Effect of enhanced recovery after radiotherapy (ERAR) on the quality of life in patients with nasopharyngeal carcinoma after radiotherapy: A randomized controlled trial

Nasopharyngeal carcinoma is prevalent in Southern China and Southeast Asia, which is effectively managed through chemoradiotherapy for locoregionally advanced cases (LA-NPC). Despite current guidelines endorsing various rehabilitation regimens for surgery, evidence supporting the benefits of rehabilitation during systemic radiotherapy is scarce. Thus we introduce the Enhanced Recovery After Radiotherapy (ERAR) concept. We enrolled patients with stage III to IVA LA-NPC in this study. The ERAR group received comprehensive interventions encompassing nursing, oral care, psychology support, rehabilitation, nutrition, and skin health throughout their radiotherapy. The standard care group received conventional radiotherapy rehabilitation. Outcomes were evaluated at baseline, the 17th and 33rd radiotherapy sessions. Generalized estimating equations were used to evaluate group by time effects on the outcomes, controlling for key covariates. A total of 104 LA-NPC patients with a mean age of 49.2 ± 10.9 years were enrolled in the study group from August 2021 to September 2023. The ERAR group showed significant improvements in quality of life (P = 0.014), Hospital Anxiety and Depression Scale (HADS) anxiety (P < 0.001), HADS depression (P < 0.001), distress thermometer (P = 0.049), NRS2002 (P = 0.040), weight loss (P < 0.001), and Oral Health Impact Profile-14 (OHIP-14) (P = 0.040) scores outperforming the standard care group at all measured time points. The ERAR protocol significantly mitigates acute radiation-induced toxicities in LA-NPC patients. This study is anticipated to serve as a reference for clinicians and encourage the adoption of a standardized protocol aimed at facilitating rapid recovery post-radiotherapy.