| BACKGROUNDNasopharyngeal cancer(NPC),also known as "Canton Tumor",is a characteristic cancer in Guangdong Province,with an incidence rate of 200,000 to 50,000 per 100,000 people.Patients experience a long survival period during the treatment,with a low quality of life and a high burden of family and social care.There are many factors affecting the 5-year survival rate of patients,among which anxiety and depression are one of the important influencing factors.Previous studies have shown that the incidence of anxiety and depression in patients with nasopharyngeal carcinoma before and after intensity-modulated radiotherapy is as high as 23.8%-96.8%.Although some studies focused on anxiety,depression,quality of life and survival rate have been reported,there are relatively few longitudinal studies,and the relationship among them needs to be further explored.This study focuses on the changes of anxiety,depression and quality of life in patients with nasopharyngeal carcinoma before and after intensity-modulated radiotherapy,and explores the relationship between anxiety,depression,quality of life and 5-year survival rate,which can provide a reference for the formulation of multi-time clinical care strategies and specifying corresponding interventions for nasopharyngeal carcinoma patients.OBJECTIVEA longitudinal follow-up survey was carried out at four time points to dynamically analyze the change trend and influencing factors of anxiety,depression and quality of life in patients with nasopharyngeal carcinoma before and after intensity-modulated radiotherapy,so as to provide reference for early identification and early intervention of negative emotions in patients with nasopharyngeal carcinoma,improve treatment compliance,prognosis and quality of life of patients,and reduce the burden of social and family care.METHODSThe first part of the research content:longitudinal study of anxiety,depression and quality of life in patients with nasopharyngeal carcinoma before and after intensity-modulated radiation therapyFrom February 2015 to March 2017,a longitudinal study was conducted on 139 patients with nasopharyngeal carcinoma who received intensity modulated radiation therapy in a Grade A hospital in Guangdong Province by using self-rated Anxiety Scale(SAS),self-rated Depression Scale(SDS),quality of life questionnaire(EORTC QLQ-H&N35)and self-compiled general data questionnaire.The changes of anxiety,depression and quality of life of patients at 4 time points(before treatment,just after treatment,3 months after treatment,6 months after treatment)were dynamically monitored,and the incidence,change characteristics and influencing factors of anxiety,depression and quality of life of nasopharyngeal cancer patients at 4 time points were analyzed.The second part of the research content:the relationship between anxiety,depression,quality of life and 5-year survival rate in patients with nasopharyngeal carcinoma before and after intensity-modulated radiation therapy.A total of 139 patients with nasopharyngeal carcinoma from first part of the research content were followed up for 5 years from the time they were first admitted for treatment to the end of March 2022.The distant metastasis and 5-year survival rate were used as follow-up outcome indicators.The study examined the relationship between anxiety,depression,quality of life and 5-year survival rate at 4 time points(before treatment,just after treatment,3 months after treatment,6 months after treatment).STATISTICS AND ANALYSISStatistical analysis was conducted using the statistical software SPSS 26.0.Main statistical methods:① Quantitative data are described by the mean ± standard deviation(X±SD).Qualitative data were described as frequencies and percentages.② The incidence of anxiety and depression was compared by nonparametric test and generalized estimation equation.③ The quality of life scores at 4 time points were compared by repeated measure ANOVA.④The characteristics and influencing factors of anxiety,depression and quality of life at 4 time points before and after treatment were analyzed by a mixed linear model.⑤ 5-year survival rate was analyzed by Kaplan-Meier method and Cox proportional risk model.P<0.05 or P<0.01 had statistical significance.RESULTS1.The incidence of anxiety and depression at 4 time points before and after treatmentThe incidence of anxiety in patients with nasopharyngeal carcinoma was 19.42%,27.34%,23.74%and 32.37%before,just after,3 months after and 6 months after treatment,respectively.The incidence of anxiety at 6 months post IMRT was 1.99 times higher than that at pre-IMRT.The incidence of depression was 35.25%,53.24%,35.97%,and 35.97%,respectively.The incidence of depression post-IMRT was 2.09 times higher than that pre-IMRT.2.Quality of life score in 4-point periods before and after treatmentThe severity of the quality of life of patients increased with the accumulation of the dose of IMRT.Except for the item of using feeding tube,the F value of other items fluctuated from 4.38 to 147.90,with statistically significant differences at four time points(P<0.001).The scores of QOL reached a peak just after treatment,and did not return to the pre-treatment level at 6 months after treatment.3.The effect of anxiety and depression on quality of life at 4 time points before and after treatment of patientsA mixed linear model showed that anxiety affected swallowing(β=5.33,t=3.61,P<0.001),speaking(β=7.45,t=5.53,P<0.001),social eating(β=6.27,t=5.09,P<0.001),social contact(β=6.93,t=5.99,P<0.001),teeth(β=6.81,t=3.96,P<0.001),cough(β=3.77,t=2.05,P<0.001),feeling ill(β=8.71,t=4.10,P<0.001),with a statistical difference.Depression affected pain(β=3.90,t=2.85,P<0.001),swallowing(β=4.48,t=3.34,P<0.001),speaking(β=4.65,t=3.81,P<0.001),social:eating(β=5.36,t=4.80,P<0.001),social:contact(β=3.16,t=3.01,P<0.01),open mouth(β=5.27,t=3.39,P<0.001),painkiller(β=2.92,t=3.10,P<0.001),and the difference was statistically significant.4.Anxiety,depression,quality of life,5-year survival rate in patients with nasopharyngeal carcinoma before and after treatmentDistant metastasis,anxiety and quality of life in pre-treatment were correlated with 5-year survival rate(P<0.05).Multivariate results showed that in terms of quality of life items,feeding tubes before treatment(HR=1.10,P<0.01),social eating(HR=1.08,P<0.01)and open mouth(HR=1.04,P<0.05)at immediately after treatment,swallowing(HR=1.09,P<0.05)at 3 months after treatment,sensory problems(HR=1.04,P<0.05),sticky saliva(HR=1.05,P<0.01)at 6 months after treatment,and distant metastasis(HR=24.08,P<0.001)were all independent risk factors for 5-year survival rate,and the differences were statistically significant.CONCLUSIONDistant metastasis,pre-treatment anxiety and quality of life are risk factors for 5-year survival rate of patients with nasopharyngeal carcinoma.And,anxiety and depression are risk factors to predict the poor quality of life before and after intensity-modulated radiation therapy in patients.Clinical medical workers should take individualized intervention measures as early as possible to reduce anxiety and depression of patients,and give whole-course,dynamic and systematic psychological intervention measures to improve their quality of life and survival rate. |
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