Advanced-technique radiation therapy for nasopharyngeal carcinoma in a low resource setting: a review of treatment-related quality of life

Background: Nasopharyngeal carcinoma (NPC) is a rare but significant public health concern, especially in Africa, with a rising global incidence. This study aimed to investigate the pattern of presentation, treatment outcomes and impact on health-related quality of life (HRQOL) of NPC patients at a tertiary institution in Lagos, Nigeria.

Methodology: A retrospective review of all nasopharyngeal cancer patients (n = 125) treated at a tertiary centre in Lagos, Nigeria, from May 2019 to 2022 was done. The European Organisation for Research and Treatment of Cancer (EORTC) H&N 35 questionnaire was used to assess HRQOL at 1-year post treatment and the data were analysed using a statistical package for the social sciences v26.0.

Results: Among 125 patients, the mean age was 46.21 ± 17.82 years with 76% male. Comorbidities were reported in 34 patients (27.2%), smoking history in 18 patients (14.4%) and 50 patients (40%) reported alcohol consumption. Environmental risk factors were identified in six patients (4.8%). The most prevalent histology was squamous cell carcinoma (92.8%), and stage IV was the most common stage (42.4%). Chemoradiation was the primary treatment (63.2%), with intensity-modulated radiotherapy being the most utilised approach (51.2%). Among 125 patients, 51 completed the EORTC questionnaire. Weight loss, sticky saliva, dry mouth, difficulties in swallowing and problems with the sense of taste and smell were the most severe symptoms reported by patients. In the follow-up, 79.2% of patients were reached (50.4% alive, 28.8% deceased). Mortality was significantly associated with age >65 years, weight loss at presentation and consumption of grilled/smoked food.

Conclusion: The study highlights key aspects of NPC in our region including the predominance in males, advanced disease stage at presentation and persistent symptoms post-treatment. Our findings point to the need for targeted initiatives to improve early detection and quality of life for nasopharyngeal patients in the country.