Quality of life after CAR-T cell therapy. A mixed-methods study: Experience from clinical practice

Background Therapies with chimeric antigen receptor (CAR) T-cells represent a new treatment option for patients with relapsed or refractory hematologic malignancies. Objective In which areas is the quality of life of patients receiving CAR T-cell therapy impaired from the clinician's perspective? Methods Mixed-methods study with questionnaires and interviews. Participants were presented with a list of quality of life domains that can be impaired after CAR-T cell therapy according to a systematic review. This list contained 94 areas, some with subareas, so that a total of 112 different issues were included. Results Two hematologists and four nurses took part in the survey. Of the 112 issues surveyed, 27 met the criteria for both relevance and priority. Of these 27 issues, the following were rated as most relevant: lack of energy, distress, worry about disease recurrence and worsening health, fever or chills, hallucinations, confusion, and difficulty writing. Conclusion CAR-T cell therapies can specifically impair quality of life. These impairments are probably underreported in previous studies because specific questionnaires are still lacking. When informing patients about the possible consequences of CAR-T cell therapy, cognitive impairments (e.g., hallucinations, confusion) and impairments due to infections should be mentioned in addition to fatigue and distress. Psycho-oncologists should be familiar with the specific spectrum of side effects of CAR-T cell therapies.