The Effects Of Treatment On Sleep And Fatigue In Patients With Nasopharyngeal Carcinoma

Objective To longitudinally study the dynamic changes of the sleep quality and fatigue in the process of neoadjuvant chemotherapy plus concurrent chemoradiation therapy in patients with nasopharyngeal carcinoma(NPC).To explore the factors of sleep quality and fatigue before and after neoadjuvant chemotherapy and after neoadjuvant chemotherapy plus concurrent chemoradiation,for early identify the high-risk patients with sleep disorder and fatigue,and as a basic for timely intervention,improving the patient's quality of life.Methods Sixty-two patients who were diagnosed with nasopharyngeal carcinoma and chose neoadjuvant chemotherapy plus concurrent chemoradiotherapy were selected from July 2016 to October 2017 in Department of Radiation Oncology,Cancer Hospital of Guangxi Medical University.All of the objects were used Pittsburgh Sleep Quality Index Scale(PSQI),Cancer Fatigue Scale(CFS),M.D.Anderson Symptom Inventory(MDASI)to measure their sleep quality,fatigue level and symptoms before and after neoadjuvant chemotherapy and after concurrent chemoradiotherapy.The results of the test were analyzed by the paired design four list chi-square,the repeated measurement variance analysis,Spearmen correlation analysis and the binary classification logistic regression.Results 1 Sleep Quality The incidence of sleep disorder before treatment was 47.2% in patients with nasopharyngeal carcinoma,after neoadjuvant chemotherapy was 56.5% and after concurrent chemoradiotherapy was 67.7%.The patients' sleep before treatment as baseline,before the treatment,the patients who had no sleep disorder had 25 percent burdened sleep disorder after neoadjuvant chemotherapy,and 50 percent of them burdened sleep disorder after concurrent chemoradiotherapy.Patients with sleep disorder before treatment,63.6 percent of the patients still had sleep disorder after neoadjuvant chemotherapy,and 83.4 percent of them still burdened sleep disorder after concurrent chemoradiation.In terms of PSQI scores,PSQI scores after concurrent chemoradiation increased significantly 3.130(95% CI: 1.183 5.078,p=0.001)than before treatment,significantly higher 2.717(95% CI: 1.256 4.179,p=0.001)than after neoadjuvant chemotherapy,but before and after neoadjuvant chemotherapy the PSQI scores were no significantly statistical difference.2 Fatigue The total score of fatigue after concurrent chemoradiation significantly increased 4.000(95%CI:0.891-7.109,p=0.008)than before treatment,higher 4.652(95%CI:1.972-7.332,p=0.000)than after neoadjuvant chemotherapy,but before and after neoadjuvant chemotherapy,no significantly statistical difference.3 Symptoms The four most severe and highest frequency of symptoms,before treatment,were fatigue,sleep uneasiness,distress,forgetfulness;After neoadjuvant chemotherapy,were nausea,poor appetite,fatigue,dry mouth;After chemoradiation,were dry mouth,vomiting,nausea,sleep disturbance.Fatigue symptom was more aggravating after chemoradiation than after neoadjuvant chemotherapy,but with no significant difference withbefore treatment.After chemoradiation,nausea and vomiting were worse than before treatment,but there was no significant difference compared with after neoadjuvant chemotherapy.After chemoradiation poor appetite,sleepiness,dry mouth more significantly increased than before and after neoadjuvant chemotherapy treatment.4 Related Factors Single factor analysis showed that the patients' PSQI scores before and after neoadjuvant chemotherapy and after concurrent chemoradiation were respectively positively correlated with fatigue total scores before and after neoadjuvant chemotherapy and after concurrent chemoradiation(r were 0.554,0.554,0.510,all p values < 0.01).Before treatment PSQI score,were no significant correlation with the symptoms except positively correlated with nausea and vomiting(all p values < 0.01);after neoadjuvant chemotherapy PSQI scores only positively correlated with sleep uneasy(p < 0.05);after chemoradiation PSQI scores were positively correlated with pain,fatigue,nausea,sleep uncomfortable,distress,shortness of breath,poor appetite,sleepiness and sadness(p < 0.05).Binary classification logistic regression analysis results showed that the patient's age was associated with the sleep disorder after neoadjuvant chemotherapy(OR = 1.14,95% CI = 1.01-1.28,p = 0.037).The PSQI scores after neoadjuvant chemotherapy was associated with sleep disorder after chemoradiation(OR = 4.02,95% CI = 1.20-13.44,p =0.024,).Patient's gender,marital status,educational level,BMI and clinical stage of disease were no significant correlation with sleep quality and fatigue.Conclusion Compared with the sleep quality and fatigue of nasopharyngeal carcinoma(NPC)patients before treatment,after neoadjuvant chemotherapy,the sleep quality and fatigue were not obviously change.But after neoadjuvant chemotherapy plus concurrent chemoradiotherapy,patients' sleep and fatigue became worse.After neoadjuvant chemotherapy and concurrent chemoradiationtherapy,the incidence of sleep disorder obviously increased in patients who had no sleep disorder before treatment.The incidence of sleep disturbance still kept high in patients who had sleep disorder before treatment after neoadjuvant chemotherapy and concurrent chemoradiation therapy.Before and after neoadjuvant chemotherapy,and neoadjuvant chemotherapy plus concurrent chemoradiation,patient's sleep quality was closely related to fatigue,poorer sleep quality,heavier fatigue degree.Before treatment and after chemoradiation sleep quality was associated with the occurrence and degree of patients' symptoms.Older patients was more prone to burden sleep disorder after neoadjuvant chemotherapy.And after neoadjuvant chemotherapy patients' sleep quality worse,the more prone to burden sleep disorder after concurrent chemoradiotherapy.