Anxiety and depression in nasopharyngeal carcinoma patients and network analysis to identify central symptoms: A cross-sectional study from a high-incidence area.

PURPOSE: To determine the prevalence of anxiety and depression in patients with nasopharyngeal carcinoma (NPC) and to identify central symptoms and bridge symptoms among psychiatric disorders. METHODS: This cross-sectional study recruited patients with NPC in Guangzhou, China from May 2022, to October 2022. The General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used for screening anxiety and depression, respectively. Network analysis was conducted to evaluate the centrality and connectivity of the symptoms of anxiety, depression, quality of life (QoL) and insomnia. RESULTS: A total of 2806 respondents with complete GAD-7 and PHQ-9 scores out of 3828 were enrolled. The incidence of anxiety in the whole population was 26.5% (depression, 28.5%; either anxiety or depression, 34.8%). Anxiety was highest at caner diagnosis (34.2%), while depression reached a peak at late-stage radiotherapy (48.5%). Both moderate and severe anxiety and depression were exacerbated during radiotherapy. Coexisting anxiety and depression occurred in 58.3% of those with either anxiety or depression. The generated network showed that anxiety and depression symptoms were closely connected; insomnia was strongly connected with QoL. "Sad mood", "Lack of energy", and "Trouble relaxing" were the most important items in the network. Insomnia was the most significant bridge item that connected symptom groups. CONCLUSION: Patients with NPC are facing alarming disturbances of psychiatric disorders; tailored strategies should be implemented for high-risk patients. Besides, central symptoms (sad mood, lack of energy, and trouble relaxing) and bridge symptoms (insomnia) may be potential interventional targets in future clinical practice.

Factors Influencing Job Retention and Quality of Life amongst Nasopharyngeal Carcinoma Patients.

OBJECTIVE: To evaluate the quality of life (QoL) amongst Thai nasopharyngeal cancer patients (NCP) and identify associated factors with QoL. METHODS: This study was based on secondary data from a cross-sectional study that aimed to develop the Thai version of functional assessment of cancer therapy with nasopharyngeal cancer subscale demographic data, clinical information of participants, and Functional Assessment of Cancer Therapy with Nasopharyngeal cancer subscale (FACT-NP) were utilized. Data were analyzed using Student's t-test, rank-sum test, variance analysis, and the Kruskal-Wallis test. Multiple linear regression with the stepwise model was used to determine multiple variable analysis. Statistical significance was defined at p-value < 0.05. RESULTS: Two hundred and thirty NCP were included in the study with a mean age of 50.3±12.4 years. According to our findings, 68.3% were male, 81.7% were married or living with a partner, and 86.1% were Buddhism had the Eastern Cooperative Oncology Group (ECOG) performance status between 0-2 (95.2 %). The employment status, education level, economic status, ECOG, stage , and disease status significantly influenced patients' QoL. Patients who had active treatment and received prophylactic percutaneous gastrostomy  were also impacted by the FACT-NP score. In the multivariate analysis, employment status, ECOG, and disease status were shown to be significant factors that were associated with their QOL in the final model. CONCLUSION: Employment status was a socioeconomic factor that led to positive QOL amongst NCP.

Unmet Supportive Care Needs of Survival Patients with Nasopharyngeal Carcinoma.

This study examined unmet supportive care needs for nasopharyngeal carcinoma (NPC) patients by cancer stage and treatment phase, as well as the factors associated with these unmet needs. At a cancer center in central Taiwan, information on consultations and services patients received at the resource center was described in the service chart. We extracted data available for NPC patients to evaluate their unmet supportive care needs (health information, patient care, treatment, nutritional, psychosocial, and economic) and their association with sex, age, cancer stage, and treatment phase. The 145 NPC patients were 68.3% male, 60.0% less than 50 years old, and 83.5% diagnosed at stages III and IV. The most prevalent unmet need was nutritional (40.7%), followed by psychosocial and patient care, with economic unmet needs the least (4.8%). Women were more likely than men to have patient care unmet needs (32.6% vs. 15.2%). Nutritional unmet need was higher in older patients than in younger ones (83.3% vs. 35.6%), with an adjusted odds ratio (aOR) of 9.39 (95% confidence interval (CI) = 2.17-40.70). Psychosocial unmet needs were higher in younger patients than old patients (34.5% vs. 0%) and in patients interviewed during follow-up period than those at newly diagnosed (55.2% vs. 23.1%). In conclusion, the most commonly reported concern was nutritional unmet needs for NPC patients. Their unmet needs may vary by demographic and disease factors, including patient sex and age, cancer stage, and treatment phase.

