International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationPhysical Distress, Emotional Status, and Quality of Life in Patients With Nasopharyngeal Cancer Complicated by Post-Radiotherapy Endocrinopathy
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.
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Conflict of interest: none.