Distinct fatigue trajectories in patients with nasopharyngeal carcinoma undergoing radiotherapy
MASCC (Multinational Association of Supportive Care in Cancer) shared a post on X about a paper by
“New open-access article in Supportive Care in Cancer: Springer Journal: Identification of distinct fatigue trajectories in patients with nasopharyngeal carcinoma undergoing radiotherapy: an observational longitudinal study.”
Authors: Jieling Wu, Xinru Yang, Qiqi He, Zhiying Zhan, Zilan Wu, Litao Zhuo, Li Su, Wenlong Lyu, Jinru Ye, Xiurong Song, Jinsheng Hong and Jihong Song.
A total of 182 patients with nasopharyngeal carcinoma (NPC) completed baseline assessments from July 2021 to January 2024. Due to aggravated radiotherapy-related toxicities, three patients discontinued assessments at T2, T4, and T6, while three others withdrew from radiotherapy at T7.
Fatigue levels were analyzed using latent growth curve modeling (LGCM), which indicated a nonlinear increase in fatigue during radiotherapy (initial level: 1.822, P < 0.001; slope: 0.958, P < 0.001) with a peak at T6, followed by a decline (P < 0.001). Patients receiving concurrent chemotherapy in the fourth week experienced significantly higher fatigue at T5 (β = 0.330, P = 0.010).
Latent class growth modeling (LCGM) identified three distinct fatigue trajectory groups: mild fatigue persistence (29.7%), mild fatigue growth (52.2%), and moderate fatigue persistence (18.1%). The mild fatigue persistence group exhibited a stable but mild fatigue level throughout treatment.
The mild fatigue growth group showed an increase from mild to moderate fatigue (I = 1.247, P < 0.001; S = 1.414, P < 0.001; Q = –0.125, P < 0.001), while the moderate fatigue persistence group started with moderate fatigue (I = 4.691, P < 0.001) and increased slowly. The peak fatigue for both mild groups occurred at T6, aligning with the overall trend.
Predictors of more severe fatigue trajectories included higher PG-SGA scores (OR: 1.43–1.52), marital status (married patients had significantly higher odds of fatigue persistence, OR: 4.47–39.91), anxiety, and low family income. Patients with higher anxiety levels were more likely to experience moderate fatigue persistence.
The study also confirmed that concurrent chemotherapy exacerbated fatigue, particularly in the second cycle, likely due to cumulative radiation effects on the pituitary gland.
This study is the first to classify fatigue trajectories in NPC patients undergoing radiotherapy, highlighting significant inter-group disparities. The findings suggest that targeted interventions addressing nutritional status, psychological support, and financial burdens may help mitigate treatment-related fatigue.
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