Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Support Care Cancer. 2010 Mar;18(3):335-42. doi: 10.1007/s00520-009-0657-8. Epub 2009 May 31.
Advanced cancer patients can experience many concurrent symptoms. It has been suggested that certain symptoms can cluster together and have a synergistic effect on patient morbidity. The objective of this study was to explore the presence of symptom clusters in patients with brain metastases treated with whole brain radiotherapy (WBRT).
Patients with brain metastases were asked to rate their symptoms and quality of life (QOL) using the Spitzer Quality of Life Index (SQLI) and a study-designed 17-item symptom questionnaire. Utilizing a principal component analysis, the SQLI and symptoms were analyzed for the presence of symptom clusters. The Cronbach's alpha statistic was used to estimate the internal consistency and reliability of the derived clusters. Follow-up was carried out at baseline and 1, 2 and 3 months following WBRT.
Between August 2005 to October 2007, 129 patients with brain metastases were enrolled. Analysis of the SQLI items revealed two clusters. Cluster 1 consisted of activity, daily living and health, while cluster 2 consisted of support and outlook. Cronbach's alpha was 0.69 and 0.40, respectively, for the two clusters, which accounted for 64% of the total variance. Analysis of the 17 additional symptoms revealed three clusters at baseline. These clusters changed slightly over time, but certain symptoms appeared to remain together: (1) trouble concentrating and confusion, (2) memory loss and decreased alertness, (3) nausea and vomiting, (4) numbness and weakness, and (5) dizziness and headache. These clusters persisted despite WBRT.
Symptom clusters exist in patients with brain metastases. Although the clusters varied over time, they did not weaken or disintegrate following WBRT, suggesting the latter one may not significantly improve the QOL and symptom distress in this group.
晚期癌症患者可能同时出现多种症状。某些症状可能会聚集在一起，并对患者的发病率产生协同作用，这一观点已得到证实。本研究的目的是探讨全脑放疗（WBRT）治疗脑转移瘤患者中症状群的存在情况。
采用斯皮策生活质量指数（SQLI）和研究设计的 17 项症状问卷，对脑转移瘤患者进行症状和生活质量（QOL）评估。利用主成分分析，对 SQLI 和症状进行分析，以确定是否存在症状群。采用 Cronbach's alpha 统计量估计得出的聚类的内部一致性和可靠性。在 WBRT 前后 1、2 和 3 个月进行随访。
2005 年 8 月至 2007 年 10 月，共纳入 129 例脑转移瘤患者。对 SQLI 项目的分析显示存在两个聚类。聚类 1 包括活动、日常生活和健康，聚类 2 包括支持和展望。两个聚类的 Cronbach's alpha 分别为 0.69 和 0.40，占总方差的 64%。对另外 17 个症状的分析显示，基线时有三个聚类。这些聚类随时间略有变化，但某些症状似乎仍然存在：（1）注意力不集中和困惑，（2）记忆力减退和警觉性降低，（3）恶心和呕吐，（4）麻木和无力，以及（5）头晕和头痛。这些聚类在 WBRT 后仍然存在。
脑转移瘤患者存在症状群。尽管聚类随时间而变化，但在 WBRT 后并未减弱或瓦解，这表明后者可能不会显著改善这组患者的 QOL 和症状困扰。
