Symptom clusters and quality of life in Chinese patients with heart failure

BackgroundEffective symptom assessment and management can improve quality of life in patients with heart failure. However, how psychological symptom cluster, physical symptom cluster and heart failure symptom cluster influence the quality of life of patients with heart failure remains unknown.Aims(a) To describe the symptom clusters among Chinese patients with heart failure (HF), (b) explore the relationship between symptom clusters and quality of life (QOL), and (c) detect if physical and psychological symptoms are mediators of the association between heart failure symptom and QOL.MethodsThree hundred and one patients with heart failure completed measures of symptom (MSAS), QOL and demographic and clinical characteristics. Multiple regression analysis was used to analyse the data.FindingsThe mean age of participants was 72.19 years (range 31–96 years). Each patient was approximately accompanied by an average of 11.19 symptoms (range 0–31), and the top six most common symptoms of Chinese HF patients were shortness of breath, difficulty sleeping, difficulty breathing when lying flat, lack of energy, lack of appetite and cough. Both physical symptom cluster and psychological symptom cluster were the mediators of the relationship between heart failure symptom cluster and QOL.ConclusionsThere were mediating effects of physical symptom cluster and psychological symptom cluster between heart failure symptom cluster and QOL in Chinese patients with HF. Operative assessment, management and alleviation of physical symptoms and psychological symptoms should be prioritised in symptom management strategies for the clinical caregivers.     

Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the memorial symptom assessment scale

The objectives of this study were twofold: (1) to explore and compare the symptom experience of seriously ill hospitalized cancer and noncancer patients near the end of life using the Memorial Symptom Assessment Scale (MSAS) and (2) to determine if the MSAS is a valid and useful measure of symptom distress for patients with noncancer conditions. This was a prospective cohort study of hospitalized patients with end-stage congestive heart disease, chronic pulmonary disease, cirrhosis, or metastatic cancer. Eligible patients were interviewed to ascertain symptom prevalence, severity and distress using the MSAS and levels of fatigue using the Piper Fatigue Scale (PFS). Sixty-six patients with metastatic cancer and 69 patients with end-stage disease were enrolled in the study. There was a significant difference in the prevalence of selected physical symptoms, but not psychological symptoms, between cancer and noncancer patients. There were no significant differences in symptom distress scores, a computed score of frequency, severity and distress, if the symptom was present. In both groups the principal components factor analysis with varimax rotation yielded one factor comprising psychological symptoms and a second factor comprising three subgroups of physical symptoms. Internal consistency was high for the psychological subscale (Cronbach alpha coefficients of 0.85 for the cancer group and 0.77 for the noncancer group) and for the physical subscale groupings, with coefficients ranging between 0.78 to 0.87. The symptom scores were significantly correlated with perceptions of fatigue. These findings show that both seriously ill cancer and noncancer patients experience symptom distress, and that the MSAS seems to be a reliable measure of symptom distress in noncancer patients, as well as with cancer patients.     

乳腺癌患者化疗期症状群困扰风险预测模型的构建与评价

目的 构建化疗期乳腺癌患者自我报告症状群困扰高风险预测模型并评价模型的预测性能。方法 采用便利抽样法,选取2019年10月—2021年5月在上海市、山东省、江苏省、浙江省4所三级甲等医院接受化疗并符合纳入标准的乳腺癌患者647例,按5折交叉验证法以8∶2的比例随机分为建模组和验证组。在建模组中采用随机森林算法构建,在验证组中采用受试者操作特征曲线、Hosmer-Lemeshow拟合优度检验、校准曲线以及决策曲线综合评价模型的预测性能,最后对各影响因素进行重要性排序。结果 乳腺癌患者高症状困扰发生率建模组为33.27%,验证组为29.23%。预测模型的受试者操作特征曲线下面积为0.91,灵敏度为65.8%,特异度为93.5%;Hosmer-Lemeshow拟合优度检验P=0.136;决策曲线显示高于参考线。身体心像、自我效能感、经济负担等为最主要的预测因子。结论 基于随机森林算法构建的预测模型具有良好的预测性能,对识别症状困扰高风险的乳腺癌患者有重要意义。     

