Patient Reported Symptoms and Quality of Life during Radiotherapy: Cross-Sectional Analytical Study in a Tertiary Care Setting

Abstract

Radiotherapy is integral to cancer care, yet its impact on patient-reported symptoms and health-related quality of life (HRQoL) remains understudied. Objectives: To assess the severity of patient-reported symptoms and HRQoL during active radiotherapy and examine associations between specific symptoms and QoL domains among adult cancer patients. Methods: This cross-sectional analytical study was conducted from July 2024 to June 2025 at Bahawal Victoria Hospital, Bahawalpur. A total of 85 adult patients undergoing external beam radiotherapy (without concurrent chemotherapy) completed validated PRO instruments, the EORTC QLQ-C30 and site-specific modules (e.g., QLQ-H&N35, QLQ-CR29), and the PRO-CTCAE at mid-treatment. Data were analyzed using SPSS Version 23.0; Spearman correlation and multiple linear regression identified symptom QoL relationships. Results: Mean global QoL score was 58.4 ± 18.3. Fatigue (64.7 ± 24.1), pain (57.3 ± 26.8), and insomnia (52.9 ± 28.4) were the most severe symptoms. PRO-CTCAE revealed 71.8% reported moderate to severe fatigue. Fatigue (r = –0.52), pain (r = –0.48), and appetite loss (r = –0.41) strongly correlated with lower QoL (all p<0.001). Regression confirmed fatigue (β = –0.31), pain (β = –0.24), and palliative intent (β = –8.9) as independent predictors of reduced global QoL (adjusted R² = 0.486). Conclusions: Fatigue, pain, and treatment intent significantly impair QoL during radiotherapy. Routine PRO integration and context-adapted supportive care are urgently needed to preserve patient well-being in resource-limited oncology services.