The need for psychological counseling in breast cancer patients before radiotherapy during the COVID-19 pandemic.

The aims of this study were to explore the need for psychological counseling in breast cancer patients before radiotherapy during the COVID-19 pandemic, to distinguish which type of psychological guidance they demanded and to investigate the related factors that could be associated with the need for psychological counseling. A total of 112 eligible patients diagnosed with stage I-IV breast cancer who had received surgery were included. The self-rating depression scale (SDS), self-rating anxiety scale (SAS), Pittsburgh sleep quality index (PSQI), cancer fatigue scale (CFS), and survey for the need for psychological counseling were completed for all subjects prior to radiotherapy. A total of 8.9% and 3.6% of patients suffered from depression and anxiety during the COVID-19 pandemic, respectively. The prevalence of sleep disturbance was 62.5%. Only 12.5% of the patients needed psychological counseling, especially for the type of tumor diagnosis and treatment rather than COVID-19-related protection. The higher the total CFS score was, the lower the need for psychological counseling in breast cancer patients during this pandemic (OR = 0.91, 95% CI = 0.84-0.98). Patients who received 7-8 chemotherapeutic cycles had 6.7 times the risk of needing psychological counseling when compared with those who received 1-6 chemotherapeutic cycles. Fewer breast cancer patients suffered from depression and anxiety before radiotherapy during the COVID-19 pandemic. However, a large number of patients complained of sleep disturbance and fatigue. The majority of patients did not need psychological counseling. More chemotherapeutic cycles or less fatigue could increase their risk of needing psychological counseling, especially for tumor diagnosis and treatment, but not COVID-19-related protection.

Sleep, depression, and anxiety in family caregivers of nasopharyngeal carcinoma patients before therapy.

Sleep disturbance, anxiety, and depression are frequently observed in cancer patients. There have fewer studies about the sleep and emotional status of nasopharyngeal carcinoma (NPC) patient family caregivers (FCs) before treatment. We explored the sleep, depression, and anxiety in NPC patient FCs before therapy, compared sleep quality between caregivers with and without depression and anxiety, and examined and related factors of sleep disturbance in FCs of NPC patients before therapy. FC-patient dyads included from two centers were 92 in total. The proportions of poor sleep, anxiety, and depression in NPC patient FCs were 45.7%, 43.5%, and 54.3%, respectively. FCs with anxiety or depression were more inclined to report decreased sleep quality. Depressed caregivers were 11.11 times more to be poor quality sleep before patients treatment (OR = 11.11, 95%; CI = 2.94-42.05). NPC patient FCs before treatment are at high risk of sleep disturbances, depression, and anxiety, especially those already experiencing anxiety and depression symptoms.

Sleep in nasopharyngeal carcinoma patients before chemotherapy, after induction chemotherapy, and after concurrent chemoradiotherapy.

Sleep disturbance is frequently observed in cancer patients before, during and after oncology treatment. We explored the sleep features of patients before treatment, after induction chemotherapy, and after concurrent chemoradiotherapy for nasopharyngeal carcinoma (NPC). Ninety eligible patients diagnosed with NPC (stages III to IVc) and treated with induction chemotherapy plus concurrent chemoradiotherapy were included. The Pittsburgh Sleep Quality Index (PSQI) was applied to assess sleep before treatment, after induction chemotherapy, and after concurrent chemoradiotherapy. The median global PSQI scores in patients with NPC before treatment, after induction chemotherapy, and after concurrent chemoradiotherapy were 5, 6, and 10, respectively. The median scores of daytime dysfunction, sleep disturbance and habitual sleep efficiency were statistically significant at the pretreatment, after induction chemotherapy and after concurrent chemoradiotherapy timepoints (P < 0.049, P < 0.001 and P < 0.001, respectively). However, minimal changes were observed in all subscores after induction chemotherapy. Patients with poor sleep quality after induction chemotherapy were more prone to suffer worse sleep after concurrent chemoradiotherapy (OR = 12.6, 95%; CI = 2.4-67.3). Induction chemotherapy had less effect on the quality of sleep in NPC patients. Patients experienced a significant increase in sleep disturbance after concurrent chemoradiotherapy, particularly those with bad sleep after induction chemotherapy.

Effects of intensity-modulated radiotherapy and chemoradiotherapy on attention in patients with nasopharyngeal cancer.