The Prevalence and Determinants of Return to Work in Nasopharyngeal Carcinoma Survivors.

PURPOSE: To assess the employment status in working-age survivors of nasopharyngeal carcinoma (NPC) and explore clinical, treatment, and sociodemographic factors that may facilitate or impede successful return to work (RTW). METHODS AND MATERIALS: This Canadian study was part of a larger cross-sectional study assessing late toxicities in 107 disease-free survivors of NPC who received curative-intent intensity modulated radiation therapy ≥4 years earlier. For this substudy, eligible participants were employed at diagnosis and were of working age (<65 years) at study enrollment. Patient-reported work status (modified Radiation Therapy Oncology Group Work Status Questionnaire), quality of life (Functional Assessment of Cancer Therapy-Head and Neck questionnaire), symptom burden (MD Anderson Symptom Inventory for head and neck cancer), anxiety and depression (Hospital Anxiety and Depression Scale), neurobehavioral functioning (Frontal Systems Behavior Scale), and neurocognitive function (Montreal Cognitive Assessment) were assessed. Univariable and multivariable logistic regression models were used to explore the impact of variables on RTW status. RESULTS: Among 73 eligible patients, the median age was 53 years (range, 32-64) and median time from intensity modulated radiation therapy completion was 7.3 years (range, 4.2-11.1). At enrollment, 45 (62%) were working, of whom 14 (31%) had reduced work hours from diagnosis by a median of 12 h/wk (range, 4-30). Overall, mean work hours decreased from 41.6 to 37.8 h/wk (P = .005). Currently employed (vs unemployed) patients were younger (P = .017) and reported better performance status (P = .013). They had higher quality of life (P = .044), lower symptom burden (P = .03), less significant change from their baseline neurobehavioral function (P = .008), and disability (P = .0025) or private health benefits (P = .035). Anxiety, depression, occupation type, income, and Montreal Cognitive Assessment score were not significantly associated with RTW in the univariable analysis. Age, change in baseline neurobehavioral function, and having private health benefits were all independent predictors of RTW. CONCLUSIONS: The majority of long-term survivors of NPC do RTW, although almost one-third report working fewer hours. Prospective research is needed to better understand and facilitate successful RTW in survivors of NPC.

Characteristics of symptom distress in Chinese nasopharyngeal carcinoma patients and its relation to mood disturbance: A cross-sectional study.

OBJECTIVE: To evaluate the psychometric properties of a modified Chinese version of the Symptom Distress Scale (SDS), to explore symptom distress and its association with mood disturbance and factors that related to levels of symptom distress and mood disturbance. METHODS: A cross-sectional, correlation design was adopted. A convenience sample of 190 nasopharyngeal carcinoma (NPC) patients was recruited from a Cancer Center in Guangzhou, China, with 169 patients completing the study. RESULTS: The psychometric properties of the modified SDS were satisfactory (Cronbach's α = 0.80) with test-retest reliability (correlation coefficient = 0.71). Education, marital status, disease stage and SDS scores were significant influencing factors of mood disturbance. The overall symptom distress level of NPC patients was higher than that of other cancer groups, with dry mouth being the most distressing symptom. Symptom distress level was influenced by age, marital status, disease stage, treatment modality and number of radiotherapy (RT) sessions. CONCLUSION: More pain and symptom management care should be focused on patients who are older, single or divorced patients, those with late-stage disease, and those subjected to multimodality therapy. Symptom distress was the most significant influencing factor of NPC patients' mood status.

