# Assessment of patient-reported symptom and psychological distress after neoadjuvant chemo-immunotherapy and lung resection for non-small cell lung cancer

## TL;DR

This study compares physical and psychological symptoms in lung cancer patients who received neoadjuvant chemo-immunotherapy versus surgery alone, finding no significant differences in reported symptoms over time.

## Contribution

The study provides real-world evidence that neoadjuvant chemo-immunotherapy does not worsen patient-reported symptoms in lung cancer patients.

## Key findings

- No difference in total symptom scores between patients with and without neoadjuvant chemo-immunotherapy.
- Anxiety and depression scores were similar between the two groups.
- A similar proportion of patients reported improved or stable symptoms in both groups.

## Abstract

Neoadjuvant chemo-immunotherapy is associated with oncologic benefits in patients undergoing resection for locally advanced non-small cell lung cancer (NSCLC). We assessed patient-reported physical and psychological symptoms following neoadjuvant chemo-immunotherapy and surgery compared to stage-equivalent patients who were operated during the same period without neodjuvant treatment.

All consecutive patients submitted to lung resection for clinical stage II and III NSCLC between March 2023 and December 2024 and alive at the time of the interview were approached for the study. Their patient-reported symptoms were assessed using the Non-Small Cell Lung Cancer Symptom Assessment Questionnaire (NSCLC-SAQ) and their psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS).

Of the 138 patients initially screened, 82 completed the survey. Median time from surgery to the interview was 13.9 months. There was no difference in total NSCLC-SAQ score between patients undergoing upfront surgery (S) and surgery after neoadjuvant chemo-immunotherapy (CT-IO) (P = .64). Chemo-immunotherapy was not independently associated with total NSCLC-SAQ score after multivariable regression analysis. The average anxiety and depression scores were also similar between the 2 groups. Finally, a similar proportion of patients in the 2 groups reported to have symptoms similar or better than before starting treatment.

Our findings show in a real clinical practice setting that neoadjuvant chemo-immunotherapy is not negatively associated with patient-reported physical or psychological symptoms in the medium to long-term follow-up compared to surgery alone. These results can be used as information tool during patients’ counselling.

Recent advances in the multimodal treatment of lung cancer have significantly transformed the therapeutic landscape of this aggressive disease.