癌症患者的症状群调查研究

目的了解癌症患者疾病发展和治疗过程中的相关症状,探讨其症状群种类和数量.方法使用中文版安德森症状评估量表对155例住院癌症患者进行调查,采用探索性因子分析法统计症状群.结果癌症患者发生率高的症状依次是疲乏、口干、睡眠不安.严重程度症状依次为食欲下降、呕吐、疲乏和睡眠不安.Spearman相关分析显示,除气短与食欲下降、呕吐之间相关性无统计学意义(P>0.05)之外,其余各症状之间相关性均具有统计学意义且均存在正相关关系(P<0.05).探索性因子分析得出3个症状群,分别为疾病行为症状群、上消化道症状群、心理症状群.各症状群的Cronbach’sα系数分别为0.69、0.83、0.75.结论癌症患者存在多种症状群,对癌症患者应探索以症状群为基础的干预模式,以求能够产生更好的临床效果,提高癌症患者的生存质量.     

Symptom Burden Clusters: A Challenge for Targeted Symptom Management. A Longitudinal Study Examining Symptom Burden Clusters in Breast Cancer

ContextAlthough there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters.ObjectivesTo explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer.MethodsIn this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups.ResultsThree clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with “change in the way food tastes” as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden.ConclusionThis study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients.     

Symptom Clusters in Head and Neck Cancer: A Systematic Review and Conceptual Model

ObjectiveThe two approaches to symptom-cluster research include grouping symptoms and grouping patients. The objective of this systematic review was to examine the conceptual approaches and methodologies used in symptom-cluster research in patients with head and neck cancer.Data sourcesArticles were retrieved from electronic databases (CINAHL, MEDLINE via Ovid, APA PsycINFO, Scopus, Embase, and Cochrane Central Register of Controlled Trials-CENTRAL), five grey literature portals, and Google Scholar. Seventeen studies met the eligibility criteria. Eight studies grouped symptoms to identify symptom clusters, of which two used qualitative methods. The number of symptom clusters ranged from two to five, and the number of symptoms in a cluster ranged from 2 to 11. Nine studies grouped patients based on their experiences with multiple symptoms. Cluster analysis and factor analysis were most commonly used. Despite variable names and composition of symptom clusters, synthesis revealed three prominent symptom clusters: general, head and neck cancer-specific, and gastrointestinal. Being female and quality of life were significantly associated with high symptom group or cluster severity. Biological mechanisms were sparsely examined.ConclusionSymptom cluster research in head and neck cancer is emerging. Consensus on nomenclature of a symptom cluster will facilitate deduction of core clinically relevant symptom clusters in head and neck cancer. Further research is required on understanding patients’ subjective experiences, identifying predictors and outcomes, and underlying mechanisms for symptom clusters.Implications for Nursing PracticeIdentification of clinically relevant symptom clusters would enable targeted symptom assessment and management strategies, thus improving treatment efficiencies and patient outcomes.     

卵巢癌患者的症状群与其生活质量的相关性

目的调查卵巢癌患者的症状群,并探讨症状群与其生活质量的相关性。方法便利抽样法选择2012年5-10月在山东省济南市某三级甲等医院妇科病房接受治疗的卵巢癌患者130例,采用安德森症状评估表(M.D.Anderson symptom inventory,MDASI)和卵巢癌治疗功能评估量表(the functional assessment of cancer therapy scale-ovarian,FACT-O)对其进行调查。结果卵巢癌患者有较高内部一致性的4个症状群分别为情感性症状、躯体性症状、胃肠道症状及治疗不良反应,其Cronbachα系数分别为0.838、0.632、0.715和0.613。患者生活质量评分均值为(96.78±17.13)分,与4个症状群均呈负相关(均P0.01)。其中情感性症状群、躯体性症状群及胃肠道症状群被纳入回归方程。结论卵巢癌患者存在情感性症状、躯体性症状、治疗不良反应及胃肠道症状四个主要症状群,其中情感性症状群、躯体性症状群、胃肠道症状群是生活质量的重要影响因素。因此,医护人员可以进行有针对性的治疗及心理疏导,以提高患者的生活质量。     

Stability of Symptom Clusters in Patients With Breast Cancer Receiving Chemotherapy

Context

Patients with breast cancer who undergo chemotherapy (CTX) experience between 10 and 32 concurrent symptoms. An evaluation of how these symptoms cluster together and how these symptom clusters change over time may provide insights into how to treat these multiple co-occurring symptoms.

Stability of Symptom Clusters in Patients With Lung Cancer Receiving Chemotherapy

Context

Patients with lung cancer who undergo chemotherapy (CTX) experience multiple symptoms. Evaluation of how these symptoms cluster together and how these symptom clusters change over time are salient questions in symptom clusters research.

