Treating the Web of Radiotherapy Symptoms in Head, Neck Cancer

Megan Brooks

August 26, 2022

Depression and fatigue are key psychoneurological symptoms of intensity-modulated radiotherapy (IMRT) for patients with head and neck cancer.

These core IMRT-related issues often co-occur, or cluster, alongside other symptoms, including sleep trouble, pain, and cognitive dysfunction, and this interconnectedness may make it possible to manage the network of symptoms, a new analysis finds.

"Targeting core symptoms is the key to successful symptom management interventions," lead author Yufen Lin, PhD, RN, with Emory University, Atlanta, Georgia, and colleagues write. "Once patients' symptom combinations are defined, the interventional strategies may be able to be used for a relatively longer period of time for multiple symptoms."

The study was published online August 15 in Cancer.

Psychoneurological symptoms associated with IMRT impact quality of life and survival rates in patients with head and neck cancer. Some evidence indicates that the core symptoms cluster, but research on symptom interconnections and related interventions remains limited.

To understand these associations better, Lin and colleagues used a network analysis to identify relationships between depression, fatigue, sleep trouble, pain, and cognitive dysfunction, the five most common and distressing psychoneurological symptoms reported by patients with head and neck cancer undergoing IMRT.

A total of 172 patients completed symptom questionnaires at four time points: before IMRT (T1) as well as 1 month (T2), 3 months (T3), and 12 months (T4) after.

The researchers found depression to be the "most core symptom."

Although depression rates were relatively low among study participants, with 14% to 25% of patients reporting depression across the time points, it "was highly connected with the other four symptoms," suggesting depression "may play a central role among all symptoms in the [psychoneurological symptom] network," the researchers note.

Fatigue was the most prevalent symptom, reported by 54% to 75% of patients across the time points, but related to three, not all four, of the other core psychoneurological symptoms.

The researchers also identified symptom–symptom relationships over time. The strongest relationships were for depression and sleep disturbance at T1, T3, and T4, depression and fatigue at T2, T3, and T4, and depression and cognitive dysfunction at T4.

Female gender, higher levels of stress, and no alcohol use were also associated with stronger symptom networks.

Although further studies are needed to validate these findings, the researchers note that, given the symptom–symptom relationships identified, patients may benefit from different combinations of symptom interventions, such as psychotherapy with sleep hygiene education or cognitive behavioral therapy.

Funding for this research was provided by grants from the National Institutes of Health. Lin had no relevant disclosures.

Cancer. Published online August 15, 2022. Abstract

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