Radiotherapy-induced dysphagia and its impact on quality of life in patients with nasopharyngeal carcinoma.

PURPOSE: To investigate the swallowing status and its impact on quality of life (QOL) in patients who underwent radiotherapy for nasopharyngeal carcinoma (NPC). METHODS: In this study, 334 patients with NPC who underwent radiotherapy were reviewed. Clinical characteristics, videofluoroscopic swallowing studies (VFSSs), and scores of the World Health Organization quality of life-BREF (WHOQOL-BREF) were retrospectively analyzed for all patients. RESULTS: In this study, 143 of 334 (42.8%) patients showed dysphagia. The nodular stage N3 of NPC, neoadjuvant and concurrent chemotherapy were clinical predictors for dysphagia. VFSS of patients with dysphagia showed a high incidence of vallecular residue (100%), apraxia (99%), premature bolus loss (98%), bolus formation (98%), pyriform sinus residue (95%), and mastication (94%). Moreover, WHOQOL-BREF scores for the physical health, psychological, and environment domains were lower of the dysphagia group than those of the control group (P < 0.01). Videofluoroscopic dysphagia scale scores showed significant negative correlations with scores for the physical health (R = -0.66, P < 0.01), psychological (R = -0.70, P < 0.01), social relationships (R = -0.56, P < 0.01), and environment (R = -0.61, P < 0.01) domains of WHOQOL-BREF. CONCLUSIONS: Radiotherapy-induced dysphagia is common in NPC patients and is correlated with poor quality of life. Patients, caregivers, and clinical physicians should be aware of these adverse effects and provide timely treatment for radiotherapy-induced dysphagia in collaboration with cross-disciplinary colleagues.

A cross sectional study in cognitive and neurobehavioral impairment in long-term nasopharyngeal cancer survivors treated with intensity-modulated radiotherapy.

PURPOSE/OBJECTIVES: To determine neurocognitive and neurobehavioral impairment in long-term nasopharyngeal cancer survivors (NPC) treated with intensity-modulated radiotherapy (IMRT). MATERIALS/METHODS: A cross-sectional cohort of NPC ≥4 years (y) following IMRT was assessed. Objective cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and patient-reported memory was assessed with the MDASI-HN problems remembering item. Patient and family ratings of patients' neurobehavioral symptoms of apathy, disinhibition and executive dysfunction were assessed with the Frontal Systems Behavior Scale (FrSBe). Other patient-reported symptoms (MDASI-HN), mood (HADS), and quality of life (FACT-H&N) were also collected. RESULTS: Among 102 participants: M:F = 66:36; median age 56y (32-77); median time since IMRT 7.5y (4.2-11.1). Impaired MoCA scores (<23) were observed in 33 (32%). Patient and family ratings of pre-illness neurobehavioral symptoms were in the normal range (total FrSBe T-scores 53.3 and 59.0 respectively). In contrast, post-treatment patient and family T-scores were clinically impaired (64.7, 71.3 respectively), with apathy, disinhibition and executive dysfunction post-treatment ratings all significantly worse than pre-treatment (p < 0.001). Prevalence of clinically significant post-treatment disturbance was high by patient and family ratings (48%/66% apathy, 35%/53% disinhibition, 39%/56% executive dysfunction). Post-treatment neurobehavioral symptoms strongly correlated with lower quality of life (r = -0.62) and higher anxiety (r = 0.62) and depression scores (r = 0.67, all p < 0.001). Total MoCA scores did not correlate with RT dose. However, greater declines in apathy, disinhibition and executive dysfunction were associated with receiving >75 Gy to temporal lobes. CONCLUSION: NPC treated with IMRT had moderate to high rates of neurocognitive impairment and clinically significant apathy, disinhibition, and executive dysfunction.

Food Avoidance Beliefs and Behaviors Among Chinese Cancer Patients: Validation of a New Measurement Tool.