A Longitudinal Analysis of Symptom Clusters in Cancer Patients and Their Sociodemographic Predictors

ContextExploring the relationships between concurrent symptoms or “symptom clusters” (SCs) longitudinally may complement the knowledge gained from the traditional approach of examining individual symptoms or SCs crosssectionally.ObjectivesTo identify consistent SCs over the course of one year and determine the possible associations between SCs and demographic and medical characteristics, and between SCs and emotional distress.MethodsThis study was an exploratory longitudinal analysis of SCs in a large sample of newly diagnosed cancer patients. Patients provided symptom assessment data at baseline, three, six, and 12 months. A factor analysis was conducted (controlling for the patient over time) on pain, fatigue, anxiety, depression, sleep, weight change, and food intake items to identify clusters. A panel regression on each cluster explored associations with demographic and medical characteristics and distress.ResultsIn total, 877 patients provided baseline data, with 505 retained at 12 months. Three SCs explained 71% of the variance. The somatic cluster included pain, fatigue, and sleep; the psychological cluster included anxiety and depression; and the nutrition cluster consisted of weight and food intake. Low income and treatment with radiation or chemotherapy predicted higher somatic symptom burden. Younger age, being female, low income, and treatment with surgery predicted more psychological symptomatology. Older age and treatment with surgery predicted higher nutritional burden. Patients with higher somatic, psychological, and nutritional symptom burden reported higher distress.ConclusionThe presence of SCs across the first year of diagnosis supports the need for routine and ongoing screening for the range of symptoms that may be experienced by patients. Further work is needed to develop interventions that better target individual symptoms that cluster, as well as the entire cluster itself.     

166例胃癌术后化疗患者症状群内前哨症状的调查

目的 探讨胃癌术后化疗患者症状群内前哨症状,比较不同特征胃癌术后化疗患者前哨症状评分上的差异。方法 采用方便抽样方法,选取自2019年1—11月入住江苏省中医院肿瘤内外科病房的胃癌术后化疗患者作为研究对象。采用一般资料调查表、自制症状首次出现记录表及安德森症状评估量表胃癌特异性模块,对其进行调查。采用IBM SPSS Statistic 22.0、IBM SPSS Modeler 18.0进行数据分析。结果 共调查166例胃癌术后患者,疼痛是病感症状群的前哨症状,其首次出现时间为（18.64±23.83）h,疼痛、疲乏支持度为53.0%,置信度为98.9%,疼痛、睡眠不安支持度为53.0%,置信度为60.2%;悲伤是情绪症状群的前哨症状,其首次出现时间为（11.88±8.95）h,悲伤、苦恼支持度为86.5%,置信度为99.1%;消化道症状群、胃癌特异性症状群、神经系统相关性症状群未见明确前哨症状。不同年龄、肿瘤分期、化疗次数、中医证型的胃癌术后化疗患者,其疼痛评分比较,差异均有统计学意义（P<0.05）;不同手术方式、教育程度、肿瘤分期、化疗方案、化疗次数、中医证型的胃癌术后化疗患者,其悲伤评分比较,差异均有统计学意义（P<0.05）。结论 疼痛是病感症状群的前哨症状,悲伤是情绪症状群的前哨症状;50岁以下、肿瘤Ⅳ期、第3次化疗、气滞血瘀证型的胃癌术后化疗患者,其疼痛评分最高;远端胃切除、大专及以上学历、肿瘤Ⅳ期、行伊立替康+氟尿嘧啶+亚叶酸钙化疗方案、第1次化疗及气滞血瘀证型的胃癌术后化疗患者,其悲伤评分最高。医务人员可针对前哨症状进行有针对性的评估及干预,以达到有效管理症状群的目的。     

Updates in Cancer-Related Symptom Management of Anorexia and Cachexia Syndrome

ObjectiveTo provide current evidence and updates in cancer-related symptom management of cancer anorexia-cachexia syndrome (CACS).Data sourcesTextbooks, journal articles, and the internet.ConclusionNutrition and the treatment of CACS plays a pivotal role in multimodal cancer care. The pathophysiology of nutrition in patients with cancer is complex and requires active screening and interventions. Treatment of CACS should focus on antitumor treatment, nutrition intervention, supportive pharmacologic intervention and/or other interventions that improve clinical outcomes.Implications for Nursing PracticeOncology nurses are in a pivotal position to provide proactive screening, assessment, clarify treatment options, and follow-up for patients with cancer and associated nutritional issues.     

