Otolaryngologic Symptom Burden, Emotional Distress, and Stigma in Nasopharyngeal Carcinoma Survivors: A Prospective Cohort Study.

OBJECTIVE

To examine whether otolaryngology-specific symptom burden is associated with perceived and self-stigma among nasopharyngeal carcinoma (NPC) survivors, and the mediating role of emotional well-being.

STUDY

DESIGN

Prospective observational cohort with repeated assessments.

SETTING

Kaohsiung Chang Gung Memorial Hospital, Taiwan.

METHODS

From April 2021 to October 2024, 340 NPC survivors (560 assessments) completed stigma questionnaires (assessing perceived stigma [PS] and self-stigma [SS]) and condition-specific symptom instruments (SNOT-22, ETDQ-7, EAT-10). Gaussian kernel smoothing illustrated symptom trajectories over time. Linear mixed-effects models identified factors independently associated with stigma, while mediation analysis quantified indirect effects via the SNOT-22 emotional domain.

RESULTS

Participants had a median age of 53 years (IQR 44.0-61.5) and a median follow-up of 36 months (IQR 14.0-82.0). PS > 0 occurred in 8.0% of assessments, whereas high SS (> 2.5) was present in 9.5%. High-stigma groups exhibited significantly worse symptom trajectories. In adjusted models, only the SNOT-22 emotional domain was independently associated with PS (β = 0.036; 95% CI 0.004-0.068; p = 0.026) and SS (β = 0.075; 95% CI 0.053-0.097; p < 0.001), with large between-group effect sizes (d = 0.97 and 1.41, respectively). Mediation analyses indicated full mediation of most symptom-PS associations and partial mediation of symptom-SS associations by the emotional domain.

CONCLUSION

Emotional well-being may be an important correlate of both perceived and self-stigma in NPC survivorship. Whether addressing emotional well-being can reduce stigma warrants evaluation in future studies.