OBJECTIVE: Restrictive food avoidance behavior among Chinese cancer patients is common. Yet, to the authors' knowledge, no study has investigated factors associated with such behavior. This study attempted to validate a new measurement tool, the Cancer Patients Food Avoidance Behaviors Scale (CPFAB), that assessed cancer patients' belief regarding 5 perceived benefits of practicing food avoidance, and to test its applicability. DESIGN: Cross-sectional face-to-face interviews. SETTING: Two outpatient oncology clinics in 2 different districts of Hong Kong. PARTICIPANTS: A total of 245 patients with nasopharyngeal and colorectal cancer. MAIN OUTCOME MEASURES: Assessment of psychometric properties of the CPFAB. ANALYSIS: Principal components method with oblique (Promax) rotations was performed to investigate the factor structure of the CPFAB. RESULTS: Psychometric properties, which included test-retest intraclass correlations (mean = 0.72; SD = 0.12), Cronbach α (.88-.94), floor (0.4% to 5.7%) and ceiling (0% to 7.3%) effects, and item-subscale (0.67-0.79) and subscale-total (0.68-0.89) correlations, were satisfactory. CONCLUSIONS AND IMPLICATIONS: The CPFAB, a new instrument used to assess food avoidance, was developed and validated. It showed satisfactory psychometric properties and can be used to evaluate interventions that seek to modify food avoidance attitudes among cancer patients.

Long-Term Late Toxicity, Quality of Life, and Emotional Distress in Patients With Nasopharyngeal Carcinoma Treated With Intensity Modulated Radiation Therapy.

PURPOSE: To report long-term (>4 years) toxicity and quality of life (QoL) among patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy (IMRT) in a nonendemic center. METHODS AND MATERIALS: A cross-sectional cohort study enrolled patients with NPC who were disease-free and ≥4 years after IMRT ± chemotherapy. Physician-reported adverse events (Common Terminology Criteria for Adverse Events, version 4.03) and patient-reported QoL (Functional Assessment of Cancer Therapy-Head and Neck, Functional Assessment of Chronic Illness Therapy-Fatigue), utilities (EuroQOL-5D), head and neck symptoms (MD Anderson Symptom Inventory-Head and Neck), and emotional distress (Hospital Anxiety and Depression Scale) were collected. Consenting patients also underwent endocrine screening and audiometry. RESULTS: Among 107 patients enrolled, median age at enrollment and time since treatment were 57 (32-81) and 7.5 years (4.2-11.1), respectively. Most patients (99%) received 70 Gy in 35 fractions; the majority (93%) received concurrent chemotherapy. Mean scores for the Functional Assessment of Cancer Therapy-Head and Neck, Functional Assessment of Chronic Illness Therapy-Fatigue, and EuroQOL-5D were 105.0 (46-148), 116.6 (44-160), and 0.85 (0.29-1.00), respectively. Dry mouth, mucus, swallowing/chewing, memory, and teeth/gum problems were scored highest on the MD Anderson Symptom Inventory-Head and Neck; mean symptom severity and symptom interference scores were 2.3 and 2.4, respectively. Grade 3 or higher physician-reported adverse events were noted in 50 patients (47%), most frequently hearing problems (46, 43%). Audiometry revealed significant bilateral hearing loss (grade ≥3) in 68 patients (72%). Depression (25%), anxiety (37%), and fatigue (28%) were common and strongly correlated with QoL. Most patients (69%) developed hypothyroidism; 1 patient (1%) developed pituitary dysfunction requiring hormone replacement. V50 >90 and V45 >99 to the thyroid correlated with significantly higher rates of hypothyroidism. CONCLUSIONS: Despite the implementation of IMRT, survivors of NPC still experience many physical symptoms that affect long-term QoL many years after treatment. Depression, anxiety, and fatigue remain common in long-term survivors and are highly correlated with QoL.

Effect of Resourcefulness Training on Symptoms Distress of Patients with Nasopharyngeal Carcinoma.

