Clinical Investigation
Physical Distress, Emotional Status, and Quality of Life in Patients With Nasopharyngeal Cancer Complicated by Post-Radiotherapy Endocrinopathy

https://doi.org/10.1016/j.ijrobp.2007.06.053Get rights and content

Purpose

To explore factors affecting quality of life (QOL) among patients with nasopharyngeal cancer (NPC) complicated by post-radiotherapy endocrinopathy.

Methods and Materials

This cross-sectional study was conducted in a tertiary medical center and involved a total of 43 post-radiotherapy, recurrence-free NPC patients with endocrinopathy. They performed self-assessment of their emotional status using the Beck Anxiety Inventory and Beck Depression Inventory–II, and their QoL with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire and the H&N35 cancer module.

Results

Emotional and cognitive functioning of EORTC QLQ-C30 were the most affected. Fatigue, insomnia, and pain were the main concerns. Of the patients, 22 (51.2%) had anxiety and 19 (44.2%) had depression. Both depression and anxiety were negatively correlated with functional scales and global QoL but positively correlated with symptom scales. Multiple linear regression analysis revealed that physical distress symptoms of QLQ-C30 and physical functioning were the significant predictors of global QoL. Emotional and social functioning could predict depression, whereas emotional and physical functioning were significant predictors of anxiety.

Conclusions

NPC patients with post-radiotherapy endocrinopathy exhibit impaired cognitive function and negative emotions. Symptoms of physical distress play an important role in QoL perception. Measurement of EORTC QLQ-C30 can be a useful instrument for the early detection of patients' impaired cognitive function and psychological morbidity. The high psychological distress related to the endocrine disturbances or the impact of NPC itself needs further study.

Introduction

Nasopharyngeal cancer (NPC) is highly prevalent in Southeast Asia (1). Its annual incidence rate in Taiwan is approximately 5.96 cases per 100,000 persons, making NPC the 9th most prevalent cancer in the country (2). It has been one of the 10 leading causes of cancer death up to 1996, but ranked 14th in the 2 years preceding 2005 (2). However, complications such as mucositis and sequelae such as dry mouth resulting from the main treatment modality of radiotherapy, continue to significantly impact NPC patients 3, 4, 5, 6. Because the effectiveness of radiotherapy has been realized in clinical practice, NPC patients have had a better chance at cancer-free life for an extended period. However late complications, including dry mouth and primary hypothyroidism, are usually chronic, progressive, and irreversible 7, 8.

Hypothalamic–pituitary dysfunctions after radiotherapy for NPC are well documented in several studies 9, 10, 11, including ours 8, 12, 13, 14. Although brain injuries are irreversible, endocrine disturbances are amenable to therapy. Over the past decades, subjective well-being has become recognized as important as biomedical outcome parameters, ushering a growing body of literature concerning health-related quality of life (QoL). However, research focusing on NPC patients' psychological well-being remains sparse, and there has been no study exploring the mental health of NPC patients complicated by endocrinopathy, even though patient-centered medical care has already drawn much attention (15).

This study aimed to assess the emotional status, subjective and functional outcome, and their relationship among recurrence-free NPC patients with post-radiotherapy endocrinopathy. It also aimed to investigate predictive factors of QoL.

Section snippets

Participants

This study was conducted from February 2004 to February 2005 at the outpatient Endocrinology Clinic of the National Taiwan University Hospital. From our previous research, we noted that post-radiotherapy NPC patients could develop hypothalamic–pituitary dysfunction from cranial irradiation (8). Thus patients with complicated physical discomfort such as malaise, constipation, decreased libido, and muscle cramps were referred from the Department of Otolaryngology to the Endocrinology Clinic for

Results

Basic background information of the patients is shown in Table 1. The mean age was 52.0 ± 8.7 years (median, 52.0 years; range, 33–68 years). Of the patients, 17 (39.5%) patients were male. A total of 24 patients (55.8%) were unemployed. The postradiation time varied: <5 years in 15 patients (34.9%), 5–10 and 10–15 years in 9 patients (20.9%), and >15 years in 10 patients (23.2%). The mean time after radiotherapy was 114.4 ± 94.4 months (median, 104.0 months; range, 4–411 months).

