147 - Long Term Effects of Cognitive Behavioral Therapy on Late Toxicities, Depressive and Anxiety Symptoms in Patients with Locoregional Advanced Nasopharyngeal Carcinoma Undergoing Chemoradiotherapy: A Ra

F. Liu¹, H. Wang², C. Jiang¹, X. Wu¹, C. Fan¹, X. Ye¹, Y. Li¹, Y. Qiu¹, L. He¹, S. Xiao¹, Q. Zhao¹, W. Wu¹, C. Tan³, Y. Li³, R. He⁴, W. Liu¹, and K. Chen¹; ¹Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China, ²Department of Radiation Oncology, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China, ³Hengyang Medical School, University of South China, Hengyang, China, ⁴Hunan Normal University School of Medicine, Changsha, China

Purpose/Objective(s): We hypothesized that the addition of cognitive behavioral therapy (CBT) to chemoradiotherapy can reduce the incidence of late toxicities, depressive and anxiety symptoms in patients with locoregional advanced nasopharyngeal carcinoma (LA-NPC). The purpose of this randomized controlled study was to determine whether concurrent and adjuvant CBT could reduce the incidence of late toxicities, depressive and anxiety symptoms in patients with LA-NPC treated with chemoradiotherapy. Materials/

Methods: A total of 301 patients with stage III-IVa (8th AJCC) nasopharyngeal carcinoma (NPC) were randomly assigned in a 1:1 ratio to receive either CBT plus chemoradiotherapy (CBT group, n = 150) or treatment as usual (TAU) plus chemoradiotherapy (TAU group, n = 151). All patients were treated with induction chemotherapy followed by cisplatin based concurrent chemoradiotherapy (CCRT). Intensity-modulated radiation therapy (IMRT) was administered at a dose of 70.4 Gy/32 fx and 72.6 Gy/33 fx to the gross tumor volume of the nasopharynx (GTVnx) in stage T1-2 and T3-4 disease, respectively. All patients received irregular intervals of educational sessions that include information on health, nutrition, and psychology. In the CBT group, patients received additional series of 6 CBT sessions for 6 weeks during CCRT, and this was followed by adjuvant CBT sessions every 4-weeks for 1 year. CBT combined behavioral, cognitive, and educational strategies, which focused on introduction and establishment of a therapeutic relationship, understanding the relationships between thoughts, emotions, and behavior, cognitive restructuring, consolidating the experiences of dealing with emotional problems. Late toxicities were evaluated. Depression and anxiety, and survival were also assessed. This trial is registered with chictr.org.cn (ChiCTR2000034701).
Results: The median follow-up was 36 months. Compared to the TAU group, the CBT group had a lower incidence of grade 3 to 4 late adverse events, including dry mouth (0% vs 4.0%, P = .040), weight loss (0% vs 4.6%, P = .022), fatigue (0.7% vs 5.3%, P = .043), insomnia (1.3% vs7.3%, P = .024), and skin fibrosis (0% vs 4.0%, P = .040). No grade 5 toxicity (death) occurred during the follow-up period. Patients in the CBT group showed significantly less depression and anxiety than patients in the TAU group from the completion of radiotherapy to 36 months after radiotherapy completion (P < .05). No differences in 3-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were observed between the two treatment groups (P > .05).
Conclusion: The addition of CBT to chemoradiotherapy significantly reduced the incidence of late toxic effects (dry mouth, weight loss, fatigue, insomnia, and skin fibrosis), with reduced depressive and anxiety symptoms in patients with locoregional advanced NPC.