Assessment of Psychological Well-Being in Nasopharyngeal Carcinoma Survivors

Background: Nasopharyngeal cancer patients have high levels of psychological morbidity after treatment due to factors including the sequelae of chemoradiation. Our objective is to assess self-reported psychological symptoms, quality of life, and social support in patients treated for nasopharyngeal carcinoma, and to identify correlates within patient histories.

Methods: We conducted a cross-sectional cohort study, collecting patient-reported inventories of emotional distress (Hospital Anxiety and Depression Scale, HADS), cancer-related quality of life (Functional Assessment of Cancer Therapy-Nasopharyngeal Cancer, FACT-NP), and social support (Medical Outcomes Study Social Support Scale, MOS-SS scale). We conducted a retrospective chart review of patient demographics, pathology, and treatment data. HADS (scored on a scale from 0 to 28) scores of 7 or more prompted referral for psychiatric care. Spearman’s rho was used to assess correlation between scales. Patients belonging to two groups—those who did and those that did not require psychiatric referral—were compared.

Results: A total of 14 patients were included. Median age at treatment was 58 years (range, 35–72), and median time from treatment completion to survey was 3.8 years (1.1–14.1). Ten patients (71%) had advanced stage (III/IV) disease. Thirteen patients (93%) were treated with definitive chemoradiation. Mean total HADS score was 10.36 ± 6.7, depression (D) component mean was 5.21 ± 3.3, and anxiety (A) component mean was 5.14 ± 4.2. 5 patients (36%) were referred for psychiatric care due to elevated HADS scores, of whom one patient declined with no plans for treatment, two were receiving treatment already, and two accepted referral. Age, gender, race, smoking hx, skull base invasion, tumor histology (squamous vs. non squamous cell carcinoma), TNM stage, and recurrence were comparable between the groups. Total HADS score inversely correlated with both the emotional (rs = −0.687, p = 0.028) and tumor site-specific concern (rs = −0.667, p = 0.035) subscales of FACT-NP. MOS-SS also negatively correlated with HADS (rs = −0.738, p = 0.023). None of the functional, physical, or social subscales showed a strong correlation to HADS score. There was no strong association between any of the FACT-NP subscales with the MOS social support scale, or between any two of the FACT-NP subscales.

Conclusion: Quality of life and social support play key roles in psychological outcomes of nasopharyngeal cancer patients. There were no identifiable differences in psychological well-being in any specific patient demographic, highlighting the importance of continued monitoring in the surveillance period of all NPC patients. Notably, time from treatment did not show an association, indicating that psychological sequelae tend to be persistent.