Association Between Pretreatment Emotional Distress and Survival Outcomes in Patients With Advanced Non-Small-Cell Lung Cancer: an individual patient data meta-analysis of 4632 patients in 7 trials

Emotional distress (ED) associated with worse survival outcomes in patients with melanoma and non-small-cell lung cancer treated with immune checkpoint inhibitors (ICIs). However, several preclinical studies suggest the association between stress and cancer treatment extends beyond ICIs alone. Here we used an individual patient data (IPD) meta-analysis of 4632 patients in 7 trials and a Kaplan-Meier analysis to verify broader connection between ED and survival outcomes in NSCLC patients. Kaplan-Meier analysis show that compared with patients without ED, patients with ED had worse survival outcomes, regardless of ICIs or chemotherapy (hazard ratio (HR) of overall survival (OS), 1.21, p=0.01; hazard ratio of progression-free survival (PFS), 1.19, p=0.01). IPD meta-analysis also supported results above (HR of OS, 1.18, 95% confidence interval (CI), 1.07-1.30; HR of PFS, 1.15, 95% CI, 1.03-1.28). Our research suggest that ED is only a prognostic biomarker in NSCLC, rather than a predictive biomarker for ICIs.