This study evaluated the short-term effects of intensity-modulated radiotherapy (IMRT) and cisplatin concurrent chemo-radiotherapy (CCRT) on attention in patients with nasopharyngeal cancer (NPC). Timely detection and early prevention of cognitive decline are important in cancer patients, because long-term cognitive effects may be permanent and irreversible. Thirty-eight NPC patients treated with IMRT (17/38) or CCRT (21/38) and 38 healthy controls were recruited for the study. Neuropsychological tests were administered to each patient before treatment initiation and within a week after treatment completion. Changes in attention performance over time were evaluated using difference values (D-values). Decreased attention was already observable in patients with NPC prior to treatment. Baseline quotient scores for auditory attention, auditory and visual vigilance, and auditory speed were lower in patients treated with CCRT than in healthy controls (P=0.037, P=0.001, P=0.007, P=0.032, respectively). Auditory stamina D-values were higher in patients treated with IMRT alone (P=0.042), while full-scale response control quotient D-values were lower in patients treated with CCRT (P=0.030) than in healthy controls. Gender, depression, education, and sleep quality were each related to decreased attention and response control. Our results showed that IMRT had no negative acute effects on attention in NPC patients, while CCRT decreased response control.

Sleep characteristics and psychological symptoms in patients with locally advanced nasopharyngeal carcinoma before and after intensity-modulated radiotherapy and concurrent chemotherapy.

Sleep disturbances and psychological distress are the most common adverse effects associated with cancer diagnosis and treatment. The aim of this study was to examine sleep and psychological characteristics in patients with local-advanced nasopharyngeal carcinoma (NPC) following completion of intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy, and to describe the predictors of post-test psychological symptoms after treatment. Sleep quality and psychological symptoms were measured using Pittsburgh sleep-quality index (PSQI) and symptom checklist-90 in 60 local-advanced NPC patients treated with IMRT and concurrent chemotherapy, respectively. After treatment, the subscores of subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction increased significantly compared with their pre-test scores. Similar results were observed for the mean PSQI global score. However, for psychological symptoms, only subscores of somatization and depression were higher than their baseline level. Multivariate analysis revealed that concurrent chemotherapy cycle was the only predictor of depression after treatment among all of the psychological symptoms assessed. These findings indicate that sleep disturbance and psychological distress are significant problems in NPC patients treated with IMRT and concurrent chemotherapy. Patients who receive many cycles of concurrent chemotherapy may be at an increased risk of depression after completion of IMRT.

Cognitive function, mood, and sleep quality in patients treated with intensity-modulated radiation therapy for nasopharyngeal cancer: a prospective study.

OBJECTIVE: The aim of this study was to prospectively evaluate the cognitive function, depression, anxiety, and sleep quality in patients with nasopharyngeal cancer (NPC) before and after intensity-modulated radiotherapy (IMRT). METHODS: Eligible patients with newly diagnosed NPC treated with primary IMRT were recruited. A series of neuropsychological tests were performed within 1 week before and after IMRT. Cognitive function was measured with the Das-Naglieri cognitive assessment system. The Self-rating Anxiety Scale and Self-rating Depression Scale were used to assess mood states. Sleep quality was evaluated by means of the Pittsburgh Sleep Quality Index. RESULTS: A total of 51 patients were enrolled. The overall prevalence of depression, anxiety, and poor sleep quality showed a significant increase after RT, compared with their pre-RT levels (39.2% vs. 3.9%, p = 0.000; 19.6% vs. 3.9%, p = 0.039; 64.7% vs. 37.3%, p = 0.003, respectively). Multiple linear regression analysis revealed that pre-RT depression and younger age and pre-RT anxiety and younger age were significant predictors of post-RT depression and anxiety, respectively (p < 0.05). Poor sleep quality before treatment was also associated with poor sleep after RT (p = 0.032). However, the cognitive function evaluated by the cognitive assessment system from pre-RT was similar to the post-RT results. CONCLUSIONS: Exposure to ionizing radiation for the treatment of NPC decreased mood and sleep quality following IMRT, especially for patients with depression, anxiety, younger age, or poor sleep before treatment. No acute cognitive deficits were found resulting from IMRT, but the long-term effects of RT might still warrant concern.