BACKGROUND Symptom distress is very common in patients with nasopharyngeal carcinoma (NPC) during radiotherapy, seriously affecting their quality of life and impeding the process of rehabilitation. Resourcefulness training can enhance the level of resourcefulness and benefit-finding, palliate symptom distress, and promote disease rehabilitation. However, the effects of resourcefulness training on local complications and benefit-finding in NPC patients during radiotherapy remains poorly understood. MATERIAL AND METHODS Questionnaires and resourcefulness training intervention were used in this study. The relationships among resourcefulness, benefit-finding, and symptom distress of 304 NPC patients were analyzed and the effects of resourcefulness training on NPC patients (N=80) were evaluated during radiotherapy. RESULTS Among the 304 NPC patients, age, educational level, occupation, family monthly income, method of payment of medical expenses, and histological types were significant factors influencing resourcefulness and benefit-finding. The patients' resourcefulness was positively correlated to their benefit-finding; and their distress was negatively correlated to their resourcefulness. After resourcefulness training for 2 months, average scores of the resourcefulness and benefit-finding were significantly increased in the intervention group (N=40) compared to those in the control group (N=40). Average scores of symptom distress were significantly reduced in the 2 groups, but they were reduced more significantly in the intervention group than in the control group. CONCLUSIONS The patients' benefit-finding and symptom distress were correlated with their resourcefulness. Resourcefulness training could enhance the level of resourcefulness and benefit-finding, palliate symptom distress, and promote disease rehabilitation in NPC patients during radiotherapy.

Health-Related Quality of Life of Patients with HPV-Related Cancers in Indonesia.

BACKGROUND: Human papillomavirus (HPV)-related cancers are a serious concern in developing countries. Valid estimates of a country-specific health-related quality of life (HRQOL) for patients with HPV-related cancers provide a substantial tool in determining the burden of the disease. OBJECTIVES: To investigate the HRQOL of patients with HPV-related cancers in Indonesia. METHODS: The HRQOL of patients with HPV-related cancers (cervical, uterine, nasopharyngeal, head and neck, and anogenital cancer) was assessed using the EuroQol five-dimensional questionnaire (EQ-5D). Validity and reliability were assessed by means of construct validity and test-retest reliability methods, respectively. Subsequently, the EQ-5D utility index was calculated using the Thailand value set. RESULTS: The EQ-5D came out as a valid and reliable questionnaire for measuring the HRQOL of patients with HPV-related cancers in Indonesia. From a total of 520 patients diagnosed with HPV-related cancers, 404 patients were excluded because of not fulfilling the inclusion criteria, and so 116 patients finally participated in the study. The mean age of the patients was 47.5 ± 12.03 years. Most of the patients were women (56.0%) and married (97.4%), and less than half of them had finished high school (32.7%). Moreover, the proportions of nasopharyngeal, cervical, head and neck, anogenital, and uterine cancers in the study population were 29.3%, 24.6%, 22.4%, 14.2%, and 9.5%, respectively. The average HRQOL of the patients with HPV-related cancers was 0.69 ± 0.10, with the highest and lowest estimates applying to uterine cancer (0.84 ± 0.29) and head and neck cancer (0.58 ± 0.33), respectively. CONCLUSIONS: The HRQOL of patients with HPV-related cancers was found to be reduced to a certain extent in our study for Indonesia.

Network-level dysconnectivity in patients with nasopharyngeal carcinoma (NPC) early post-radiotherapy: longitudinal resting state fMRI study.

