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Patients' lived experiences of fractures during immune checkpoint inhibitor therapy: a qualitative study
Mahdi Neshan1,2, Maira Quintanilha3, Nese Yuksel4
1Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Abstract:
Fractures during or after immune checkpoint inhibitor therapy were experienced as "a small price to pay" relative to cancer survival. Despite their functional and psychological impact, patients emphasized the importance of rehabilitation and more transparent communication regarding fracture risks.
Background:
While bone fractures following immune checkpoint inhibitor (ICI) therapy have been increasingly reported, patients' lived experiences and the associated functional and psychological consequences are not well understood. This study aimed to evaluate patients' descriptions of their fracture experiences during and after their ICI therapy.
Methods:
In this qualitative descriptive study, 15 patients who experienced fractures during or after ICI therapy were interviewed. Participants were recruited between March 2024 and July 2025. Semi‑structured interviews were audio‑recorded, transcribed verbatim, and analyzed using Braun and Clarke's thematic analysis approach. Coding was conducted independently by a single researcher and subsequently reviewed by the full research team.
Results:
The analysis showed that fracture experiences were interpreted within the context of a core theme: "a small price to pay." Participants viewed fractures as less important when compared with the risk of mortality from cancer. They demonstrated different pathways of adaptation and recovery, highlighting the importance of physical rehabilitation and the need for empathy from healthcare providers. Additionally, although patients were unaware of the association between immunotherapy and bone fractures, they noted that this information would not have changed their initial desire to receive treatment, although it would have been helpful in providing them with better insight and a greater sense of control.
Conclusion:
Bone fractures in ICI recipients have a significant impact on patients' overall functioning, although they do not diminish patients' desire to continue treatment. Providing patients with information about these risks helps them prepare for injury prevention and manage the unintended consequences.