Cancer-Related Symptom Assessment in France: Validation of the French M. D. Anderson Symptom Inventory

This multicenter study was intended to validate the French version of the M. D. Anderson Symptom Inventory (MDASI-Fr) in French cancer patients (n = 162) with solid tumors or hematological malignancies. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used as a part of the validation. Factor analysis showed three underlying constructs for symptom items: general symptoms (pain, fatigue, disturbed sleep, shortness of breath, drowsiness, dry mouth, and numbness or tingling items); emotional and cognitive components (distress, sadness, and remembering items); and a gastrointestinal component (nausea, vomiting, and lack of appetite items), with Cronbach's alphas of 0.79, 0.73, and 0.71, respectively. Convergent validity was established by comparing MDASI-Fr items with the EORTC QLQ-C30 scale and the Brief Pain Inventory (BPI). Overall, the 19-item MDASI-Fr score correlated well with the QLQ-C30 global health status, and the pain item of the MDASI-Fr was highly correlated with the short form of the BPI. The most prevalent symptoms were fatigue, distress, dry mouth, and pain. Twenty-five percent of patients reported moderate or severe pain (numeric rating scale >4 on 0–10 severity ratings). Physician ratings of global change on a second visit were significantly associated with changes in patient ratings on the MDASI-Fr, supporting the sensitivity of the measure. Symptoms interfered most with work and general activity. The MDASI-Fr is a valid and reliable tool for measuring symptom severity and interference in French cancer patients.     

Associations Among Hypogonadism,C-Reactive Protein,Symptom Burden,and Survival in Male Cancer Patients with Cachexia: A Preliminary Report

ContextCachexia is characterized by muscle wasting, anorexia, and elevated inflammatory markers. In patients without cancer, hypogonadism is associated with lower lean body mass, increased symptom burden, and decreased survival. Hypogonadism in cancer cachexia could exacerbate symptoms, facilitate a proinflammatory state, and decrease survival.ObjectivesTo explore the relationships among these factors, a retrospective study of male cancer patients was conducted.MethodsThe charts of 98 consecutive male patients referred to a cachexia clinic at a comprehensive cancer center were reviewed. All patients reported weight loss of >5% within the preceding six months; the median age was 60 years. Fifty-seven (58%) had serum C-reactive protein (CRP), and 68 (69%) had total testosterone evaluated. Symptoms were evaluated by the Edmonton Symptom Assessment Scale.ResultsMedian CRP was 20 mg/L, and median testosterone level was 185 ng/dL (6.42 nmol/L) (normal ≥240 ng/dL or 8.36 nmol/L). There was an inverse correlation between testosterone and CRP levels (P < 0.01). Lower testosterone was associated with increased dyspnea and insomnia (P < 0.05). Poor appetite and insomnia (P < 0.05) correlated with elevated CRP. Survival of patients with testosterone levels ≤185 ng/dL (6.42 nmol/L) was decreased compared with that of those with levels >185 ng/dL (13 vs. 62 weeks, P = 0.004). Patients with CRP levels >10 mg/L had decreased survival compared with those with levels ≤10 mg/L (15 vs. 46 weeks, P = 0.01). The combination of hypogonadism and elevated CRP was associated with poorer prognosis. Elevated CRP levels were associated with increased symptom burden and decreased survival. Low testosterone was associated with decreased survival and correlated inversely with CRP levels, dyspnea, and insomnia.ConclusionOur preliminary results suggest that testosterone and CRP may be additive or synergistic as markers for survival in male patients and could be useful in future prognostic models.     

Stable Symptom Clusters and Evolving Symptom Networks in Relation to Chemotherapy Cycles

ContextThe existence of stable symptom clusters with variations or changes in cluster membership and the merging of symptom clusters over time urge us to investigate how symptom relationships change over time.ObjectivesTo identify stable symptom clusters and understand networks among symptoms using longitudinal data.MethodsSecondary data analysis was conducted using data from a nonblinded randomized clinical trial, which evaluated the effect and feasibility of the developed cancer symptom management system. For the present study, data from all participants of the original trial were analyzed (N = 249). The severity of 20 symptoms was measured before the start of chemotherapy (CTx) and during the initial four cycles of CTx. Symptom clusters were identified using principal component and hierarchical cluster analyses, and network analysis was used to explore the relationships among symptoms.ResultsThree common symptom clusters were identified. The first cluster consisted of anxiety, depression, sleep disturbance, pain, and dyspnea. Fatigue, difficulty concentrating, and drowsiness formed a second stable cluster throughout the CTx cycles. The third cluster comprised loss of appetite, taste change, nausea, and vomiting. In terms of the symptom networks, close relationships were recognized, irrespective of symptom severity level, between anxiety and depression, fatigue and drowsiness, and loss of appetite and taste change. Fatigue was the most central symptom with the highest strength. Edge thickening after starting CTx demonstrated evolving symptom networks in relation to CTx cycles.ConclusionStable symptom clusters and evolving networks were identified. The most central symptom was fatigue; however, the paucity of studies that investigated symptom networks and central symptoms calls for further investigations on these phenomena. Identification of central symptoms and underlying mechanisms will guide efficient symptom management. Future studies will need to focus on developing comprehensive interventions for managing symptom clusters or targeting central symptoms.     

