Comparison of long-term quality of life and their predictors in survivors between paediatric and adult nasopharyngeal carcinoma in the intensity-modulated radiotherapy era.

ABSTRACT

BACKGROUND: To compare the differences in long-term quality of life (QoL) between survivors of paediatric and adult patients with nasopharyngeal carcinoma (NPC) and assess the clinical factors that predict long-term QoL. METHODS: We enrolled 420 long-term NPC survivors who were alive for at least 8 years after treatment, including 195 paediatric and 225 adult patients diagnosed and treated with intensity-modulated radiotherapy (IMRT) at Sun Yat-sen University Cancer Centre (SYSUCC) between 2011 and 2015. Data on clinical factors and EORTC QLQ-C30 were collected from all participants. The QoL of paediatric and adult NPC survivors was compared. RESULTS: The paediatric group had significantly better outcomes in global health status (paediatric 80.2 ± 12.7; adult 77.2 ± 11.5; P = 0.027), physical function (paediatric 98.5 ± 4.6; adult 95.1 ± 7.0; P < 0.001), role function (paediatric 97.0 ± 9.2; adult 90.5 ± 15.2; P < 0.001), social function (paediatric 96.0 ± 8.9; adult 93.5 ± 11.8; P = 0.038), insomnia (paediatric 1.9 ± 7.8; adult 13.1 ± 22.3; P < 0.001), constipation (paediatric 1.3 ± 7.5; adult 8.0 ± 17.4; P < 0.001), diarrhea (paediatric 0.7 ± 4.6; adult 2.8 ± 9.3; P = 0.010), and financial difficulties (paediatric 1.9 ± 7.8; adult 11.0 ± 19.8; P < 0.001), but poorer cognitive function (paediatric 88.3 ± 9.9; adult 93.8 ± 12.6; P < 0.001) than the adult group. Pretreatment clinical factors, including T stage, N stage, and pre-treatment EBV (Epstein-Barr Virus) DNA, showed a strong association with QoL. However, the factors that affected the QoL outcomes differed between the two groups. In survivors of paediatric cancer, global health status/QoL was strongly correlated with T stage (P < 0.001) and clinical stage (P = 0.018), whereas it was strongly correlated with pre-treatment EBV DNA (P = 0.008) in adults. CONCLUSION: Paediatric survivors of NPC have a significantly better QoL than adult NPC survivors. Moreover, pre-treatment T stage, N stage, and EBV DNA significantly influenced the overall health status of the survivors. These results highlight the need to tailor care to both age groups to promote better long-term health outcomes.