Of the 43

Discussion

The present study investigates the QoL of post-radiotherapy NPC patients complicated with endocrinopathy, and its relationship with emotional status. The results demonstrate that emotional and cognitive functionings are significantly affected over other measures of function. The low mean scores of emotional functioning are similar to those of previous studies 29, 30.

In this study, the median time point for the assessment of QoL after radiotherapy is 8.67 years, which was 5.9 years and 3.4 years

Conclusions

In conclusion, NPC patients with post-radiotherapy endocrinopathy demonstrate impaired cognitive function and obvious negative emotions that are strongly associated with functional status, physical distress, and QoL. The different dimensions of EORTC QLQ-C30 seem to mirror depression or anxiety as measured by BDI or BAI, making it a potentially useful instrument for the early identification of patients at risk for difficulties and compromised QoL.

Acknowledgments

This study was supported by Research Grant NSC94-2314-B-002-189 from the National Science Council of Taiwan. The authors are indebted to Dr. Jeng-Yuh Ko, Otolaryngologist, for his case referral and cooperative patient care; Dr. Lai-Lei Ting, Radiation Oncologist, for reviewing this manuscript; and Chang-Wei Wang for data processing and statistical analysis.

References (45)

  • G.S. Huang et al.

    Side effects of the patients with nasopharyngeal carcinoma during receiving radiotherapy

    J Chinese Oncol Soc

    (1987)
  • Y.H. Lai et al.

    Symptom distress, catastrophic thinking, and hope in nasopharyngeal carcinoma patients

    Cancer Nurs

    (2003)
  • E. Hammerlid et al.

    Health-related quality of life three years after diagnosis of head and neck cancer—a longitudinal study

    Head Neck

    (2001)
  • T.S. Huang et al.

    Effect of cranial irradiation on hypothalamus-pituitary function: Follow-up study one year after radiotherapy

    J Formos Med Assoc

    (1991)
  • E. Woo et al.

    Temporal lobe and hypothalamic-pituitary dysfunctions after radiotherapy for nasopharyngeal carcinoma: A distinct clinical syndrome

    J Neurol Neurosurg Psychiatry

    (1988)
  • A.J. Parkin et al.

    Memory loss following radiotherapy for nasal pharyngeal carcinoma—an unusual presentation of amnesia

    Br J Clin Psychol

    (1991)
  • P.W. Lee et al.

    Effects of radiation therapy on neuropsychological functioning in patients with nasopharyngeal carcinoma

    J Neurol Neurosurg Psychiatry

    (1989)
  • T.S. Huang et al.

    Early effects of cranial irradiation on hypothalamic pituitary function

    J Formos Med Assoc

    (1990)
  • P.U. Chieng et al.

    Reduced hypothalamic blood flow after radiation treatment of nasopharyngeal cancer: SPECT studies in 34 patients

    Am J Neuroradiol

    (1991)
  • T.S. Huang et al.

    A prospective study of hypothalamus pituitary function after cranial irradiation with or without radiosensitizing chemotherapy

    J Endocrinol Invest

    (1994)
  • N.K. Aaronson et al.

    The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology

    J Natl Cancer Inst

    (1993)
  • Cited by (31)

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

      2018, International Journal of Radiation Oncology Biology Physics
      Citation Excerpt :

      Other NPC series have shown a peak in emotional distress at the time of diagnosis, which subsequently decreases after treatment (34). However, others have recognized that patients remain at risk for psychological distress long after completion of treatment (35, 36). A recent Italian NPC cohort showed almost identical rates of depression and anxiety at 24% and 33%, respectively.

    • Male hypogonadism associated with advanced cancer: A systematic review

      2010, The Lancet Oncology
      Citation Excerpt :

      Of 381 potentially relevant unique publications, six were eligible for inclusion in our systematic review (figure 1).5,16,17,19–21 Some studies were excluded because patients with advanced cancer were not included22–24 or data on associations between male hypogonadism and clinical outcomes of interest were not reported.25–27 The six reviewed publications included a total of 476 patients (table).5,16,17,19–21

    View all citing articles on Scopus

    Conflict of interest: none.

    View full text