The Unique Symptom Burden of Patients Receiving CAR T-Cell Therapy

• Published in: Seminars in oncology nursing 2021-12, Vol.37 (6), p.151216, Article 151216
• Main Authors: Whisenant, Meagan S., Srour, Samer A., Williams, Loretta A., Subbiah, Ishwariah, Griffin, Donna, Ponce, Darcy, Kebriaei, Partow, Neelapu, Sattva S., Shpall, Elizabeth, Ahmed, Sairah, Wang, Xin Shelley
• Format: Article
• Language: English
• Subjects: Cancer; CAR T-cell therapy; Fatigue - etiology; Hematological malignancies; Humans; Immunotherapy, Adoptive; Neoplasms - therapy; Patient-reported outcomes; Quality of life; Symptom burden; Symptoms
• ISSN: 0749-2081; 1878-3449
• DOI: 10.1016/j.soncn.2021.151216

There is little research on the patient experience of symptom burden from CAR T-cell therapy, and no validated measure specific to the symptoms of CAR T-cell therapy currently exists. The purpose of this study was to identify symptoms experienced and to determine the content domain for a patient-reported outcome (PRO) measuring symptom burden for patients who had received standard of care CAR T-cell therapy for advanced B-cell lymphoid malignancies. Semi-structured qualitative interviews were conducted with a sample of 21 patients who had received CAR T-cell therapy. Content analysis was used to define the symptom burden content domain. Sixty-two percent of patients were interviewed within 3 months of therapy; 81.0% experienced cytokine release syndrome and 28.6% experienced neurotoxicity. Content analysis found 31 symptoms related to disease and treatment. The most common disease-related symptom identified by patients was pain (43%). The most common symptoms identified by patients as related to CAR T-cell therapy included fatigue (tiredness) (62%), lack of appetite (29%), headache (29%), chills or feeling cold (24%), and feeling confused (24%). The qualitative analysis also confirmed that symptoms interfere with daily activities, work, walking, relationships with others, mood, and enjoyment of life. Patients who receive standard CAR T-cell therapy experience numerous symptoms related to disease and CAR T-cell therapy, including symptoms related to the T-cell infusion. Symptoms may result in interference with daily activities, relationships, treatment adherence, and mood. Oncology nurses should be aware of and assess symptom related to CAR T-cell therapy.