Abstract
ObjectiveThis secondary longitudinal analysis describes distinct quality of life trajectories during eight months of radiation therapy (RT) among patients with nasopharyngeal cancer (NPC) and examines factors differentiating these trajectories.Methods253 Chinese patients with NPC scheduled for RT were assessed at pre-treatment, and 4 months and 8 months later on QoL (Chinese version of the FACT-G), optimism, pain, eating function, and patient satisfaction. Latent growth mixture modelling identified different trajectories within each of four QoL domains: Physical, Emotional, Social/family, and Functional well-being. Multinomial logistic regression compared optimism, pain, eating function, and patient satisfaction by trajectories adjusted for demographic and medical characteristics.ResultsWe identified three distinct trajectories for physical and emotional QoL domains, four trajectories for social/family, and two trajectories for functional domains. Within each domain most patients (physical (77%), emotional (85%), social/family (55%) and functional (63%)) experienced relatively stable high levels of well-being over the 8-month period. Different Physical trajectory patterns were predicted by pain and optimism, whereas for Emotion-domain trajectories pain, optimism, eating enjoyment, patient satisfaction with information, and gender were predictive. Age, appetite, optimism, martial status, and household income predicted Social/family trajectories; household income, eating enjoyment, optimism, and patient satisfaction with information predicted Functional trajectories.ConclusionMost patients with NPC showed high stable QoL during radiotherapy. Optimism predicted good QoL. Symptom impacts varied by QoL domain. Information satisfaction was protective in emotional and functional well-being, reflecting the importance in helping patients to establish a realistic expectation of treatment impacts.
Highlights
Nasopharyngeal carcinoma (NPC) is a significant cancer predominating in certain populations and ethnic groups originating from South-East Asia and Southern China, Polynesia, Southern Africa, the Middle-East and North Africa, and the Arctic [1,2]
In NCP existing longitudinal studies of quality of life (QoL) have used averaged data from all patients, thereby obscuring individual patterns of change. To address this gap we report a secondary analysis of an existing longitudinal dataset to explore adjustment trajectories in QoL over three time points before, during and on completion of eightmonths of radiation therapy among patients with NPC
Subject characteristics At each clinic session every second patient in the sample frame was targeted for recruitment but if manpower shortages did not permit this, a 1 in 5 or 1 in 10 recruitment protocol was adopted as necessary
Summary
Nasopharyngeal carcinoma (NPC) is a significant cancer predominating in certain populations and ethnic groups originating from South-East Asia and Southern China, Polynesia, Southern Africa, the Middle-East and North Africa, and the Arctic [1,2]. There were an estimated 84,000 incident cases and 56,000 deaths attributable to NPC in 2008 [2]. Whist constituting only 0.7% of the world cancer burden [2], in those countries most affected NPC is a significant disease. In southeast Asia it constitutes up to the sixth most common cancer in countries where a high population proportion is of Southern Chinese descent [2], so much so that it is often referred to colloquially as ‘‘the Chinese cancer’’. Incidence is approximately three times higher among males than females [1,2]
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