In this study, we seek to longitudinally investigate the network-level functional connectivity (FC) alternations and its association with irradiation dose and cognition changes in the early stage post radiotherapy (RT) in nasopharyngeal carcinoma (NPC) patients. We performed independent component analysis (ICA) of resting state blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) from 39 newly diagnosed NPC patients before receiving treatment (baseline), and 3 months post-RT. the default mode network (DMN), salience network (SN), and executive control network (ECN) were extracted with well-validated software (GIFT). Inter-network connectivity was assessed using the functional network connectivity (FNC) toolbox. The inter- and intra-network FC was compared between time points, and the z value of FC alternation was correlated with the RT dose value and cognitive changes. Compared with baseline, the FC of the left anterior cingulate cortex (ACC) within the DMN, and the right insular within the SN, significantly reduced 3 months post-RT, with greater effects at higher doses in the right insular. Bilateral ECN FC was also significantly lower 3 months post-RT compared to the baseline. Chemotherapy was not associated with inter- and intra- network FC change. We found intra- and inter-network FC disruption in NPC patients 3 months post-RT, with the right insular showing a dose-dependent effect. Thus, this network-level FC may serve as a potential biomarker of the RT-induced brain functional impairments, and provide valuable targets for further functional recovery treatment.

Effectiveness of an Intervention to Promote Self-Efficacy on Quality of Life of Patients with Nasopharyngeal Carcinoma of the Zhuang Tribe Minority in Guangxi, China: A Prospective Study.

BACKGROUND Nasopharyngeal carcinoma (NPC) is endemic in China and patient self-management is poor. Minorities may suffer from psychological problems during treatments for NPC. This study aimed to implement an intervention to promote self-efficacy of minority patients (Zhuang tribe, Guangxi, China) with NPC to improve their quality of life (QOL). MATERIAL AND METHODS This was a prospective study of 120 patients with NPC treated at the First Affiliated Hospital of Guangxi Medical University (Guangxi, China), randomized to conventional care (n=60, controls) or conventional care plus self-efficacy interventions based on health education, behavior therapy, and psychological intervention (n=60, self-efficacy group). Self-efficacy was evaluated using the general self-efficacy scale, and QOL using the EORTC QLQ-C30. The questionnaires were completed at discharge, at 6 months, and at 1 and 2 years. The primary outcome was QOL. RESULTS There was no difference in QOL at baseline. From study start to hospital discharge, overall QOL scores decreased in both groups, but this decrease was more important in the control group (controls: -39.31 vs. self-efficacy: -27.04, P<0.05). After discharge, each functional field QOL scores and overall QOL increased with time in the 2 groups, and they were significantly higher in the self-efficacy group. CONCLUSIONS This intervention promoting self-efficacy could increase patients' own potential and initiative, enhance their confidence and ability to solve health problems, improve their coping with adverse effects of treatments, and have positive effects on their QOL. Self-efficacy theory-based interventions could be worth popularization during the treatment and recovery of minority patients with NPC.

Symptom clusters in patients with nasopharyngeal carcinoma during radiotherapy.

PURPOSE: Despite the improvement in radiotherapy (RT) technology, patients with nasopharyngeal carcinoma (NPC) still suffer from numerous distressing symptoms simultaneously during RT. The purpose of the study was to investigate the symptom clusters experienced by NPC patients during RT. METHODS: First-treated Chinese NPC patients (n = 130) undergoing late-period RT (from week 4 till the end) were recruited for this cross-sectional study. They completed a sociodemographic and clinical data questionnaire, the Chinese version of the M. D. Anderson Symptom Inventory - Head and Neck Module (MDASI-HN-C) and the Chinese version of the Functional Assessment of Cancer Therapy - Head and Neck Scale (FACT-H&N-C). Principal axis factor analysis with oblimin rotation, independent t-test, one-way analysis of variance (ANOVA) and Pearson product-moment correlation were used to analyze the data. RESULTS: Four symptom clusters were identified, and labelled general, gastrointestinal, nutrition impact and social interaction impact. Of these 4 types, the nutrition impact symptom cluster was the most severe. Statistically positive correlations were found between severity of all 4 symptom clusters and symptom interference, as well as weight loss. Statistically negative correlations were detected between the cluster severity and the QOL total score and 3 out of 5 subscale scores. CONCLUSION: The four clusters identified reveal the symptom patterns experienced by NPC patients during RT. Future intervention studies on managing these symptom clusters are warranted, especially for the nutrition impact symptom cluster.

