The Mediating Role of Sleep Quality in the Association Between Negative Affect and Cognitive Function Among Patients With Nasopharyngeal Carcinoma After Intensity-Modulated Radiotherapy

Background Cognitive function impairment is a severe yet largely unrecognized adverse reaction among patients with nasopharyngeal carcinoma (NPC) following radiotherapy. Objectives The aims of this study were to examine the level of cognitive function, explore the influencing factors of the cognitive function of NPC after intensity-modulated radiotherapy (IMRT), and identify the mediating role of sleep quality between negative affect and cognitive function. Methods In total, 200 patients with NPC after IMRT were recruited from a tertiary cancer center in Southern China between September 2020 and March 2021. Participants completed the demographic and disease-related questionnaire, Montreal Cognitive Assessment Scale, Profile of Mood States–Short Form, and Pittsburgh Sleep Quality Index. Results The mean Montreal Cognitive Assessment Scale scores were 24.42 after adjustment, with 54.5% of patients having cognitive function impairment. Education level, income, seeking rehabilitation knowledge, radiation dose, sleep quality, and negative affect entered the final regression model and explained 82.6% of cognitive function variance. The total and direct effects of negative affect and indirect effects via sleep quality on cognitive function were significant ( P < .05). Conclusions Clinicians should pay close attention to patients with poor educational levels, low income, and having difficulties seeking rehabilitation knowledge and patients who accept higher radiation doses. Improving their sleep quality and positive affect may contribute to preventing or reducing cognitive function impairment. Implications for Practice Clinical nurses should pay more attention to cognitive function among NPC patients after IMRT and take effective measures or interventions to prevent and reduce their cognitive function impairment.