The effect of early oral nutritional supplements on improving nutritional outcomes and radiation-induced oral mucositis for nasopharyngeal carcinoma patients undergoing concurrent chemoradiotherapy.

BACKGROUND: To explore the value of early oral nutritional supplements (ONS) in patients with nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy (CCRT). METHODS: Patients with newly diagnosed II-IVA stage NPC were analyzed and divided into Early and Routine ONS groups according to whether they received early ONS at the beginning of CCRT. Changes in nutritional indicators, incidence of treatment-related toxicity, radiation interruption, and completion of CCRT were compared. RESULTS: In total, 161 patients with NPC were analyzed, including 72 in the Early ONS group and 89 in the Routine ONS group. Multivariate analysis showed that early ONS was an independent protective factor for concurrent chemotherapy ≥2 cycles, and a protective factor against ≥grade 3 radiation-induced oral mucositis (RIOM) and weight loss >5%. In stage III-IVA patients, early ONS was beneficial in decreasing the risk of severe malnutrition. CONCLUSIONS: Early ONS can improve nutritional outcomes, reduce RIOM, and enhance treatment adherence.

Anxiety and depression status prior to radiotherapy in patients with nasopharyngeal carcinoma and its effect on acute radiation toxicities.

OBJECTIVE: The objective of this work is to explore anxiety and depression status prior to radiotherapy in patients with nasopharyngeal carcinoma (NPC) and its effect on acute radiation toxicities. METHODS: A total of 267 NPC patients were enrolled between August 2013 and September 2016. The anxiety and depression status of the patients prior to radiotherapy was evaluated using the Hospital Anxiety and Depression Scale. Acute radiation toxicities were assessed weekly and recorded according to the Common Terminology Criteria for Adverse Events version 4.0. Logistic regression analysis was used to identify the predictive factors for acute radiation toxicities. RESULTS: The rates of anxiety and depression status prior to radiotherapy were 35.2% and 25.5%, respectively. Anxiety was a significant predictor of vomiting (P = 0.001, OR = 2.874) and dysphagia (P = 0.029, OR = 2.080). Depression was a significant predictor of dysgeusia (P = 0.030, OR = 2.957). In addition, age was a significant predictor of dysphagia (P = 0.001, OR = 1.131). CONCLUSIONS: Anxiety and depression status prior to radiotherapy aggravate acute radiation toxicities in patients with NPC. Assessment of the anxiety and depression status and appropriate interventions should be an integral part of treatment to relieve radiation injury during intensity-modulated radiotherapy.

High-efficiency X-ray luminescence in Eu3+-activated tungstate nanoprobes for optical imaging through energy transfer sensitization.

X-ray luminescence optical imaging has been recognized as a powerful technique for medical diagnosis due to its deep penetration and low auto-fluorescence in tissues. However, the low luminescence efficiency of current X-ray luminescence nanoprobes remains a major hurdle for sensitive bioimaging in practical medical applications. Here we present a new kind of energy transfer-sensitized X-ray luminescence nanoprobe (PEG-NaGd(WO4)2:Eu) for highly effective optical bioimaging. Under X-ray excitation, the tungstate host absorbs the X-ray photons and then transfers the energy to the Eu3+ luminescence center, thus enhancing the luminescence efficiency of the nanoprobes for high sensitivity optical in vivo imaging. Moreover, the shortened T1 relaxation response of Gd3+ ions and X-ray attenuation capability of W atoms enable the nanoprobes to serve as efficient contrast agents for magnetic resonance imaging (MRI) and computed tomography (CT) imaging. Therefore, combined with the MRI, CT and X-ray luminescence imaging capabilities, the present PEG-NaGd(WO4)2:Eu nanoprobes could be used as promising multimodal imaging contrast agents in biological systems.

Modified-Nutrition Index is a Significant Prognostic Factor for the Overall Survival of the Nasopharyngeal Carcinoma Patients who Undergo Intensity-modulated Radiotherapy.

PURPOSE: To explore whether the modified-nutrition index (m-NI) is a prognostic factor for the overall survival (OS) in nasopharyngeal carcinoma (NPC) patients who undergo intensity-modulated radiotherapy (IMRT). METHODS: Clinical data were prospectively collected from NPC patients who underwent IMRT at our hospital between October 2008 and December 2014. The patient nutritional status before radiotherapy was evaluated using the m-NI, based on eight nutrition indicators including body mass index, arm muscle circumference, albumin, total lymphocyte count, red blood cell count, hemoglobin, serum pre-albumin, and transferrin. The independent prognostic value of m-NI for the OS was evaluated. RESULTS: A total of 323 patients (229 males, 94 females) were included in this study, and the follow-up rate was 99.7% (322/323). The 1-, 3-, and 5-yr OS rates between malnutrition and normal nutrition groups by using the m-NI were 93.0% vs. 96.9%, 76.4% vs. 82.8%, and 61.8% vs. 77.1%, respectively. A regression analysis showed that the m-NI was the significant prognostic value for the OS in NPC. CONCLUSIONS: The m-NI before radiotherapy is a significant prognostic factor for the OS in NPC patients. Further validation of our instrument is needed in other NPC patients.

