Evaluation Of Pituitary And Sexual Function In NPC Patients As Well As Cognition Intervention

Background and ObjectiveThe human sexual activity is very complicated, it consists of physical andpsychical process, and so does the sexual dysfunction. Many tumor patientssuffer a sexual dysfunction after treatment, such as patients with rectalcancer, cervical cancer, prostate cancer or breast cancer. In these cases,it's mainly due to injury to sexual organs and neurovascular caused by diseaseand treatments. Preservation of their sexual function depends on the surgicalmodification and substitution of therapy, such as adoption of nerve-sparingtechniques in operation, implantation of prosthesis as well as medicine.Radiotherapy remains the radical treatment option for nasopharyngealcarcinoma (NPC) with little directly damage to sexual organs orneuro-vasculature. There have been some studies revealed the presences in someof the NPC survivors, which is highly correlated with wrong cognitions. Thewrong cognitions include "cancer is an infective disease", "healthcondition might not be allowed to perform sexual activity after treatment", "sexual activity may delay rehabilitation and induce relapse aftertherapies", and so on. However, there is little study on the extent and causesof sexual dysfunction and how to preserve it. In this study, author tried toresolve these problems from the follow two aspects and verify the effect ofintervention on sexual function.Firstly, pituitary gland might be involved in the field of radiation inNPC patients. As a part of neuroendocrine system, anterior pituitary secretesmany of hormones such as growth hormone (GH), prolactin (PRL), luteinizinghormone (LH), follicle stimulating hormone (FSH), thyroid stimulatinghormone(TSH) and adrenocorticotropin(ACTH), et al, which take part in theregulation of physiological activities. All above hormones are related tosexual function except for GH. MaJun's study showed that in NPC patients treated with external beam radiotherapy, pituitary might received as high as6000cGy which exceeds the TD5/5 dose limit of pituitary. The symptoms ofdyspituitarism such as hyperprolactinemia, dwarfishness and secondumhypothyrosisalso are observed in clinic which are usually manifested 2 to 5years after radiotherapy. Some researchers presumed that dypituitarismpreceded by a long term subclinical phase, in which the concentration of hormonechanged without symptoms, and the results of hormone detection in NPC patientshave proved it. In the first part of this study, blood was sampled from NPCpatients before and after treatment for GH, PRL, LH, FSH and TSH so as to assessthe function of pituitary and the relation with sexual function.Secondly, many studies have disclosed the requests and cognition disorderin cancer patients which include being informed of diagnosis and informationof disease and treatment. Previous research demonstrated the relationshipbetween cognition and sexual function. There are numerous influencing factorsof cognition such as type of cancer, patients' educational background, gender,age and the method of treatment. In China, patients are usually cared by theirrelatives, so their cognition may be affected by relatives. Therefore in thesecond part of this study, a questionnaire was designed to collect theinformation of NPC patients' and their relatives' cognition so as to supplya reference of intervention in clinic.Thirdly, as a malignant tumor, NPC may bring cancer patients' negativeemotion such as anxiety and depression. The incidences of these emotions wereestimated as high as 92.1% and 66.6% respectively, and both of them are relatedto sexual dysfunction. Bai applied cognitive intervention to NPC patients, hesuccessfully reduced the negative emotion and improved the functions ofcognition and role, as well as quality of life (QOL). In the third part, basedon the incorrect cognitions discovered in previous study, cognitiveintervention was adopted in NPC patients to verify its effect on protectingthe patients' sexual function. Methods and MaterialsThe first part: Short-term effects of irradiation on pituitary innasopharyngeal carcinoma patients after radiotherapyBlood were sampled in 31 newly diagnosed NPC patients at pre-therapy,post-therapy and the first time of follow-up visiting, the methods ofchemiluminescent immunoassay (CLIA) and radioimmunoassay (RIA) were employedin detecting GH, PRL, LH, FSH and TSH. Total irradiation dose delivered topituitary was obtained from the treatment planning system (TPS).The second part: Comparison of cognition between cancer patients and theirrelativesSixty pairs of newly hospitalized cancer patients and their relatives wereinvestigated by using of a self-designed questionnaire. The questionnaireconsists of two volumes for patients and relatives respectively, in which thecondition of being informed of diagnosis, cognition of disease and treatmentwere involved. There are 21 identical items in the two volumes which include4 items for being informed of diagnosis, 4 items for cognition of disease and13 items for cognition of treatment. There are also 4 and 2 different itemsin these two volumes respectively. In the first week of therapy, patient andrelative were requested to complete the questionnaire with a patient in sceneto avoid the reciprocal influence, and the questionnaires were anonymous toensure the validity.The third part: Effects of cognitive intervention on sexual function inpost-therapy patients with nasopharyngeal carcinomaO'Leary(1995) Brief Male Sexual Function Inventory Scale was applied formale patients and Female Sexual Function Index (FSFI) for female to assesssexual function in pre- and post-treatment. Cognitive inventions wereperformed on 31 new NPC patients. ResultsThe first part:Doses delivered to 30%, 50%, 80%, 100% volume of pituitary were calculatedin TPS(treatment planning system) which were 4640.32±2117.01cGy,3511.29±2404.04 cGy, 2674.19±2405.47 cGy and 2422.58±2323.28 cGy,respectively. The mean concentration of 5 detected hormones remained in normallimits regardless the dose level the pituitary received. At the time of firstfollow-up visiting, GH increased with statistical significance in all doselevel, and in accordance with the dose received. PRL increased at the end oftreatment and decreased at the time of follow-up visiting when 100% volume ofpituitary received less than 4000cGy dose irradiated. Interestingly, PRLchanged in a contrary way when the dose was above this level. After a dose lessthan 4000cGy irradiated, LH decreased at the end of treatment and then increasedat post-treatment, but when the dose was more than 4000cGy, LH decreasingcontinually before the time of first follow-up visiting. TSH was likely to bethe least affected by irradiation whatever the irradiation dose was. Comparedto the pre-treatment level, it fluctuated within the normal limits.The second part:It showed significant statistical difference between patients' and theirrelatives' in 5 subjects of the questions: do you get information of thediagnosis; how do you like to inform patients of diagnosis; is it necessaryto tell patient intimate therapeutic regimen; who makes a decision on treatmentmodality; if the treatment is unable to cure the disease, would you like tokeep going. The patients educational background and occupation affected theircognition on being informed of the diagnosis. Patients with better educationalbackground and occupation were proposed to have better QOL.The third part: In male patients of the intervention group, all sexual function domainscores and total score remained stable. Fifteen male and 1 female patients inthe control group as well as 2 female patients in the intervention group ceasedsexual activities after treatment. In contrast, either sexual function domainor total score in male patients of the control group decreased with statisticalsignificance except for perception.ConclusionIn the cohort of this study, pituitary received certain dose afterradiotherapy completed, ranging from 400cGy to 8000cGy. The changing of 5different pituitary secreting hormone levels varied within the normal limitsin 3 months after irradiation. However, some of them showed significantstatistical difference when compared to that of pre-treatment orpost-treatment level, indicating functional changes of the pituitary gland.Patients and their relatives have different cognition of being informedof the diagnosis and therapy methods. Most of the relatives would keep theinformation of diagnosis and treatment as a secret to the patients.Within 1 year after treatment, some of the NPC patients would developdisorder of sexual function, which is highly correlated to incorrect perception.Cognitive intervention played an important role in protected NPC patients'sexual function after radiotherapy. It is valuable in clinical application.