Exploring Physical and Psychological Needs and Quality of Life in Patients With Advanced Cancer Receiving Immunotherapy

Primary outcomes

1. Patient-Report Outcome-- Common Terminology Criteria for adverse events (PRO-CTCAE)

   Time frame: The data will be collected once a week within 3 months and once in 3-4 weeks in 4th-12th months during treatment.

   Interviewers graded the severity of adverse events according to the Common Terminology Criteria for adverse events (CTCAE), version 5, from the National Cancer Institute (NCI). In this study, we included 33 important symptoms from PRO-CTCAE in immunotherapy patients.

2. Symptom Severity Scale (SSS)

   Time frame: The data will be collected at five times (Before treatment for baseline, the 3rd, 6th, 9th, and 12th month)

   The Symptom Severity Scale (SSS) was used to evaluate the symptom severity of cancer patients. It included 25 common symptoms in cancer patients.The severity was scored by an 11-point numerical rating scale, from 0 (not at all) to 10 (very severe).

3. Distress Thermometer (DT)

   Time frame: The data will be collected at five times (Before treatment for baseline, the 3rd, 6th, 9th, and 12th month)

   The Distress Theremometer is utilized to assess patients' emotional distress and its sources. The assessment was developed by National Comprehensive Cancer Network (NCCN) and to evaluate the psychological distress level of cancer patients. It a single-item-11-point scale, from 0 to 10 points, which ask patients about their overall distress level over the past week, with higher scores indicating higher levels of distress.

4. The COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT)

   Time frame: The data will be collected at five times (Before treatment for baseline, the 3rd, 6th, 9th, and 12th month)

   The COST-FACIT developed by Souza, is used to assess patients' financial distress. It evaluates the financial situation of patients undergoing treatment for chronic diseases. The scale consists of 12 items rated on a 0 to 4 Likert-type scale, where 0 indicates "not at all important" and 4 indicates "very important." Lower scores indicate greater financial toxicity.

5. The Functional Assessment of Cancer Therapy-Immune Checkpoint Modulator (FACT-ICM)

   Time frame: The data will be collected at five times (Before treatment for baseline, the 3rd, 6th, 9th, and 12th month)

   The FACT-ICM is used to assess the quality of life in cancer patients undergoing immunotherapy. It comprises 25 symptom-related items specific to immune checkpoint modulation therapy and 27 items from the Functional Assessment of Cancer Therapy-General (FACT-G), totaling 52 items. Ratings are done on a 0 to 4 Likert-type scale, where 0 indicates no distress at all and 4 indicates extreme distress.

6. European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC-QLQ-C30)

   Time frame: The data will be collected at five times (Before treatment for baseline, the 3rd, 6th, 9th, and 12th month)

   To assess the convergent validity of the FACT-ICM, we employed this scale to analyze the correlation between two sets of quality of life data. It consists of 30 items assessing five major functional domains in cancer patients. Ratings for most items are done on a 1 to 4 Likert-type scale, where 1 indicates no presence and 4 indicates very severe presence of symptoms, with higher scores indicating poorer quality of life.

7. Supportive Care Needs Survey-Short Form 34 (SCNS-SF34)

   Time frame: The data will be collected at five times (Before treatment for baseline, the 3rd, 6th, 9th, and 12th month)

   The SCNS-SF34 comprises 34 items and utilizes a 1 to 5 Likert-type scoring system, where 1 indicates no need and 5 indicates the greatest need for assistance. Scores for each domain, based on the total scores of individual items, are standardized to a range of 0 to 100, with higher scores indicating greater unmet needs in that domain.