Sleep characteristics and psychological symptoms in patients with locally advanced nasopharyngeal carcinoma before and after intensity-modulated radiotherapy and concurrent chemotherapy

Abstract

Sleep disturbances and psychological distress are the most common adverse effects associated with cancer diagnosis and treatment. The aim of this study was to examine sleep and psychological characteristics in patients with local-advanced nasopharyngeal carcinoma (NPC) following completion of intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy, and to describe the predictors of post-test psychological symptoms after treatment. Sleep quality and psychological symptoms were measured using Pittsburgh sleep-quality index (PSQI) and symptom checklist-90 in 60 local-advanced NPC patients treated with IMRT and concurrent chemotherapy, respectively. After treatment, the subscores of subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction increased significantly compared with their pre-test scores. Similar results were observed for the mean PSQI global score. However, for psychological symptoms, only subscores of somatization and depression were higher than their baseline level. Multivariate analysis revealed that concurrent chemotherapy cycle was the only predictor of depression after treatment among all of the psychological symptoms assessed. These findings indicate that sleep disturbance and psychological distress are significant problems in NPC patients treated with IMRT and concurrent chemotherapy. Patients who receive many cycles of concurrent chemotherapy may be at an increased risk of depression after completion of IMRT.

Factors associated with depression over time in head and neck cancer patients: A systematic review

“…In total 33 of these articles fulfilled the eligibility criteria. In addition, two studies were included after screening the reference lists, resulting in 35 articles . These 35 articles provided results on 27 separate studies.…”

“…Of the 25 studies that focused on factors associated with depression at a single time point, publication year ranged from 1999 to 2018 . Most studies focused on mixed HNC patients, while four studies focused on nasopharyngeal, oropharyngeal, or oral cancer . The majority measured symptoms of depression, while four studies measured a clinical diagnosis of depression .…”

“…The majority measured symptoms of depression, while four studies measured a clinical diagnosis of depression . Symptoms of depression were measured using the Hospital Anxiety and Depression Scale (HADS) depression domain, Center for Epidemiological Studies Depression Scale (CES‐D), Beck Depression Inventory (BDI), self‐rating depression scale (SDS), and the Symptom Checklist (SCL) depression domain . With respect to a clinical diagnosis of depression, two studies extracted data from an insurance database on the International Classification of Diseases (ICD) diagnosis on depression, and two studies used a structured clinical interview to identify the presence of a Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV diagnosis of depression .…”

“…Eleven of the 35 studies were of high methodological quality (Appendix B). The majority of studies (23/35) did not have a baseline participation rate (the percentage of all eligible patients who wants to participate) of at least 80% or showed selective nonresponse (characteristics of participants differed from those patients who were not willing to participate) .…”

“…The majority of studies (23/35) did not have a baseline participation rate (the percentage of all eligible patients who wants to participate) of at least 80% or showed selective nonresponse (characteristics of participants differed from those patients who were not willing to participate) . Twenty‐one studies included less than 100 patients and about half (17/35) performed multivariate analyses …”