Effect of chemoradiotherapy on nutrition status of patients with nasopharyngeal cancer.

We aimed to assess the effect of chemoradiotherapy on the nutritional status of patients with nasopharyngeal cancer (NPC) and to detect the risk factors for poor nutrition status in NPC patients after radiotherapy. A total of 104 NPC patients participated in this clinical observational study. Psychological distress and nutritional indicators were measured prior to chemoradiotherapy. During the course of radiation therapy, side effect symptoms were assessed weekly. At the end of radiotherapy, nutritional indicators were measured again. Logistic regression was used to identify the risk factors for poor nutritional status after radiotherapy. The values of the 9 nutritional indicators were significantly lower after radiotherapy (P < 0.001) than the initial values before treatment. After radiotherapy, 20.19% of patients had more than 10% weight loss. At a significance level of α = 0.05, the risk factors for poor nutritional status were old age (P = 0.042), female gender (P < 0.001), late stage of the disease (P = 0.013), depression (P = 0.024), high side effect score (P = 0.007), and moderate nutritional status before radiotherapy (P = 0.015). Radiotherapy affects the nutritional status of NPC patients. To prevent malnutrition during radiotherapy, nutritional assessment and intervention should be an integral part of treatment.

Prevalence of anxiety and depression and their risk factors in Chinese cancer patients.

PURPOSE: This paper aimed to obtain information on the levels of anxiety and depression among cancer patients in China. The factors influencing these psychological problems were also analyzed. METHODS: A total of 1,217 cancer patients were interviewed, and each participant was asked to complete a self-administered questionnaire. The anxiety status, depression status, disease stage, tumor site, pain status, and performance status of the patients during the week prior to the interview were assessed. RESULTS: The anxiety and depression prevalence rates were 6.49 and 66.72 %, respectively. The prevalence rates of depression were 60.62 % for head and neck cancer, 77.19 % for lung cancer, 57.9 % for breast cancer, 75.81 % for esophagus cancer, 63.40 % for stomach cancer, 68.42 % for liver cancer, 54.37 % for colorectal cancer, and 71.13 % for cervix cancer. The factors influencing depression of patients were performance status (P < 0.0001), pain (P = 0.0003), age (P < 0.0001), and education level (P < 0.0001). The risk factors of anxiety were performance status (P = 0.0007), age (P < 0.0001), and gender (P < 0.0001). CONCLUSIONS: Depression was a more important psychological problem than anxiety in cancer patients. Compared with 3.8 % of the prevalence of depression in normal population, depression level was high among Chinese cancer patients. Patients with lung, esophagus, and cervix cancers were the high-risk groups for depression. Poor performance status, pain, old age, and low-level education were the predicting factors for depression.

Assessment of the relationship between resilience and quality of life in patients with digestive cancer.

AIM: To study the relationship between resilience and quality of life (QOL) in patients with digestive cancer. METHODS: The resilience of patients was measured prior to treatment, and their psychological distress, fatigue status, and treatment side effects were assessed 3 wk after. Their QOL was measured after their treatment ended. A relationship model of these variables was constructed using path analysis. RESULTS: Resilience explained 33.2% of the variance in psychological distress, 16.1% of the variance in fatigue, and 1.23% of the variance in side effects. The relationship between resilience and QOL was statistically significant (ß = 0.119, t = 4.499, P < 0.001) when psychological distress, fatigue, and side effects were absent from the regression model, whereas the adjusted regression coefficient of resilience was not statistically significant (t = 1.562, P > 0.05) when these variables were added. Psychological distress, together with fatigue and side effects, could explain 52.40% of the variance in QOL (P < 0.05). Physiological distress accounted for 28.94% of the total effect on QOL, fatigue accounted for 33.72%, side effects accounted for 22.53%, and resilience accounted for 14.80%. CONCLUSION: Resilience is not an independent predictor of QOL in patients with digestive cancer, but it is a main factor influencing psychological distress and side effects.

Application of the Chinese version of the MFI-20 in detecting the severe fatigue in cancer patients.

