Investigating Cognitive/Affective/Sleep disturbance symptoms in Patients Receiving High-Dose Interleukin-2 Therapy

Patients undergoing intensive treatments for life-limiting chronic illnesses such as cancer often experience severe cognitive, affective, and sleep disturbance symptoms. Immunotherapies such as high-dose Interleukin-2 (IL-2) can result in severe alterations in cognition, affect, and sleep. These alterations not only prevent patients from receiving their full course of treatment but also severely impact the quality of life of patients and their care partners. A mixed-method case study approach was used to investigate the trajectory of these symptoms from three key informants (the patient receiving IL-2, the care partner, and the primary nurse) in ten IL-2 cases over up to four treatment hospitalizations. Quantitative measurement scores and qualitative reports of symptom change were compiled to understand the symptom trajectory within and across treatment hospitalizations.

This dissertation includes a systematic literature review in Chapter 2 that highlights the lack of trajectory analysis surrounding cognitive, affective, and sleep disturbance symptoms in patients undergoing IL-2, as well as the gravity and impact that these symptoms have on patients and their families. Chapter 3 features the study team’s evaluation of methods using a case study approach to collect quantitative and qualitative data from one patient, care partner, and primary nurse as a case triad to examine cognitive, affective, and sleep disturbance symptoms one patient diagnosed with MRCC experienced during one hospitalization for IL-2 treatment and served as the foundation for the larger study. Chapters 4 and 5 synthesized data from case informants in the larger study and described the trajectory of cognitive symptoms and affective and sleep disturbance symptoms, respectively, that patients receiving IL-2 therapy for renal cell carcinoma experienced within and across hospitalizations.

Cognitive, affective, and sleep disturbance symptoms are often synergistic and interdependent. Of these symptoms, fatigue and anxiety were the most frequently reported, worsening with each subsequent dose of IL-2, suggesting a cumulative dosing effect. Interventions should be uniquely designed to target patients receiving IL-2, care partners, nurses, and the healthcare team with the aim of reducing commonly reported yet severely incapacitating symptoms. A reduction in these symptoms can reduce other cognitive, affective, and sleep disturbance symptoms, improving the patient’s overall symptom trajectory experience.