The psychological status in patients with nasopharyngeal carcinoma during radiotherapy.

PURPOSE: The psychological status of nasopharyngeal carcinoma (NPC) patients cannot be ignored. Few studies have studied the dynamic changes and influencing factors of psychological status in NPC patients during radiotherapy. The purpose of this study was to investigate the changing trends and risk factors of anxiety and depression in NPC patients during radiotherapy. METHODS: Demographic and clinical data of 232 newly treated NPC patients were collected. Before radiotherapy, the fourth week, and the end of radiotherapy were observational timepoints. Anxiety and depression states were evaluated by the hospital anxiety and depression scale. RESULTS: Scores of anxiety before radiotherapy, in the fourth week and at the end of radiotherapy were 6.32 ± 3.19, 7.87 ± 3.49, and 9.08 ± 3.69, respectively (P < 0.001). Incidence rates of anxiety were 34.0%, 55.1%, and 64.0% (P < 0.001). Depression scores were 5.31 ± 3.19, 7.07 ± 3.63, and 8.32 ± 3.89 (P < 0.001). Incidence rates of depression were 25.0%, 43.9%, and 56.0% (P < 0.001). Gender, age, education level, smoking, and treatment-related toxicity scores (P < 0.05) were independent risk factors for anxiety in patients with NPC during radiotherapy, while age, education level, and treatment-related toxicity scores (P < 0.05) were independent risk factors for depression in these patients. CONCLUSION: The incidence and degree of anxiety and depression in NPC patients increased during radiotherapy. Age, education level, and treatment-related side effects influenced anxiety and depression. More psychological nursing should be given to the NPC patients who are more likely to suffer from psychological distress.

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.

The effect of psychological condition before radiotherapy on prognosis in 390 patients initially treated for nasopharyngeal carcinoma.

PURPOSE: To explore whether anxiety and depression are prognostic indexes for overall survival in patients with nasopharyngeal carcinoma (NPC) who underwent intensity-modulated radiotherapy (IMRT). METHODS: Clinical data were collected for NPC patients who underwent IMRT. Anxiety and depression were investigated before radiotherapy by using the Hospital Anxiety and Depression Scale (HADS). The survival rate was calculated by the Kaplan-Meier method, and survival curves were compared among patients with different levels of anxiety and depression. The Cox risk regression model was used to screen the factors affecting survival. RESULTS: A total of 390 initially treated NPC patients were included in the study. Among them, 166 patients suffered from anxiety, and 95 patients suffered from depression before radiotherapy. The 5-year overall survival rates for patients with and without anxiety before radiotherapy were 71.6% and 81.8% (χ2 = 5.31, P = 0.021), respectively. The 5-year overall survival rates for patients with and without depression before radiotherapy were 74.3% and 78.1% (χ2 = 0.05, P = 0.82), respectively. Cox regression analysis indicated clinical stages (HR = 3.982, 95% CI: 2.365~6.705), anxiety (HR = 1.832, 95% CI: 1.140~2.944), and gender (HR = 0.555, 95% CI: 0.313~0.984) as independent prognostic factors. CONCLUSION: Anxiety before radiotherapy is associated with poor prognosis in NPC patients.

Prognostic value of nutritional impairment on treatment-related toxicity and survival in patients with nasopharyngeal carcinoma taking normal nutrition before radiotherapy.

BACKGROUND: To investigate nutritional impairment during intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC) taking normal nutrition before IMRT and its effect on treatment-related toxicities (TRTs) and survival. METHODS: Modified nutrition index (m-NI) of 187 patients with NPC, comprised eight indicators (body mass index, circumference of upper arm muscles, total lymphocyte count, red blood cell count, levels of albumin, pre-albumin, transferrin, and hemoglobin), were evaluated before/after IMRT. Patient characteristics, m-NI, and the follow-up data for survival and TRTs were analyzed. RESULTS: The m-NI scores of patients with NPC decreased significantly after IMRT. Severe nutritional impairment (SNI; decrease in m-NI score ≥50%) was an independent prognostic factor for overall survival (OS) and an independent risk factor for grade ≥2 oral mucositis. Classification T4 disease and smoking were SNI risk factors. CONCLUSIONS: SNI during IMRT is a risk factor for oral mucositis and a prognostic factor for worse OS in patients with NPC.

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.