Symptoms, symptom burden, and influencing factors in patients treated with Nivolumab

Immune checkpoint inhibitors such as nivolumab are increasingly used in cancer treatment; however, their side effects may significantly affect patients' well-being and quality of life. This study aimed to determine symptom burden and influencing factors in patients receiving nivolumab immunotherapy.

This descriptive, cross-sectional study was conducted between October 2024 and January 2025 in a medical oncology clinic. A total of 53 patients receiving nivolumab participated. Data were collected through face-to-face interviews using a patient information form, a 40-item symptom assessment form, and the ECOG Performance Status Scale.

The most common symptoms were skin-related toxicities such as itching (18.9%) and dryness (20.8%), gastrointestinal problems like constipation (15.1%), and pulmonary symptoms such as fatigue (17%), cough (17%), and dyspnea (15.1%). Neurological symptoms like numbness and tingling in hands and feet (11.3%) were also reported. Among endocrine toxicities, hypothyroidism was observed in 20.8% of patients. Patients receiving concurrent chemotherapy had significantly higher symptom burden. Additionally, patients with adequate and balanced nutrition reported fewer and milder symptoms. Most patients had good performance status (81.1% fully active).

Nivolumab-related symptoms are influenced by both treatment-related and individual lifestyle factors. Adequate nutrition and avoiding concurrent chemotherapy may help reduce symptom severity.