Measuring symptom prevalence, severity and distress of cancer survivors

The purpose of this paper is to describe patients’ self-reported symptom occurrence, symptom intensity and symptom distress at post-treatment of cancer therapy. A total of 243 outpatients with heterogeneous solid tumours within 12 months following the completion of initial cancer treatment (chemotherapy or radiotherapy) were assessed using the Chinese version of the Memorial Symptom Assessment Scale (MSAS). The mean age of the sample was 54.2 ± 12 and over half (57.6%) were women. The most common diagnoses were breast cancer (26.3%) and colon cancer (23.5%). The median number of symptoms per patient was 8 (range 0–23 symptoms) and the most prevalent were dry mouth (49.8%), lack of energy (46.9%), worry (39.1%), pain (35%) and feeling drowsy (33.7%). The mean symptom severity and distress scores measured on the MSAS were 1.92 ± 0.2 (range 1.7–2.3) and 1.37 ± 0.3 (.9–2), respectively. The prevalence of certain symptoms was influenced by the primary site of cancer. Pain, worrying and difficulty in swallowing were the most clinically important symptoms. In conclusion, intense physical and psychological symptoms were highly prevalent and distressing to cancer survivors. Comprehensive symptoms assessment is a requisite toward effective symptom control.     

Perceived symptoms and the supportive care needs of breast cancer survivors six months to five years post-treatment period

PurposeThis study characterized the range and levels of perceived symptoms and unmet needs reported by breast cancer survivors in the half-year to five year post-treatment period, and determined whether the symptoms can be a predictor of unmet needs.MethodsIn a cross-sectional study, 150 breast cancer survivors (mean age: 55.1 ± 8 years) at the half-year to five year post-treatment period were enrolled for analysis. The measuring scales used included the Memorial Symptom Assessment Scale (MSAS), and the Supportive Care Needs Survey Short Form (SCNS-SF34).Results88% of the survivors reported having at least one symptom, while 51% reported at least one unmet need. Lack of energy was the most prevalent symptom (47%), followed by numbness/tingling in hands/feet (41%). Most of the survivors had unmet needs in the Health care system/Information domain (37% reported at least one unmet need for help), followed by Psychological needs (29%). The mean scores for the SCNS-SF34 domains, except for sexuality, were significantly higher in the high-symptom group (mean 17.6–32.2) compared with the low-symptom group (mean 3.5–22.3) (p < 0.01). Regression of the SCNS-SF34 domain scores against the MSAS scores revealed an increase in the explained variance of from 14% to 54%.ConclusionOur results suggest that breast cancer survivors continue to experience a multitude of symptoms, and the burden of symptoms may be associated with unmet needs across a range of domains.     

The effect of symptom clusters on functional status and quality of life in women with breast cancer

PurposeThe purposes of this study of women with breast cancer receiving chemotherapy with/without radiation therapy were to determine whether: (1) subgroups of oncology outpatients can be identified based on a specific symptom cluster (i.e., pain, fatigue, sleep disturbances, depression); (2) these subgroups differ on outcomes (i.e., functional status, quality of life); (3) subgroup membership changes over time.MethodsA secondary data analysis using data collected from 112 women at initial chemotherapy. Symptom and outcome measures were completed at three time points: baseline (i.e., the week before cycle two – T1); end of cancer treatment (T2), end of the study (approximately one year after the start of chemotherapy – T3). Cluster analysis identified patient subgroups based on symptom severity scores.ResultsAt T1 and T2, four patient subgroups were identified: ALL LOW (one or no symptom greater than the cut score), MILD (two symptoms), MODERATE (three or four symptoms), and ALL HIGH (four symptoms). At T3, three subgroups were identified: MILD, MODERATE and ALL HIGH. Subgroups with high severity levels of all four symptoms had poorer functional status and QOL at each time point than other subgroups (p < 0.001). Group membership changed over time.ConclusionsSubgroups of patients with different symptom experiences were identified. For some patients severity of all four symptoms persisted months after cancer treatment. Initial and ongoing assessment to identify those patients in the ALL HIGH patient subgroup is important so that appropriate interventions to improve functional status and quality of life can be offered.     

Self-reported physical and psychological symptom burden in adults with cystic fibrosis

Symptom burden is a key component of health-related quality of life in patients with cystic fibrosis (CF). To examine symptom prevalence and characteristics of adults with CF, we administered the Memorial Symptom Assessment Scale (MSAS), a previously validated measure of symptom burden, to CF patients enrolled in the Project on Adult Care in CF. The mean age of the 303 respondents (response rate 91%) was 32.8 years (range, 19-64); 58% were female, and their mean baseline pulmonary function (FEV(1) % predicted) was 69% (SD 28%). The median number of symptoms reported was 10, and there was no difference in the number of symptoms reported based on age, gender, or FEV(1). The most prevalent symptoms were cough (94%), shortness of breath (77%), and lack of energy (77%). Lack of energy and irritability caused the highest level of distress. MSAS symptom subscales were only moderately correlated with symptom status domains from existing CF health-related quality of life measures. Factor analysis led to the development of three distinct MSAS CF-symptom subscales, each with high internal validity. These findings show that adults with CF have a high symptom burden, particularly with respiratory and psychological symptoms, and that the new MSAS CF-specific subscales are a reliable measure of symptom distress in the CF population.     