Comparison of Fatigue,Pain, and Depression in Patients With Advanced Kidney Disease and Cancer—Symptom Burden and Clusters

Context

Although symptom clusters have been studied in the context of cancer, few data exist in chronic and end-stage kidney disease (CKD/ESKD) patients.

Symptom Clusters and Quality of Life in Patients With Breast Cancer Receiving Endocrine Therapy in China

ObjectivesBreast cancer patients undergoing endocrine therapy experience various symptoms that have long-term effects on their quality of life. However, which symptom clusters are expressed and affect patients’ quality of life remain significantly controversial. Therefore, we aimed to explore symptom clusters among breast cancer patients receiving endocrine therapy and identify the impact of these clusters on their quality of life.Data SourcesThis secondary analysis of data from a cross-sectional study aimed to explore the symptom experiences and quality of life of breast cancer patients receiving endocrine therapy. The participants were invited to complete the Functional Assessment of Cancer Therapy–Breast (FACT-B) and Endocrine Subscale (ES). Principal component analysis, Spearman correlation analyses, and multiple linear regression were used to explore symptom clusters and identify their influence on quality of life.ConclusionData from 613 participants were obtained, and 19 symptoms were included in the principal component analysis, which identified five symptom clusters: the systemic, pain and emotional, sexual, vaginal, and vasomotor symptom clusters. Adjustment for covariates revealed that the systemic and pain and emotional symptom clusters were negative predictors of quality of life. The fitted model explained approximately 38.1% of the variance.Implications for Nursing PracticeThis study demonstrated that breast cancer patients receiving endocrine therapy experienced symptoms that tended to occur in five clusters (i.e., systemic, pain and emotional, sexual, vaginal, and vasomotor symptoms). Developing interventions for the systemic and pain and emotional symptom clusters may effectively improve patients’ quality of life.     

Respiratory Failure,Noninvasive Ventilation,and Symptom Burden: An Observational Study

Background

Noninvasive ventilation (NIV) is commonly used to manage acute respiratory failure due to decompensated cardiorespiratory disease. We describe symptom burden in this population.

A Longitudinal Study of PROMIS Pediatric Symptom Clusters in Children Undergoing Chemotherapy

Context

Children in treatment for cancer experience multiple, troubling, and interrelated symptoms. Analyzing the interrelatedness of symptoms and how that changes during treatment could yield clinically relevant patient profiles to guide patient care.

Prevalence of Psychoneurological Symptoms and Symptom Clusters in Women with Breast Cancer Undergoing Treatment: Influence on Quality of Life

ObjectivesTo identify subgroups of psychoneurological symptoms (PNS) and their relationship to different clinical variables in a sample of women with breast cáncer (BC) with different type of treatment, and the possible influence of these on quality of life (QoL), using a factorial principal components analysis.Data SourcesObservational, cross-sectional, non-probability study (2017–2021) at Badajoz University Hospital (Spain). A total of 239 women with BC receiving treatment were included.Results68% of women presented fatigue, 30% depressive symptoms, 37.5% anxiety, 45% insomnia, and 36% cognitive impairment. The average score obtained for pain was 28.9. All the symptoms were related between themselves, and within the cluster of PNS. The factorial analysis showed three subgroups of symptoms, which accounted for 73% of variance: state and trait anxiety (PNS-1), cognitive impairment, pain and fatigue (PNS-2), and sleep disorders (PNS-3). The depressive symptoms were explained equally by PNS-1 and PNS-2. Additionally, two dimensions of QoL were found (functional-physical and cognitive-emotional. These dimensions correlated with the three PNS subgroups found. A relationship was found between chemotherapy treatment and PNS-3, and its negative impact on QoL.ConclusionsA specific pattern of grouped symptoms in a psychoneurological cluster with different underlying dimensions has been identified which negatively influences QoL of survivors of BC.Implication for Nursing PracticeIt is important to raise awareness among professionals and patients about the existence of a cluster of PNS, the patient's profile, as well as the factors that exacerbate them. This will allow them to be treated more effectively and comprehensively.