Radiation-induced cerebellar-cerebral functional connectivity alterations in nasopharyngeal carcinoma patients.

The current study aimed to investigate the altered cerebellar-cerebral functional connectivity (FC) induced by radiotherapy to nasopharyngeal carcinoma (NPC) patients. Twenty-four NPC patients without treatment, and 35 NPC patients receiving radiotherapy underwent functional MRI scanning. Montreal cognitive assessment (MoCA) was performed to evaluate the cognitive status of all participants. FC between 10 predefined cerebellar seeds, which were demonstrated to be involved in different brain functional networks, and all brain voxels was obtained for each participant. Using a second-level two-sample t-test, three significantly different FCs between the two patient groups were found, including the connections between the left lobule VIII and the right medial frontal gyrus, the left lobule VIII and the right crus I, and the right lobule VIIb and the right fusiform gyrus. The altered cerebellar-cerebral FCs were also significantly correlated to the MoCA score, as well as the attention score, one of the seven subscores in MoCA. We suggested that the altered cerebellar-cerebral FCs may underlie the radiation-induced cognitive deficits in NPC patients, especially in the domain of attention. Furthermore, considering the functional networks in which the altered connections involved, the anticorrelation between the default network and dorsal attention network may be impaired, and the mediating function of the frontoparietal network to dorsal attention network may be disrupted. The significantly altered cerebellar-cerebral FC may serve as the potential biomarker in revealing the radiation-induced functional abnormalities and may help in the early intervention to the cognitive impairment.

[Effect of smart-phone application on complications of chemoradiotherapy and quality of life in patients with nasopharyngeal carcinoma].

Objective:To investigate the interventional effect of smart-phone application on development of complications of chemoradiotherapy in patients with nasopharyngeal carcinoma (NPC) after discharge.Method:Sixty-five NPC patients receving first chemoradiotherapy were randomly divided into two groups. Control group including 33 patients, use traditional oral Health education. Intervention group including 32 patients, use a smart-phone application after discharge. The smart-phone application with text and graphics was established to conduct health education and dynamically manage discharged patients for promoting themselves health management. Poisonous side reactions and quality of life of two groups were investigated at discharge and 6 months after discharge.Result:There were not significant difference between two groups on complications of chemoradiotherapy and quality of life at discharge. After discharge 6 months, the incidence of oral mucositis, dry mouth, nasal obstruction and difficulty in opening mouth of intervention group were lower than control group significantly, while the quality of life of intervention group higher than control group significantly (P< 0.05). Conclusion:Smart-phone application can reduce complications of chemoradiotherapy, and improve the quality of life in patients with NPC after discharge.

Psychological distress and coping in nasopharyngeal cancer: an explorative study in Western Europe.

Nasopharyngeal carcinoma (NPC) is the head and neck cancer with the greatest impact on patients' quality of life. The aim of this explorative study is to investigate the psychological distress, coping strategies and quality of life of NPC patients in the post-treatment observation period. Twenty-one patients disease-free for at least two years were assessed with a medical and a psycho-oncological evaluation. Clinically relevant depressive symptoms (CRD) were present in 23.8% of patients and 33.3% reported clinically relevant anxiety symptoms (CRA). Patients with CRD and CRA showed a significantly higher score in the use of hopelessness/helplessness and anxious preoccupation coping strategies and a worse quality of life. Even in the post-treatment period, about a quarter of patients showed CRD and CRA. Results showed that patients with high anxiety or depressive symptoms seem to use dysfunctional coping strategies, such as hopelessness and anxious preoccupation, more than patients with lower levels of anxiety and depression. The use of these styles of coping thus seems to be associated to a higher presence of CRA or CRD symptomatology and to a worse quality of life.

Development and validation of quality of life scale of nasopharyngeal carcinoma patients: the QOL-NPC (version 2).

