With the availability and increasing use of immunotherapies, such as checkpoint inhibitors, anti PD-1, and anti-CTLA-4 agents the trajectory of some patients diagnosed with metastatic cancers including melanoma, lung, and genito-urinary, has been transformed.
Immunotherapy treatments, while very effective in managing disease in some people, are not without consequences. Some patients experience a range of unwanted side-effects that impact continuation of treatment. With rapidly changing expectations about treatment options, toxicity, and disease outcomes due to the rapid incorporation of these drugs into the clinical cancer armamentarium, both patients and healthcare professionals can be unprepared for the psychosocial impacts.
Qualitative research conducted in Australia and the United Kingdom suggests that symptom management must be prioritised to minimise patient discomfort and distress. Consensus guidelines for the management of symptoms and toxicity associated with immunotherapy for advanced cancers are in development in the United Kingdom. Adaptation of these guidelines into the Australian setting and incorporation into practice will help to guide the physical management of symptoms. However, there will remain a gap in knowledge as to how best support patients experiencing high levels of uncertainty about their prognosis and the future. Here we will explore what is known about psychological impact of ongoing treatment with immunotherapy and the transformation of incurable disease into a chronic cancer state on patients, caregivers, and healthcare professionals.