Dynamic Changes,Influencing Factors Of Early Cognitive Function,and Its Influence On Quality Of Life In Patients With Nasopharyngeal Carcinoma Undergoing Intensity Modulated Radiation Therapy

Objective:This longitudinal survey on the cognition and quality of life of patients with nasopharyngeal carcinoma(NPC)treated by Intensity modulated radiotherapy(IMRT)was conducted in a third-grade class-A general hospital in Nanchang City.The purpose was to investigate the dynamic changes of cognitive function and quality of life before and after IMRT in patients with NPC,analyze the influencing factors of cognitive function of patients before and after IMRT,explore the influence of cognitive changes on quality of life of patients with NPC after IMRT,and provide theoretical basis for clinical identification of high-risk patients with early radiation brain injury and timely prevention,intervention and improvement of quality of life.Methods:This study was a longitudinal study.150 NPC patients who were to treate with IMRT in the oncology department of a third-grade class-A general hospital in Nanchang City,Jiangxi Province from July 2018 to January 2020 were selected by convenient sampling method,Finally,130 patients completed four times of follow-up investigations.The Beijing version of Montreal Cognitive Assessment Scale(MOCA),The Chinese version of Functional Assessment of Cancer Therapy–head and neck(FACT-H&N)and the self-made General Situation Questionnaire were used to investigate the dynamic characteristics of cognitive function and quality of life of patients in different periods before and after radiotherapy,the influencing factors of cognitive function and the impact on quality of life.The data of cognitive function and quality of life before radiotherapy were taken as the baseline data,and the data of end of radiotherapy,0~3months,3~6 months after radiotherapy were followed up.SPSS 25.0 was used for descriptive analysis,repeated measurement analysis of variance,t-test,single factor analysis of variance,multiple linear regression analysis and Pearson correlation analysis.Results:1.The MOCA score in patients with NPC before IMRT,at the end of IMRT,0~3 months after IMRT and 3~6 months after IMRT were(23.25 ± 3.53),(21.47 ± 3.44),(20.25 ± 3.12)and(20.41 ± 3.35),respectively.2.The FACT-H&N score in patients with NPC before IMRT,at the end of IMRT,0~3 months after IMRT and 3~6 months after IMRT were(119.34 ± 8.46),(76.00 ± 14.11),(98.35 ± 13.18)and(108.82 ± 13.38),respectively.3.Univariate analysis showed that MOCA score were significantly different in age,education level,clinical stage and occupational characteristics of patients with NPC before IMRT(P < 0.05);in age,education level,clinical stage,total dose of radiotherapy,radiation dose of bilateral temporal lobe,occupational characteristics of patients with NPC at the end of IMRT(P < 0.05);in age,education level,clinical stage,total dose of radiotherapy,radiation dose of bilateral temporal lobe,occupational characteristics and depression of patients with NPC at 0~3 months after IMRT(P < 0.05);in age,education level,clinical stage,radiation dose of bilateral temporal lobe and occupational characteristics of patients with NPC at 3~6 months after IMRT(P < 0.05).4.Multiple linear regression analysis showed that age,education level and occupational characteristics were the main influencing factors of MOCA score in patients with NPC before IMRT;and age,education level,radiation dose of bilateral temporal lobe and occupational characteristics were the main influencing factors at the end of IMRT,0~3 months after IMRT and 3~6 months after IMRT.5.Pearson correlation analysis showed that there was no significant correlation between MOCA score and FACT-H&N score in patients with NPC before IMRT(P > 0.05);there was a Slightly positive correlation between MOCA score and FACT-H&N score at the end of IMRT,0~3 months after IMRT and 3~6 months after IMRT(P < 0.05).Conclusion:1.The cognitive function of NPC patients was obviously damaged over time after IMRT.At 3~6 months after IMRT,the cognitive function of NPC patients recovered slightly,but there was no significant difference with 0~3 months after IMRT,which was still significantly lower than that at the end of IMRT and before IMRT.2.The quality of life of NPC patients decreased sharply during IMRT,and then increased gradually with time.However,the quality of life of NPC patients at 3~6 months after IMRT did not return to the level before IMRT.3.Age,education and occupation were the main factors that affect the cognitive function of patients with NPC.During and early after IMRT,the radiation dose of bilateral temporal lobes has also become an important influencing factor of cognitive function.The clinical radiotherapy technology still needs to be improved to reduce the incidence of cognitive disorders.Attention should be paid to the follow-up of cognitive function when patients with characteristic of old age,low educational level,engaged in manual labor and the Maximum radiation dose to bilateral temporal lobe?70Gy.4.The cognitive function of patients with NPC has no effect on their quality of life before IMRT,while there was certain influence after IMRT.Clinical medical workers can improve their quality of life from the perspective of preventing cognitive decline or improving cognitive function.