BACKGROUND: The aim was to develop and validate the quality of life scale for nasopharyngeal carcinoma (NPC) patients, the QOL-NPC (version 2), a specific instrument to measure quality of life for NPC patients. METHODS: The QOL-NPC was developed and validated according to standard procedures. The patients were assessed using the QOL-NPC, FACT-G, and FACT-H&N. Classical test theory was used to evaluate the reliability, validity, and responsiveness of the QOL-NPC. RESULTS: A total of 487 patients (97.4 %) completed the questionnaire. The QOL-NPC comprised four domains, as follows: physical function (eight items); psychological function (five items); social function (five items); and side effects (eight items). All of the items had a lower proportion of missing data. Cronbach's alpha values of the domains ranged from 0.72 to 0.84. The split-half reliability coefficients ranged from 0.77 to 0.84. All of the intra-class correlation coefficients were > 0.8. The normed fit index, non-normed fit index, and comparative fit index were >0.89. The root mean square error of approximation was 0.097, with a 90 % confidence interval (0.093, 0.100). The domain scores of the QOL-NPC were significantly correlated with the FACT-G and FACT-H&N (P < 0.05). All of the domain scores of patients using different amounts of radiotherapy were significantly different (P < 0.001). All domain scores decreased at the completion of radiotherapy, with effect sizes ranging from -0.82 to -0.22. CONCLUSIONS: The QOL-NPC is valid for measuring QOL with good reliability, validity, and responsiveness. The QOL-NPC is recommended to measure the QOL for Chinese NPC patients.

Avoiding allogenic blood transfusions in endoscopic angiofibroma surgery.

BACKGROUND: Surgical approaches for many tumours are often limited by blood loss, exposure and risk to vital anatomical structures. Therefore, the standard of care for certain skull base tumours has become endoscopic transnasal resection. Other surgical disciplines often use cell salvage techniques, but review of the otolaryngology literature revealed very few case reports. This study investigated the value and safety of salvage-type autologous blood transfusion during the endoscopic resection of juvenile nasopharyngeal angiofibromas (JNA). METHODS: JNA is a rare vascular nasal tumour and the study extended over a 3-year period to obtain adequate patient numbers. All patients undergoing endoscopic resection during this period were included in the population sample. Ten patients with JNA were identified and underwent embolization prior to the endoscopic resection. In all cases the intraoperative blood salvage apparatus was used. Close post-operative monitoring was performed. RESULTS: Homologous blood transfusion could be avoided in all cases. Postoperative monitoring revealed transient bacteraemia in two cases where the leukocyte filter was not used, but no evidence of septicaemia. CONCLUSIONS: Perioperative cell saver and autologous blood transfusion in endonasal JNA surgery is safe. Homologous blood transfusion can be avoided by using this technique. The use of cell salvage allows for single stage surgery without the need to abandon surgery due to excessive blood loss and its future use is promising.

Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students.

OBJECTIVES: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any "regular, repetitive offer" (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on "physician-assisted suicide," "euthanasia" and "palliative sedation," based on a fictitious case vignette study. METHOD: The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering). The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures. RESULTS: Out of 301 students in total, 241 (80%) participated in the survey; 109 answered the version 1 questionnaire (physical suffering) and 132 answered the version 2 questionnaire (emotional suffering). The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal) and euthanasia (illegal) correctly (81.2% and 93.7%, respectively), while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the assessment of the legality of palliative sedation: it was considered legal more frequently in the physical suffering version (88.1% vs. 75.8%). CONCLUSION: The majority of the students surveyed wrongly assumed that physician-assisted suicide is a punishable offense in Germany. However, a narrow majority considered physician-assisted suicide ethically acceptable in the case study presented. Compared to euthanasia, more than twice as many participants considered physician-assisted suicide acceptable. There was no significant difference between personal attitudes towards palliative sedation, physician-assisted suicide or euthanasia in light of physical or emotional suffering. Educational programs in this field should be expanded both qualitatively and quantitatively, especially considering the relevance of the subject matter, the deficits within the knowledge of legal norms and the now even higher complexity of the legal situation due to the new law from December 2015.