Gleason John F, Case Douglas, Rapp Stephen R, Ip Edward, Naughton Michelle, Butler Jerome M, McMullen Kevin, Stieber Volker, Saconn Paul, Shaw Edward G
Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
J Support Oncol. 2007 Oct;5(9):427-33, 436.
A symptom cluster comprises three or more concurrent symptoms. There is a paucity of symptom cluster research in cancer patients. Data from a previously conducted clinical trial were analyzed to search for symptom clusters. This phase III, placebo-controlled, double-blind, prospective, randomized clinical trial of 66 patients assessed the effect of prophylactic d-threo-methylphenidate (d-MPH) on quality of life (QOL) in newly diagnosed brain tumor patients receiving brain radiation therapy. Patients received 5-15 mg of d-MPH or placebo twice daily starting on week 1 of radiation therapy and continuing for 8 weeks post radiotherapy. QOL data were collected at baseline; the end of radiation therapy; and 4, 8, and 12 weeks following radiation therapy using the Functional Assessment of Cancer Therapy (FACT), the FACT-Brain subscale, and the Center for Epidemiologic Studies Depression Scale. Exploratory factor analysis, multidimensional scaling (MDS), and cluster analysis were used to search for symptom clusters. The trial failed to show a treatment effect; patients receiving d-MPH or placebo were analyzed together to search for clusters. Two symptom clusters were identified using exploratory factor analysis--a language cluster including difficulty reading, writing, and finding the right words and a mood cluster including feelings of sadness, anxiety, and depressed mood; these clusters were supported by MDS and cluster analysis. Our results suggest that interventions that target both cognitive function and mood should be considered in this patient population. Further research on symptom clusters in brain tumor patients is needed.
症状群由三种或更多并发症状组成。癌症患者中症状群的研究较少。分析了先前进行的一项临床试验的数据以寻找症状群。这项针对66名患者的III期、安慰剂对照、双盲、前瞻性、随机临床试验评估了预防性右型甲基苯丙胺（d-MPH）对接受脑部放射治疗的新诊断脑肿瘤患者生活质量（QOL）的影响。患者从放射治疗第1周开始，每天两次接受5-15毫克d-MPH或安慰剂治疗，并在放疗后持续8周。在基线、放疗结束时以及放疗后4周、8周和12周使用癌症治疗功能评估（FACT）、FACT-脑分量表和流行病学研究中心抑郁量表收集生活质量数据。采用探索性因素分析、多维标度法（MDS）和聚类分析来寻找症状群。该试验未能显示出治疗效果；将接受d-MPH或安慰剂治疗的患者合并分析以寻找症状群。通过探索性因素分析确定了两个症状群——一个语言群，包括阅读、写作困难以及难以找到合适的词汇；一个情绪群，包括悲伤、焦虑和抑郁情绪；这些症状群得到了MDS和聚类分析的支持。我们的结果表明，对于该患者群体应考虑针对认知功能和情绪的干预措施。需要对脑肿瘤患者的症状群进行进一步研究。
