Health-Related Quality of Life and Psychosocial Outcomes in Long-term Survivors Treated with Immune Checkpoint Inhibitors: A Nationwide Multicenter Study

Taha Koray Sahin^1*Fatih Atalah²Bahadır Köylü³Ahmet Oruc⁴Aydin Acarbay²Akgun Karakok²Sevgi Dogan⁴Cevat Ilteris Kikili⁵Görkem Turhan⁶Gamze Emin⁶Selahattin Celik⁷Ilknur Deliktas Onur⁸Tuba Ugur Tuzcu⁹Sedat Biter¹⁰Safa Can Efil¹¹Fadime Sinem Ardic¹²Azer Gokmen¹³Halil Goksel Guzel¹⁴Kadri Turan¹⁵Ahmet Kürsad Disli¹⁶Salih Tünbekici¹⁷Erdem Goker¹⁷Mevlude Inanc¹⁶Ozlem Ozdemir¹⁵Banu Ozturk¹⁴MUSLİH ÜRÜN¹³Hatime Arzu Yasar¹²Mehmet Ali Nahit Sendur¹¹Ismail Oguz Kara¹⁰Osman Sutcuoglu⁹Ozturk Ates⁸Tulay Eren⁷Atila Yildirim⁶Saadettin Kilickap¹⁸Omer Dizdar¹⁹Fatma Alev Turker¹⁹Mustafa Erman¹⁹Mehmet Artac⁴Fatih Selcukbiricik⁵Sercan Aksoy²⁰Deniz Can Guven¹⁹

• ¹Hacettepe University, Ankara, Türkiye
• ²TC Saglik Bakanligi Goztepe Prof Dr Suleyman Yalcin Sehir Hastanesi, Istanbul, Türkiye
• ³Koc Universitesi Hastanesi, Istanbul, Türkiye
• ⁴Necmettin Erbakan Universitesi, Meram, Türkiye
• ⁵Koc Universitesi, Istanbul, Türkiye
• ⁶Karadeniz Teknik Universitesi, Trabzon, Türkiye
• ⁷TC Saglik Bakanligi Ankara Etlik Sehir Hastanesi, Ankara, Türkiye
• ⁸Ankara Dr Abdurrahman Yurtaslan Onkoloji Egitim ve Arastirma Hastanesi, Ankara, Türkiye
• ⁹Gazi Universitesi, Ankara, Türkiye
• ¹⁰Cukurova Universitesi, Adana, Türkiye
• ¹¹TC Saglik Bakanligi Ankara Sehir Hastanesi, Çankaya, Türkiye
• ¹²Ankara Universitesi, Ankara, Türkiye
• ¹³Van Yuzuncu Yil Universitesi, Van, Türkiye
• ¹⁴TC Saglik Bakanligi Antalya Egitim ve Arastirma Hastanesi, Antalya, Türkiye
• ¹⁵TC Saglik Bakanligi Izmir Sehir Hastanesi, Izmir, Türkiye
• ¹⁶Erciyes Universitesi Tip Fakultesi, Kayseri, Türkiye
• ¹⁷Ege Universitesi, Izmir, Türkiye
• ¹⁸Istinye Universitesi, Istanbul, Türkiye
• ¹⁹Hacettepe Universitesi Hastaneleri, Ankara, Türkiye
• ²⁰Hacettepe Universitesi Onkoloji Enstitusu, Ankara, Türkiye

Background: The increasing use of immune checkpoint inhibitors (ICIs) has resulted in a growing population of long-term survivors (LTS). However, the long-term psychosocial and quality of life (QoL) outcomes in these patients remain underexplored. This study aimed to evaluate QoL, psychological morbidity, fear of cancer progression (FoP), and functional outcomes in cancer patients treated with ICIs for at least six months without disease progression. Methods: This cross-sectional, multicenter study included 346 adult cancer patients from 17 tertiary oncology centers in Türkiye. Participants had received ICIs for ≥6 months in (neo)adjuvant or metastatic settings. Standardized questionnaires assessed QoL, psychological distress, FoP, immune-related adverse events (irAEs), and work status. Results: The median age of the cohort was 62 years (IQR: 53–69). Average survivor QoL was comparable to the Turkish general population; but 119 (34.5%) survivors had poor QoL. Clinically relevant symptoms of depression and anxiety were present in 24.3% and 20.8% of patients, respectively, while 48% reported FoP. The overall return-to-work rate among patients initially employed was 50.9%, with 72.7% returning within the first year. Depression, anxiety, and FoP were negatively correlated with all QoL domains. All grade irAEs were common (53.8%) but not significantly associated with worse QoL (p=0.149). Conclusions: This study represents one of the largest cohorts to date evaluating survivorship issues among LTS treated with ICIs. Among patients receiving ICIs for at least six months, nearly one-third experienced impaired QoL, primarily driven by psychological distress and FoP. Further research is needed to address survivorship care in this population.