Symptom Trajectories and Subtypes in Patients With Nasopharyngeal Carcinoma Receiving Intensity‐Modulated Radiotherapy: A Prospective Cohort Study

Aims To characterize the longitudinal trajectories of symptom burden, identify shifts in core symptoms and explore distinct symptom subtypes in patients with nasopharyngeal carcinoma receiving intensity‐modulated radiotherapy. Design A prospective longitudinal observational study. Methods This prospective study included 248 patients with nasopharyngeal carcinoma undergoing intensity‐modulated radiotherapy between May 2024 and December 2025. Seven core symptoms were assessed at seven time points from baseline to treatment completion. Generalized estimating equations (GEE), network analysis and latent profile analysis (LPA) were used to examine symptom trajectories, core symptoms and subtypes. Results Symptom burden increased progressively throughout radiotherapy. Taste disturbance and radiation‐induced dry mouth showed the greatest deterioration. Network analysis revealed temporal shifts in core symptoms, with radiation‐induced oral mucositis (RIOM) and pain predominating in the early phase, dry mouth in the mid‐phase, and oral mucositis accompanied by psychological distress in the late phase. Distinct symptom subtypes were identified, varying in number across treatment phases and significantly associated with clinical stage and cervical function. Conclusions Symptom burden worsens progressively during intensity‐modulated radiotherapy, with dynamic shifts in symptom interrelationships and distinct patient subtypes. These findings highlight the need for longitudinal monitoring and stage‐specific management. Implications for the Profession and Patient Care Nurses should implement stage‐specific symptom management, prioritizing oral mucositis and pain early, dry mouth mid‐phase and psychological distress later in treatment. Routine longitudinal assessment supports early identification of high‐risk patients and informs individualized nursing interventions. Impact This study addresses the evidence gap on symptom dynamics in nasopharyngeal carcinoma radiotherapy. Findings reveal progressive worsening, shifting core symptoms, and distinct subtypes, guiding tailored assessment and risk‐stratified care in oncology nursing practice. Reporting Method This study followed the STROBE guidelines for reporting observational research. Patient or Public Contribution This study did not include patient or public involvement in its design, conduct, or reporting.