PURPOSE: This study aimed to apply the Multidimensional Fatigue Inventory Scale (MFI-20) for detecting severe fatigue in cancer patients, estimating the prevalence rates of severe fatigue in patients with various tumors and those receiving various treatments, as well as assessing the risk factors for severe fatigue in cancer patients after treatment. METHODS: This study was divided into two stages. In the first stage, we randomly selected 353 residents and obtained their scores in the Chinese version of MFI-20. We then calculated the 95th percentile of their MFI-20 score. In the second stage, we selected 715 hospital cancer patients diagnosed from 2010 to 2011 and obtained their data on fatigue, resilience, and quality of life. The 95th percentile of the MFI-20 score in the residents was deemed as the cutoff score for detecting patients with severe fatigue. The χ (2) test was used to detect the differences among the prevalence rates of severe fatigue, and multivariate logistic regression was used to detect the predictors of severe fatigue after treatment. RESULTS: The 95th percentile of the MFI-20 score in the residents was 60. The difference between the quality of life of patients with MFI-20 score ≤ 60 and patients with MFI-20 score >60 was statistically significant (92.33 ± 12.86 and 75.03 ± 15.85, t = 10.44, P < 0.0001). The prevalence of severe fatigue in cancer patients after treatment was 18.88 % (95 % confidence interval, 16.01-21.75 %). The prevalence rates of severe fatigue among patients with various tumors were significantly different (χ(2) = 17.59, P = 0.007), and the prevalence rates of severe fatigue among patients receiving various treatments were different (χ(2) = 8.25, P = 0.04). Patients with nasopharyngeal cancer were at the highest risk for severe fatigue (RR = 3.22), followed by patients with lung cancer and digestive tract cancer (RR = 2.41). Apart from the tumor site, old age (P = 0.01), advanced disease stage (P < 0.01), low resilience (P < 0.01), and radiotherapy (P = 0.03) were risk factors for severe fatigue after treatment. CONCLUSION: The cutoff score of 60 is suitable for determining severe fatigue in the Chinese-version MFI-20. The prevalence of severe fatigue in cancer patients after treatment is moderate. Patients receiving radiotherapy are more likely to suffer from severe fatigue than those not receiving radiotherapy. The prevalence of severe fatigue in patients with nasopharynx, lung, and digestive tract cancers is higher than that in patients with other tumors. Patients with advanced disease stage, old age, and low resilience are at high risk for severe fatigue after treatment.

Validation of the Chinese version of the resilience scale and its cutoff score for detecting low resilience in Chinese cancer patients.

PURPOSE: We aim to investigate the reliability and validity of the Chinese version of the Resilience Scale (RS-14) and to determine the cutoff score of the RS-14 for screening Chinese cancer patients with low resilience. METHODS: The current study was divided into two studies. In the first study, we randomly selected 625 people and obtained their scores in the Chinese version of the RS-14 and SF-36 using cross-sectional survey. We then calculated the validity and reliability of the Chinese version of the RS-14. In the second study, we selected 970 hospital cancer patients diagnosed during 2010 to 2011 and assessed for their resilience once and for anxiety, depression, and quality of life on two occasions. We determined the cutoff score of the RS-14 based on the maximum Youden Index, with the scores of anxiety and depression as gold standards. RESULTS: The correlation coefficients for inter-items were in the range of 0.23 to 0.68 (P < 0.001), whereas those for the item-scale were in the range of 0.62 to 0.82 (P < 0.001). Two factors represent the factor structure of the RS-14. The correlation coefficient between the RS-14 and SF-36 scores was 0.82 (P < 0.001). The split-half reliability and test-retest reliability of the RS-14 were both 0.82 (P < 0.001), and the internal consistency Cronbach's α was 0.93. The cutoff score of 64 was obtained for screening cancer patients with low resilience (sensitivity and specificity were 0.74 and 0.71, respectively). CONCLUSION: The Chinese version of the RS-14 has good validity and reliability, and it can measure the resilience of Chinese people. The cutoff score of 64 for the RS-14 is appropriate for detecting cancer patients with low resilience in order to decrease psychological stress and improving quality of life. Health care nurses can screen and detect cancer patients with low resilience based on the said cutoff score to timely provide psychological care and interventions for the patients.

Validation of the Chinese version of Multidimensional Fatigue Inventory-20 in Chinese patients with cancer.

GOALS OF WORK: The purpose of this research is to study the validation of the Chinese version of Multidimensional Fatigue Inventory-20 in measuring fatigue status of the patients with cancer in China. MATERIALS AND METHODS: The original English version of the Multidimensional Fatigue Inventory-20 was translated into a Chinese version, which was applied to measure the fatigue status of cancer patients prior to commencing chemotherapy and during the last week of chemotherapy, respectively. The reliability and criterion-related validity of the Chinese version of the Multidimensional Fatigue Inventory-20 were assessed by calculating Cronbach's α and Pearson correlation coefficients. The construct validity was analyzed by employing factor analysis. MAIN RESULTS: There were three dimensions in the Chinese version of the MFI-20, which measures the physical, mental, and spiritual fatigue of patients with cancer. All of the correlation coefficients between EORTC QLQ-C30V3.0 and MFI-20 were statistically significant (P < 0.0001). The Cronbach's α coefficient was more than 0.8 and 0.7 for total MFI-20 and for the three dimensions of the Chinese version of the MFI-20, respectively. CONCLUSIONS: The Chinese version of the MFI-20 is a reliable and valid instrument to assess fatigue in Chinese patients with cancer.