulty planning for the future in face of the uncertain prognosis following CAR-T cell therapy. 107 Additional challenges include the financial burden associated with treatment as well as the geographic, socioeconomic, and racial barriers to accessing CAR-T cell therapy.…”

Section: Psychosocial Effectsmentioning

confidence: 99%

“…41,105,108 Many patients also experience a short-term decline in quality of life during the first 2 weeks after infusion, coinciding with the period of hospitalization and peak symptom burden, while lingering fatigue, drowsiness, and reduced appetite are also common during the first 3 months. 106,[109][110][111] Despite this, it should be emphasized that successful treatment with CAR-T cell therapy has been shown to achieve rapid, meaningful, and enduring improvements in patient-reported quality of life starting within the first months of treatment. 106,[111][112][113][114] In the randomized trial ZUMA-7, second-line axi-cel was associated with a more rapid recovery of patient-reported quality of life and physical functioning by Day +100 compared to standard of care.…”

Section: Psychosocial Effectsmentioning

confidence: 99%

“…106,[109][110][111] Despite this, it should be emphasized that successful treatment with CAR-T cell therapy has been shown to achieve rapid, meaningful, and enduring improvements in patient-reported quality of life starting within the first months of treatment. 106,[111][112][113][114] In the randomized trial ZUMA-7, second-line axi-cel was associated with a more rapid recovery of patient-reported quality of life and physical functioning by Day +100 compared to standard of care. 115 Indeed, long-term survivors of CAR-T cell therapy have overall comparable self-reported measures of mental health, fatigue, and social function as the general population.…”

Section: Psychosocial Effectsmentioning

confidence: 99%

“…Additional challenges include the financial burden associated with treatment as well as the geographic, socioeconomic, and racial barriers to accessing CAR‐T cell therapy 41,105,108 . Many patients also experience a short‐term decline in quality of life during the first 2 weeks after infusion, coinciding with the period of hospitalization and peak symptom burden, while lingering fatigue, drowsiness, and reduced appetite are also common during the first 3 months 106,109–111 . Despite this, it should be emphasized that successful treatment with CAR‐T cell therapy has been shown to achieve rapid, meaningful, and enduring improvements in patient‐reported quality of life starting within the first months of treatment 106,111–114 .…”

Section: Psychosocial Effectsmentioning

confidence: 99%

See 4 more Smart Citations

Long‐term survivorship care after CAR‐T cell therapy

Puckrin,

Jamani,

Jimenez‐Zepeda

2023

European J of Haematology

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While cytokine release syndrome and immune effector cell‐associated neurotoxicity syndrome are well‐recognized acute toxicities of chimeric antigen receptor (CAR) T cell therapy, these complications have become increasingly manageable by protocolized treatment algorithms incorporating the early administration of tocilizumab and corticosteroids. As CAR‐T cell therapy expands to new disease indications and the number of long‐term survivors steadily increases, there is growing recognition of the need to appropriately evaluate and manage the late effects of CAR‐T cell therapy, including late‐onset or persistent neurotoxicity, prolonged cytopenias, delayed immune reconstitution and infections, subsequent malignancies, organ dysfunction, psychological distress, and fertility implications. In this review, we provide a practical approach to the long‐term survivorship care of the CAR‐T cell recipient, with a focus on the optimal strategies to address the common and challenging late complications affecting this unique population.

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Section: Psychosocial Effectsmentioning

confidence: 99%

Section: Psychosocial Effectsmentioning

confidence: 99%

Section: Psychosocial Effectsmentioning

confidence: 99%

Section: Psychosocial Effectsmentioning

confidence: 99%

Section: Psychosocial Effectsmentioning

confidence: 99%

See 3 more Smart Citations

Long‐term survivorship care after CAR‐T cell therapy

Puckrin,

Jamani,

Jimenez‐Zepeda

2023

European J of Haematology

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Remission after CAR T‐cell therapy: Do lymphoma patients recover a normal life?

