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Trajectory of Symptom Clusters in Nasopharyngeal Carcinoma Patients
Undergoing Radiotherapy in Southwest China: A Prospective Longitudinal Study
Based on Patient-reported Outcomes

1
Y. Li and X. Hu 1

1 Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing,
Sichuan University, Sichuan University, China

Background: Nasopharyngeal carcinoma (NPC) is most common in southwest China. Radiotherapy (RT) is
its main treatment, during when patients suffer from numerous various cancer-/RT-related symptom clusters,
leading to heavy symptom burden, low quality of life, the interruption of radiotherapy and even poor survival/
prognosis.

Objective: To explore symptom clusters, their trajectories and classification characteristics of NPC patients
during RT in southwest China.

Methods: Data were collected using the MDASI with H&N-module (weekly during RT, T1-T7), a general information
questionnaire and another five scales (baseline). R and Mplus were used to identify symptom clusters, fit
their latent class tracks, and compare the baseline differences in demographic/health-related/psychosocial
characteristics among different latent classes.

Results: A total of 235 patients were included. During RT, weekly symptom burden score (mean ± SD) surged
from 14.59±15.89 (T1) to 74.91±28.46 (T7); five symptom clusters (fatigue-related, emotion-related, sensory-related,
diet-related and sore-related) were identified, with diverse occurrence time and included symptoms. Two
or three trajectories were found in each of five symptom clusters: fatigue-related symptom burden relieving
(n=34,14%) and worsening (n=201,86%) group; emotion-related symptom burden relative flat (n=181,77%) and
rapid worsening (n=54,23%) group; slight (n=15,6.4%), medium (n=113,48.3%) and great/rapid (n=106,45.3%)
sensation loss group; diet-related symptom burden sustained high (n=18,8%) and relative low (n=216,92%) group;
Oral Presentation Abstracts
sore-related symptom burden high/rapid worsening (n=69,29%) and low/slight worsening (n=165,71%) group.
At baseline, characteristics such as gender, BMI, smoke/smoke years, drinking/drinking years, distress, anxiety,
depression, and planned radiation dose/times were significantly different between distinct symptom cluster
trajectories.

Conclusion: NPC patients in southwest China experienced increasing symptom burden and five symptom
clusters during RT. Patients who were female or with higher BMI, longer smoke/drinking years, higher level of
distress/anxiety/depression, more radiation doses/times exhibited worse symptom cluster trajectory, which
provided a theoretical basis for identifying high-risk populations early and developing tailored interventions to
improve health-related outcomes of NPC patients.

Keywords: nasopharyngeal carcinoma, radiotherapy, symptom cluster, trajectory, symptom burden

_____________________________________________________________________________________________________
Correspondence: Xiaolin Hu, Department of Nursing, West China Hospital, Sichuan University/West China School
of Nursing, Sichuan University, Sichuan University, China
E-mail: huxiaolin1220@126.com

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