Immune-related adverse reactions (irAEs) are closely related to the patient's mental status in advanced non-small cell lung cancer

Purpose: Patients with lung cancer often develop negative psychology, particularly anxiety and depression, which often leads to reduced quality of life, shorter survival time and increased mortality. The main aim of this study was to explore whether anxiety and depression contribute to a greater risk of irAEs in patients treated with combined ICIs. Methods: A total of 317 lung cancer patients receiving combined immunotherapy were included in the Cancer Hospital of Harbin Medical University from September 2018 to May 2022. The Hospital Anxiety and Depression Scale (HADS) was used to measure the anxiety and depression of patients prior to treatment with the combined ICIs. The irAEs were assessed 1–3 days after each immunotherapy treatment and recorded according to the Common Terminology Criteria for Adverse Events version 5.0. Cardinality tests, univariate and multivariate logistic regression models were used to identify risk factors for the occurrence of irAEs. Results: The prevalence of anxiety and depressive states before patients received the combined ICIs was 36.6% and 37.5% respectively. Multivariate logistic regression analysis showed that anxiety (P < 0.01, OR = 5.169) and depression (P < 0.01, OR = 3.766) were identified to increase the risk of irAEs. Patients with anxiety (P < 0.01, OR = 1.274) and depression (P < 0.01, OR = 1.098) were more likely to have a higher number of irAEs. Conclusion: We demonstrate that patients' anxiety and depressive states prior to receiving combined ICI therapy do increase the probability of irAEs and have a high chance of leading to more irAEs in patients.