Effects Of Radiotherapy And Chemotherapy On Cognitive Function And Long-term Quality Of Life In Patients With Nasopharyngeal Carcinoma

This prospective study aimed to assess the incidence,details of the change of cognitive dysfunction,predictive factors of cognitive function impairment associated with induction chemotherapy(IC),and long-term quality of life after treatment in nasopharyngeal carcinoma(NPC)patients.In the first part of the study,we included NPC patients who treated with IC from December 2018 to January 2020.Montreal Cognitive Assessment(MoCA)was used to assess cognitive function.Results showed that a total of 66 patients were analyzed in this study,and 89.4%of patients(N=56)received≥3 circles of IC.Cognitive function was assessed before each IC,and 27.3%(N=18)of the patients had cognitive dysfunction,of which attention(P=0.002),language(P<0.001),short-term memory(P=0.009),and orientation(P=0.003)showed significant downward trends,while visuospatial/executive function(P=0.42),naming(P=0.742),and abstraction(P=0.082)demonstrated no prominent decrease.In patients having cognitive function impairment,77.8%of them occurred after the first circle of IC.Multivariate analysis showed that gender(P=0.039)and education(P=0.03)were significant predictors for cognitive dysfunction.In the second part of the study,we explored the effect of radiotherapy and chemotherapy on the long-term quality of life of patients with NPC.Radiation Therapy Oncology Group radiation injury classification,MoCA,and Pittsburgh sleep quality index were used to evaluate radiation injury,cognitive function and sleep status of patients with NPC,respectively.Results showed that,with a median follow-up time of 41.9 months,xerostomia was the most common side effect(75.8%,N=44),and the majority of them(70.4%,N=31)were grade I.In addition,44.8%of the patients(N=26)suffered hearing loss,and all of them were grade I-II.When assessing cognitive function,memory loss was the most common aspect(41.3%,N=26).In addition,20%of patients(N=11)suffered sleep disturbance.In conclusion,approximately 25%of NPC patients suffered cognitive dysfunction after IC,especially in female patients and patients with lower educational level.In NPC patients with long-term follow-up after radiotherapy and chemotherapy,dry mouth and hearing loss were the most common side effects.Therefore,we should pay attention to the effect of cognitive dysfunction and sleep disturbance caused by radiotherapy and chemotherapy on the long-term quality of life of NPC patients.