Examining patient-reported late toxicity and its association with quality of life and unmet need for symptom management among nasopharyngeal cancer survivors: a cross-sectional survey

Victor C W Tam; Jerry C F Ching; Sindy S T Yip; Virginia H Y Kwong; Catherine P L Chan; Kenneth C W Wong; Shara W Y Lee

doi:10.3389/fonc.2024.1378973

Examining patient-reported late toxicity and its association with quality of life and unmet need for symptom management among nasopharyngeal cancer survivors: a cross-sectional survey

Front Oncol. 2024 Apr 17:14:1378973. doi: 10.3389/fonc.2024.1378973. eCollection 2024.

Authors

Victor C W Tam^{1

2}, Jerry C F Ching¹, Sindy S T Yip¹, Virginia H Y Kwong², Catherine P L Chan³, Kenneth C W Wong², Shara W Y Lee¹

Affiliations

¹ Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.
² Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China.
³ Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.

Abstract

Introduction: Alongside the improved survival of nasopharyngeal cancer (NPC), late radiation toxicities are alarmingly hampering survivors' quality of life. A patient-reported symptom burden survey is lacking to address the unmet need for symptom management among local NPC survivors.

Methods: A single-center cross-sectional survey was conducted on 211 NPC survivors who had completed radiation therapy for three to 120 months. We employed the Chinese version M. D. Anderson Symptom Inventory - Head & Neck Module (MDASI-HN-C), Functional Assessment of Cancer Therapy - Head & Neck (FACT-HN-C), and a question extracted from the Cancer Survivors' Unmet Needs Measure (CaSUN).

Results: Two hundred valid responses were collected. Participants suffered from at least four moderate to severe symptoms (mean = 4.84, SD = 4.99). The top five severe symptoms were dry mouth, mucus problems, difficulty swallowing or chewing, teeth or gum problems, and memory problems. MDASI-HN-C subscales were negatively correlated with the physical, emotional, functional, and HN-specific domains of the FACT-HN-C. The unmet need for symptom management was positively associated with symptom burden, either general symptoms (Adjusted odds ratio [OR_adj] = 1.566, 95% CI = 1.282 - 1.914, p < 0.001) or top-5 symptoms (OR_adj = 1.379, 95% CI = 1.185 - 1.604, p < 0.001), while negatively associated with post-RT time (OR_adj = 0.981, 95% CI [0.972, 0.991], p < 0.001).

Conclusion: Virtually all NPC survivors suffer from late toxicities, which interplay with survivors' perceptions intricately to affect their unmet needs for symptom management. Personalized supportive care strategies with regular assessments and stratifications are warranted.

Keywords: health-related quality of life; late toxicities; nasopharyngeal cancer; patient-reported outcomes; radiation therapy; survivorship; symptom burden; unmet need.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The project was internally funded by the department.