---
title: "Dysphagia, Depression, Anxiety, and Symptom Clusters in NPC Survivors After IMRT: Latent Profile a"
id: "pubmed-42813324"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42813324"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42813324/"
doi: "10.1002/cam4.72321"
published_at: "2026-10-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Dysphagia, Depression, Anxiety, and Symptom Clusters in NPC Survivors After IMRT: Latent Profile a
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42813324
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42813324/)
- **DOI:** [10.1002/cam4.72321](https://doi.org/10.1002%2Fcam4.72321)
- **Published At:** 2026-10-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This cross-sectional study enrolled 271 nasopharyngeal carcinoma (NPC) survivors treated with intensity-modulated radiotherapy (IMRT) at a tertiary cancer hospital in Guangzhou between January 2023 and December 2024. - Standardized measures assessed **dysphagia**, psychological status (depression and anxiety), and other symptoms. - Latent profile analysis (LPA) identified two dysphagia burden subgroups: a **high dysphagia burden** group (51.0%) and a **low dysphagia burden** group (49.0%). - Overall dysphagia prevalence was 57.2%; prevalence peaked at 72.7% among survivors within 6 months after treatment. - Exploratory factor analysis (EFA) produced three symptom clusters labelled Systemic/Psychological, Oral/Swallowing, and Gastrointestinal/Neuropathic. - Multivariable linear regression found that membership in the high dysphagia burden subgroup and higher **anxiety** scores significantly predicted greater severity across all three symptom clusters (p < 0.05). - Parallel mediation analysis with bootstrap resampling showed significant total effects of dysphagia subgroup membership on all clusters (p < 0.001). - **Depression** mediated the relationship between dysphagia subgroup and the Systemic/Psychological and Oral/Swallowing clusters; **anxiety** mediated the relationship between dysphagia subgroup and the Systemic/Psychological and Gastrointestinal/Neuropathic clusters. - The authors conclude that a high dysphagia burden is directly associated with larger overall symptom burden and indirectly via depression and anxiety, supporting early identification of high-risk survivors and combined swallowing and psychological interventions for comprehensive care.
## Clinical Analysis & Structured Key Points
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R. China."), [Yongjiao Kang](https://pubmed.ncbi.nlm.nih.gov/?term=Kang+Y&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China."), [Jiajie Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+J&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China."), [Yanling Wen](https://pubmed.ncbi.nlm.nih.gov/?term=Wen+Y&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China."), [Wen Hu](https://pubmed.ncbi.nlm.nih.gov/?term=Hu+W&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China."), [Yuying Fan](https://pubmed.ncbi.nlm.nih.gov/?term=Fan+Y&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China."), [Yan He](https://pubmed.ncbi.nlm.nih.gov/?term=He+Y&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#full-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.") Affiliations Expand ### Affiliations * 1 Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. * 2 Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China. * PMID: **42813324** * DOI: [ 10.1002/cam4.72321 ](https://doi.org/10.1002/cam4.72321) Item in Clipboard # The Role of Dysphagia in Depression, Anxiety, and Symptom Clusters Among Nasopharyngeal Carcinoma Survivors After Intensity-Modulated Radiotherapy: A Latent Profile and Mediation Analysis Based on a Cross-Sectional Study Hui Zhao et al. Cancer Med. 2026 Oct. Show details Display options Display options Format Abstract PubMed PMID Cancer Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cancer+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Cancer+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42813324/) . 