A Randomized Controlled Trial of Cognitive Behavior Therapy for Reducing Anxiety and Depressive Symptoms in Patients With Locally Recurrent Nasopharyngeal Carcinoma Receiving Reirradiation

Abstract

<h3>Purpose/Objective(s)</h3> We hypothesized that the addition of cognitive behavioral therapy (CBT) to reirradiation significantly reduced depressive and anxiety symptoms in patients with locally recurrent nasopharyngeal carcinoma (NPC). The purpose of this randomized trial was to compare the efficacy of cognitive behavioral therapy versus treatment as usual (TAU) on anxiety and depression, and acute adverse events in patients with locally recurrent nasopharyngeal carcinoma receiving reirradiation. <h3>Materials/Methods</h3> A total of 150 patients with diagnosis of locally recurrent T3 to T4 NPC were randomly assigned to receive CBT plus reirradiation (CBT group, n = 75) or treatment as usual (TAU) plus reirradiation (TAU group, n = 75). All patients received reirradiation using Volume Modulated Arc Therapy (VMAT). The recurrent gross tumor volume of nasopharynx (PGTVnx) was irradiated at DT 60 Gy/30 Fx in 2.0 Gy per fraction. Patients in the CBT group received a series of six CBT sessions for 6 weeks during VMAT. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS) score at baseline, the completion of reirradiation, 1 and 3 months after reirradiation. Acute adverse events were also evaluated. <h3>Results</h3> Patients in the CBT group showed significantly less depression and anxiety than patients in the TAU group after the completion of CBT (<i>P</i> < 0.01). Compared with the TAU group, the CBT group showed a significantly lower incidence of acute adverse events including fatigue, insomnia, anemia, and weight losing (<i>P</i> < 0.05). <h3>Conclusion</h3> The addition of cognitive behavioral therapy to reirradiation significantly reduced depressive and anxiety symptoms. CBT combined with VMAT is associated with reduced incidence of acute toxic effects in patients with locally recurrent T3 to T4 nasopharyngeal carcinoma. This trial is registered with chictr.org.cn, number ChiCTR2000034701.