Association between psychological distress and treatment efficacy in patients with newly diagnosed SCLC.

12107 Background: Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine malignancy known for its rapid doubling time and high growth fraction. Despite advancements, treating SCLC remains challenging, necessitating improved strategies. Prior research indicates that psychological distress can impact cancer treatment efficacy, with severe psychological distress correlating with poorer prognosis. Our study delves into the psychological distress distribution among SCLC patients and identifies potential treatment targets. Methods: Patients newly diagnosed with SCLC, receiving either chemotherapy or immunotherapy as first-line treatment, were enrolled. Psychological distress, encompassing depression and anxiety symptoms, was assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Psychological distress hormone levels, including serum cortisol and adrenocorticotropic hormone (ACTH), were measured using ELISA kits before treatment initiation. Objective response rate (ORR) and median progression-free survival (PFS) were determined through chi-square tests, Kaplan-Meier analysis, and Cox regression methods. Results: A total of 97 patients diagnosed with SCLC were included in the study, with an average age of 61.5 years. Among them, 70 cases (72.1%) were classified as extensive stage, while 27 cases (27.8%) were limited stage. Psychological distress was present in 53 patients (54.0%). Patients experiencing psychological distress exhibited a significantly lower objective response rate (ORR) compared to those without distress (50.9% vs. 72.7%; P = 0.037), along with a shorter median progression-free survival (PFS) (8.40 vs. 19.47 months; 95% CI 7.84-12.96; P = 0.004). Furthermore, elevated serum cortisol levels (P < 0.001) were observed in patients with psychological distress. In addition, higher serum cortisol concentration (P = 0.011) was associated with a poorer response to chemotherapy and immunotherapy. Conclusions: Psychological distress is prevalent among patients with SCLC. Notably, those experiencing psychological distress tend to exhibit poorer responses to chemotherapy and immunotherapy. Our investigation has uncovered a potential mechanism involving neuroendocrine hormone resistance to treatment modalities. Clinical trial information: NCT05477979 .