{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:06:14Z","timestamp":1785323174714,"version":"3.55.0"},"reference-count":41,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100011892","name":"Kaohsiung Chang Gung Memorial Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011892","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine whether otolaryngology\u2010specific symptom burden is associated with perceived and self\u2010stigma among nasopharyngeal carcinoma (NPC) survivors, and the mediating role of emotional well\u2010being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Prospective observational cohort with repeated assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Kaohsiung Chang Gung Memorial Hospital, Taiwan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From April 2021 to October 2024, 340 NPC survivors (560 assessments) completed stigma questionnaires (assessing perceived stigma [PS] and self\u2010stigma [SS]) and condition\u2010specific symptom instruments (SNOT\u201022, ETDQ\u20107, EAT\u201010). Gaussian kernel smoothing illustrated symptom trajectories over time. Linear mixed\u2010effects models identified factors independently associated with stigma, while mediation analysis quantified indirect effects via the SNOT\u201022 emotional domain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants had a median age of 53\u00a0years (IQR 44.0\u201361.5) and a median follow\u2010up of 36\u00a0months (IQR 14.0\u201382.0). PS\u00a0&gt;\u00a00 occurred in 8.0% of assessments, whereas high SS (&gt;\u00a02.5) was present in 9.5%. High\u2010stigma groups exhibited significantly worse symptom trajectories. In adjusted models, only the SNOT\u201022 emotional domain was independently associated with PS (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a00.036; 95% CI 0.004\u20130.068;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.026) and SS (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a00.075; 95% CI 0.053\u20130.097;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), with large between\u2010group effect sizes (\n                      <jats:italic>d<\/jats:italic>\n                      \u00a0=\u00a00.97 and 1.41, respectively). Mediation analyses indicated full mediation of most symptom\u2013PS associations and partial mediation of symptom\u2013SS associations by the emotional domain.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Emotional well\u2010being may be an important correlate of both perceived and self\u2010stigma in NPC survivorship. Whether addressing emotional well\u2010being can reduce stigma warrants evaluation in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70552","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T22:40:48Z","timestamp":1784673648000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Otolaryngologic Symptom Burden, Emotional Distress, and Stigma in Nasopharyngeal Carcinoma Survivors: A Prospective Cohort Study"],"prefix":"10.1002","volume":"35","author":[{"given":"Yi\u2010Lun","family":"Shih","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2129-4242","authenticated-orcid":false,"given":"Chung\u2010Ying","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute of Allied Health Sciences College of Medicine National Cheng Kung University  Tainan Taiwan"},{"name":"School of Nursing College of Nursing Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Biostatistics Consulting Center National Cheng Kung University Hospital College of Medicine National Cheng Kung University  Tainan Taiwan"},{"name":"Department of Public Health College of Medicine National Cheng Kung University  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9412-2991","authenticated-orcid":false,"given":"Wei\u2010Chih","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine  Kaohsiung Taiwan"},{"name":"Department of Otolaryngology Kaohsiung Municipal Ta\u2010Tung Hospital  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4095-5541","authenticated-orcid":false,"given":"Sheng\u2010Dean","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine  Kaohsiung Taiwan"},{"name":"Department of Otolaryngology Kaohsiung Municipal Ta\u2010Tung Hospital  Kaohsiung Taiwan"},{"name":"School of Traditional Chinese Medicine College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"School of Medicine College of Medicine National SunYat\u2010sen University  Kaohsiung 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