The persistence of symptom burden: symptom experience and quality of life of cancer patients across one year

Purpose

The purpose of this longitudinal study was to track the symptom experience in a sample of cancer patients, determine the persistence of cancer symptoms and symptom burden, and examine the relationship between symptoms and QOL over time.

Methods

Five hundred forty-two patients provided longitudinal data, completing surveys over a 12-month period. Patients had breast, colorectal, gynecologic, lung, or prostate cancer with stage 1, 2, or 3 disease. Surveys included the Memorial Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General Scale and were administered every 3 months. Demographic and clinical information and comorbidities were collected from the tumor registry.

Results

The number and type of symptoms experienced by patients varied by cancer type, but about 90 % of patients reported one or more symptoms—with prostate cancer patients reporting fewer symptoms and colorectal patients, more symptoms. Prostate patients also had the lowest symptom burden at every time point. Overall, symptom burden decreased over time, as did the Physical subscale for the MSAS. Quality of life was stable over time, except for physical well-being, which improved. Quality of life was negatively correlated with symptom burden at every time point.

Conclusions

The differences in symptom experience by cancer type suggest that assessment and management of symptoms must be individually tailored or at least adjusted by cancer type. While symptom burden decreased over time, residual symptom burden was still noteworthy. As quality of life was persistently negatively correlated with symptom burden, the results suggest the need for comprehensive symptom assessment and management.     

A study to assess the existence of the symptom cluster of breathlessness, fatigue and anxiety in patients with advanced lung cancer

The purpose of this small-scale study was to assess the existence of a symptom cluster involving breathlessness, fatigue and anxiety in patients with advanced lung cancer undergoing palliative radiation. A convenience sample of 27 patients were asked to complete a set of 100mm horizontal visual analogue scales (VAS) measuring the intensity of anxiety, breathlessness and fatigue at 3 points in time: 1 day prior to palliative radiotherapy (RT) (baseline, T0), and at week 3 (T1) and week 6 (T2) after the commencement of the RT. The prevalence of the 3 symptoms ranged from 59% to 96%. At baseline the median intensity of symptoms was mild, becoming progressively worse at T1 and T2. The correlations between the 3 symptoms were moderately strong at T1 and T2 (r=0.49-0.75). The proposed symptom cluster had high internal consistency across T0-T2. These data support the notion that the symptoms--breathlessness, fatigue, and anxiety--may be viewed as a symptom cluster. The high prevalence and moderate intensity of the symptom cluster demonstrates a need for an intervention to manage these symptoms simultaneously.     

Changes in quality of life and its related factors in liver cancer patients receiving stereotactic radiation therapy

PURPOSE: Due to the increasing use of stereotactic radiotherapy (SRT) in treating advanced liver cancer patients, the purpose of this longitudinal study was to explore the changes and factors related to quality of life (QOL) in patients receiving SRT treatment. MATERIALS AND METHODS: Liver cancer patients receiving SRT in northern Taiwan were recruited. The patients were followed up during the baseline pre-SRT and the first 6 weeks of SRT (T0 to T6) in assessing functional status and symptom severity, while depression, selected laboratory data, and QOL were assessed every 3 weeks (T0, T3, and T6). Generalized estimating equations (GEE) analysis was used to explore the significant factors related to the change in QOL. RESULTS: Ninety-nine patients with advanced liver cancer completed seven interviews. The results showed that QOL during SRT was moderate and relatively stable. Performance functional status, depression, the level of albumin, and overall symptom severity were significantly associated with changes in QOL. A further analysis of the relationships between individual symptom severity and QOL revealed that fatigue, lack of appetite, pain, and nausea were the symptoms most affecting QOL across the 6 weeks of SRT. CONCLUSION: Liver cancer patients had stable and moderate levels of QOL during SRT. Factors related to QOL across the 6 weeks were multi-dimensional. Both overall symptom severity and selected individual symptoms were important to patients' QOL. These factors should all be carefully assessed and clinically treated to enhance liver cancer patients' QOL during SRT.