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

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.