Chen Mei-Ling, Lin Chia-Chin
Graduate Institute of Nursing, Chang Gung University, Tao-Yuan, Taiwan.
J Pain Symptom Manage. 2007 Dec;34(6):590-9. doi: 10.1016/j.jpainsymman.2007.01.008. Epub 2007 Jul 16.
Cancer patients often experience multiple symptoms concurrently, a phenomenon called symptom clustering. Different symptom clusters have been identified by various symptom assessment tools, as well as by different research methods, but no study has reported whether these identified symptom clusters can be replicated in a new sample. The severity of nine symptoms in 321 cancer patients was assessed using a Taiwanese version of the M.D. Anderson Symptom Inventory. The fit between these data and a model with three symptom factors (sickness, gastrointestinal, and emotional) was evaluated using confirmatory factor analysis. Most fitness indices demonstrated a satisfactory fit between the data and a prespecified three-factor model except one; the root mean square error of approximation was <0.06. A modified model with one symptom (lack of appetite) double loaded in the sickness and gastrointestinal factors demonstrated a significantly better fit between the data and the model. Higher scores in each of the three symptom factors were associated with poorer functional status. Metastatic disease and receiving both chemotherapy and radiation therapy were associated with higher scores in sickness and gastrointestinal factors, but not in the emotional factor. Only hospitalization affected patients' scores in emotional factors. Our findings confirmed the prespecified structure of symptom clusters. A modified model showed a better fit. Patients' complex symptom experience may be better represented by subscale scores based on meaningful clusters rather than on an overall score across all symptoms.
癌症患者常常同时经历多种症状，这一现象被称为症状群聚。不同的症状评估工具以及不同的研究方法已识别出不同的症状群，但尚无研究报告这些已识别出的症状群能否在新样本中重现。使用台湾版的MD安德森症状量表对321名癌症患者的九种症状严重程度进行了评估。使用验证性因素分析评估这些数据与一个具有三个症状因子（疾病、胃肠道和情绪）的模型之间的拟合度。除了一个指标外，大多数拟合指数显示数据与预先设定的三因子模型之间拟合良好；近似均方根误差<0.06。一个修正模型中，一种症状（食欲不振）在疾病和胃肠道因子中双重负荷，该模型显示数据与模型之间的拟合度显著更好。三个症状因子中每个因子的得分越高，功能状态越差。转移性疾病以及同时接受化疗和放疗与疾病和胃肠道因子得分较高相关，但与情绪因子得分无关。只有住院会影响患者在情绪因子上的得分。我们的研究结果证实了预先设定的症状群结构。一个修正模型显示拟合度更好。基于有意义的症状群的分量表得分可能比所有症状的总分更能体现患者复杂的症状体验。
