Collins J J, Byrnes M E, Dunkel I J, Lapin J, Nadel T, Thaler H T, Polyak T, Rapkin B, Portenoy R K
Pain and Palliative Care Service, The New Children's Hospital, Westmead, New South Wales, Australia.
J Pain Symptom Manage. 2000 May;19(5):363-77. doi: 10.1016/s0885-3924(00)00127-5.
The purpose of this study was to determine symptom prevalence, characteristics, and distress in children with cancer. The Memorial Symptom Assessment Scale (MSAS) 10-18, a 30-item patient-rated instrument adapted from a previously validated adult version, provided multidimensional information about the symptoms experienced by children with cancer. This instrument was administered to 160 children with cancer aged 10-18 (45 inpatients, 115 outpatients). To confirm the instrument's reliability and validity, additional data about symptoms were collected from both the parents and the medical charts, and retesting was performed on a subgroup of inpatients. Patients could easily complete the scale in a mean of 11 minutes. The analyses supported the reliability and validity of the MSAS 10-18 subscale scores as measures of physical, psychological, and global symptom distress, respectively. Symptom prevalence ranged from 49.7% for lack of energy to 6.3% for problems with urination. The mean (+/- SD) number of symptoms per inpatient was 12.7 +/- 4.9 (range, 4-26), significantly more than the mean 6.5 +/- 5.7 (range, 0-28) symptoms per outpatient. Patients who had recently received chemotherapy had significantly more symptoms than patients who had not received chemotherapy for more than 4 months (11.6 +/- 6.0 vs. 5. 2 +/- 5.1), and those patients with solid tumors had significantly more symptoms than patients with either leukemia, lymphoma, or central nervous system malignancies (9.9 +/- 7.0 vs. 6.8 +/- 5.5 vs. 6.8 +/- 5.0 vs. 8.0 +/- 6.1). The most common symptoms (prevalence > 35%) were lack of energy, pain, drowsiness, nausea, cough, lack of appetite, and psychological symptoms (feeling sad, feeling nervous, worrying, feeling irritable). Of the symptoms with prevalence rates > 35%, those that caused high distress in more than one-third of patients were feeling sad, pain, nausea, lack of appetite, and feeling irritable. Subscale scores demonstrated large variability in symptom distress and could identify subgroups with high distress. The prevalence, characteristics, and distress associated with physical and psychological symptoms could be quantified in older children with cancer. The data confirm a high prevalence of symptoms overall and the existence of subgroups with high distress associated with one or multiple symptoms. Symptom distress is relatively higher among inpatients, children with solid tumors, and children who are undergoing antineoplastic treatment. Systematic symptom assessment may be useful in future epidemiological studies of symptoms and in clinical chemotherapeutic trials. Symptom epidemiology may also provide a focus for future clinical trials related to symptom management in children with cancer.
本研究的目的是确定癌症患儿的症状发生率、特征及痛苦程度。纪念症状评估量表（MSAS）10 - 18版是一份由先前经验证的成人版改编而来的、包含30个项目的患者自评工具，它提供了有关癌症患儿所经历症状的多维度信息。该工具应用于160名10 - 18岁的癌症患儿（45名住院患儿，115名门诊患儿）。为确认该工具的可靠性和有效性，还从患儿家长及病历中收集了有关症状的额外数据，并对一部分住院患儿进行了重新测试。患者平均只需11分钟就能轻松完成该量表。分析结果支持了MSAS 10 - 18分量表得分分别作为身体、心理和总体症状痛苦程度衡量指标的可靠性和有效性。症状发生率从精力不足的49.7%到排尿问题的6.3%不等。每位住院患儿的平均（±标准差）症状数为12.7±4.9（范围为4 - 26），显著多于每位门诊患儿的平均6.5±5.7（范围为0 - 28）症状数。近期接受化疗的患者比未接受化疗超过4个月的患者症状明显更多（11.6±6.0对5.2±5.1），实体瘤患者比白血病、淋巴瘤或中枢神经系统恶性肿瘤患者症状明显更多（9.9±7.0对6.8±5.5对6.8±5.0对8.0±6.1）。最常见的症状（发生率>35%）有精力不足、疼痛、嗜睡、恶心、咳嗽、食欲不振以及心理症状（悲伤、紧张、担忧、易怒）。在发生率>35%的症状中，超过三分之一的患者感到痛苦程度较高的症状有悲伤、疼痛、恶心、食欲不振和易怒。分量表得分显示症状痛苦程度差异很大，且能识别出痛苦程度高的亚组。癌症大龄患儿身体和心理症状的发生率、特征及痛苦程度可以进行量化。数据证实总体症状发生率较高，且存在与一种或多种症状相关的高痛苦亚组。住院患儿、实体瘤患儿以及正在接受抗肿瘤治疗的患儿症状痛苦程度相对较高。系统的症状评估在未来症状的流行病学研究及临床化疗试验中可能会有用。症状流行病学也可能为未来与癌症患儿症状管理相关的临床试验提供一个重点。