Perthus,

Colin,

Charton

et al. 2024

HemaSphere

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Chimeric antigen receptor T cells (CAR T cells) can induce prolonged remission in a substantial subset of patients with relapse/refractory lymphoma. However, little is known about patients' life after CAR T‐cell therapy. We prospectively assessed the multidimensional recovery of lymphoma patients in remission, before leukapheresis, before CAR T‐cell infusion, and 3, 6, and 12 months thereafter. Validated tools were used to measure lymphoma‐related and global health‐related quality of life (HRQoL; Functional Assessment of Cancer Therapy‐Lymphoma [FACT‐Lym] and EQ‐5D‐5L), cognitive complaint (FACT‐Cognition), fatigue (FACIT‐Fatigue subscale), psychological status (Hospital Anxiety and Depression Scale, Post‐Traumatic Check List Scale), and sexuality (Relationship and Sexuality Scale). Beyond 12 months of remission, we also surveyed physical, professional, sexual, and general life status. At 3, 6, and 12 months, 53, 35, and 23 patients were evaluable, respectively. Improvement in lymphoma‐related HRQoL was clinically relevant at 3, 6, and 12 months with a mean change from baseline of 10.9 (95% confidence interval [CI]: 5.8; 16.1), 12.2 (95% CI: 4.2; 20.1), and 11.72 (95% CI: 2.06; 21.38), respectively. Improvement in global HRQoL, fatigue, and anxiety was clinically relevant, but 20%–40% of patients experienced persistent fatigue, psychological distress, and cognitive complaints over time. Beyond 12 months after CAR T cells, 81.8% of 22 evaluable patients were satisfied with their daily life. Physical activity, professional, sexual, and global well‐being had returned to prediagnosis levels in nearly half of the patients. We found an improvement in HRQoL after CAR T‐cell therapy including anxiety, depression, sexual satisfaction, and general well‐being. However, not all patients recover a “normal life.” Further research is needed to determine which patients are at risk of quality‐of‐life impairment to improve recovery after CAR T‐cell infusion.

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Pilot Randomized Controlled Trial of an Educational Video for CAR T-Cell Therapy Recipients

Johnson,

Dhawale,

Newcomb

et al. 2024

Journal of the National Comprehensive Cancer Network

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Background: CAR T-cell therapy has transformed the treatment of hematologic malignancies, but it is complex and challenging to convey to patients. Educational video interventions are efficacious for improving patient knowledge about cancer therapeutics and informing their care preferences, yet no educational videos have been evaluated in CAR T-cell therapy. Methods: We conducted a randomized controlled trial comparing an educational video versus usual care in adults (age ≥18 years) with hematologic malignancies receiving CAR T-cell therapy at Massachusetts General Hospital. Intervention participants watched a 13-minute video depicting how CAR T-cell therapy works, logistics, toxicities, prognosis, recovery, and approaches for dealing with prognostic uncertainty. The primary outcome was feasibility (≥60% enrollment rate). Secondary outcomes included acceptability (≥80% reporting comfort with the video), patients’ knowledge about CAR T-cell therapy (10-item test), and self-efficacy (Communication and Attitudinal Self-Efficacy Scale–Cancer), decision satisfaction (Decision Conflict Scale), psychological distress (Hospital Anxiety and Depression Scale), and preference for CAR T-cell therapy. Results: We enrolled 79% (80/101) of eligible patients. Of that group, 91% (30/33) reported being very or somewhat comfortable watching the video, and 94% (31/33) would definitely or probably recommend the video. At 1 month, participants in the video arm reported higher self-efficacy (mean difference [MD], 9.2 [95% CI, –4.0 to 22.3]; Cohen’s d, 0.32), decision satisfaction (MD, 2.5 [95% CI, 0.7–4.2]; Cohen’s d, 0.67), and lower anxiety (MD, –0.8 [95% CI, –2.5 to 0.7]; Cohen’s d, 0.26) compared with participants in the usual care arm. At 1 week, both arms reported high preferences for CAR T-cell therapy (video arm, 94% [33/35]; usual care, 84% [27/32]). Conclusions: We found that an educational video for patients receiving CAR T-cell therapy was feasible and acceptable. The educational video demonstrated promising preliminary effects on patient self-efficacy and decision satisfaction and warrants further study.

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Longitudinal Patient-Reported Outcomes in Patients Receiving Chimeric Antigen Receptor (CAR) T-Cell Therapy

Cited by 3 publications

References 0 publications

Long‐term survivorship care after CAR‐T cell therapy

Long‐term survivorship care after CAR‐T cell therapy

Remission after CAR T‐cell therapy: Do lymphoma patients recover a normal life?

Pilot Randomized Controlled Trial of an Educational Video for CAR T-Cell Therapy Recipients

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