Impact of changes in psychological resilience during treatment with intensity-modulated radiotherapy on nasopharyngeal carcinoma patients: a prospective study

Abstract

Background: Nasopharyngeal carcinoma (NPC) patients can undergo changes in psychological status during treatment. The aim of this prospective study was to determine the impact of the changes in psychological resilience on the quality of life (QoL) and long-term outcomes of patients.

Methods: Patients with NPC receiving intensity-modulated radiotherapy (IMRT) between March 2017 and February 2019 were prospectively included. Their psychological resilience was evaluated by the Connor-Davidson resilience scale (CD-RISC) twice. Patients were then divided into the improved psychological resilience group and the deteriorated group. All patients were followed up for at least 2 years, and acute or late severe complications were recorded. The QoL of patients was evaluated within 1 year by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (QLQ-C30) and the Head and Neck 35-questions (HN35). Logistic regression analysis was used for the analysis of risk factors of psychological resilience in NPC patients. Similarly, linear regression analysis was used for the analysis of risk factors of QoL in NPC patients. The overall survival rate and progression-free survival rate were recorded and compared between the 2 groups using Kaplan-Meier curves.

Results: A total of 180 patients were included. The mean CD-RISC scores before radiotherapy and after radiotherapy were 55.8±7.0 and 58.4±7.8 points, respectively. Patients were divided into 104 patients in the improved group and 76 patients in the deteriorated group. Older age, advanced stage, chemotherapy treatment, and severe complications were important risk factors according to the multivariable logistic regression analysis. There were no significant differences in QLQ-C30 and HN35 scores before radiotherapy between the 2 groups, while significant differences were found in most items in the QLQ-C30 and HN35 between the 2 groups. Deteriorated resilience was identified as an important risk factor of QoL according to the multivariable linear regression analysis. NPC patients had significantly higher overall survival and progression-free survival in the improved group than in the deteriorated group.

Conclusions: Psychological resilience has an important impact on the prognosis of NPC patients, thus more attention should be paid to their psychological status during treatment with radiotherapy.

Keywords: Psychological resilience; intensity-modulated radiotherapy; nasopharyngeal carcinoma (NPC); prospective study.