2026 Oct;15(10):e72321. doi: 10.1002/cam4.72321. ### Authors [Hui Zhao](https://pubmed.ncbi.nlm.nih.gov/?term=Zhao+H&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China."), [Yongjiao Kang](https://pubmed.ncbi.nlm.nih.gov/?term=Kang+Y&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China."), [Jiajie Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+J&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China."), [Yanling Wen](https://pubmed.ncbi.nlm.nih.gov/?term=Wen+Y&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China."), [Wen Hu](https://pubmed.ncbi.nlm.nih.gov/?term=Hu+W&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China."), [Yuying Fan](https://pubmed.ncbi.nlm.nih.gov/?term=Fan+Y&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China."), [Yan He](https://pubmed.ncbi.nlm.nih.gov/?term=He+Y&cauthor_id=42813324)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-1 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42813324/#short-view-affiliation-2 "Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.") ### Affiliations * 1 Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. * 2 Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China. * PMID: **42813324** * DOI: [ 10.1002/cam4.72321 ](https://doi.org/10.1002/cam4.72321) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Objective:** To identify distinct dysphagia profiles among nasopharyngeal carcinoma (NPC) survivors and to examine the mediating roles of depression and anxiety in the relationship between these profiles and broader symptom clusters. This study hypothesized that subgroup membership would have differential effects on symptom clusters through psychological mediating pathways. The study aimed to provide evidence for the development of precision symptom management interventions. **Methods:** In this cross-sectional study, 271 survivors recruited from a tertiary cancer hospital in Guangzhou (January 2023-December 2024) completed standardized assessments of dysphagia, psychological status, and symptoms. Latent profile analysis (LPA) identified subgroups of survivors with distinct dysphagia profiles; exploratory factor analysis extracted symptom clusters, multivariable linear regression examined associated factors, and parallel mediation analysis with bootstrap resampling tested the mediating effects. **Results:** Dysphagia prevalence among NPC survivors was 57.2%, with the highest prevalence (72.7%) observed among survivors within 6 months post-treatment. LPA identified two survivor subgroups with distinct dysphagia profiles: a high dysphagia burden subgroup (51.0%) and a low dysphagia burden subgroup (49.0%). Three symptom clusters were extracted: Systemic/Psychological, Oral/Swallowing, and Gastrointestinal/Neuropathic. Membership in the high dysphagia burden subgroup and anxiety significantly predicted all clusters (p < 0.05). Mediation analyses revealed that dysphagia subgroup membership had significant total effects on all clusters (p < 0.001). Depression showed statistical mediation for the Systemic/Psychological and Oral/Swallowing clusters, whereas anxiety showed statistical mediation for the Systemic/Psychological and Gastrointestinal/Neuropathic clusters. **Conclusions:** NPC survivors exhibit distinct dysphagia burden profiles, including high- and low-burden subgroups. A high dysphagia burden profile is directly associated with a greater overall symptom burden and indirectly contributes to more severe symptom clusters via depression and anxiety. These findings highlight the need for early identification of survivors within this high-risk subgroup, and the integration of swallowing rehabilitation with psychological interventions for comprehensive symptom management. **Keywords:** anxiety; depression; dysphagia; intensity‐modulated radiotherapy; nasopharyngeal carcinoma survivors; symptom clusters. © 2026 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ The Prevalence and Determinants of Return to Work in Nasopharyngeal Carcinoma Survivors. ](https://pubmed.ncbi.nlm.nih.gov/31568813/) So N, McDowell LJ, Lu L, Xu W, Rock K, Waldron J, Bernstein LJ, Chan HB, Huang SH, Giuliani M, Hope A, O'Sullivan B, Bratman SV, Cho J, Kim J, Jang R, Bayley A, Ringash J.So N, et al.Int J Radiat Oncol Biol Phys. 2020 Jan 1;106(1):134-145. doi: 10.1016/j.ijrobp.2019.09.008. Epub 2019 Sep 27.Int J Radiat Oncol Biol Phys. 2020.PMID: 31568813 * [ The mediating role of resilience in the relationships between posttraumatic growth and depression as well as anxiety among survivors of nasopharyngeal carcinoma: a cross-sectional study. ](https://pubmed.ncbi.nlm.nih.gov/40640902/) Wang S, Lai L, Deng Y, Zhang Y, Cai Y, Huang W, Hao Y, Hou F, Li J.Wang S, et al.BMC Psychol. 2025 Jul 10;13(1):768. doi: 10.1186/s40359-025-03100-5.BMC Psychol. 2025.PMID: 40640902Free PMC article. * [ Sleep-anxiety symptom networks and subgroup characterization in nasopharyngeal carcinoma patients undergoing chemoradiotherapy: A latent profile and network analysis. ](https://pubmed.ncbi.nlm.nih.gov/42084678/) Cui X, Lin Y, Lu J, Zhang Y, Huang X, Liang L.Cui X, et al.Support Care Cancer. 2026 May 5;34(6):503. doi: 10.1007/s00520-026-10757-0.Support Care Cancer. 2026.PMID: 42084678 * [ Malnutrition-related symptom clusters and quality of life in nasopharyngeal carcinoma patients during radiotherapy: a net
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