Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
Support Care Cancer. 2012 Jan;20(1):95-105. doi: 10.1007/s00520-010-1070-z. Epub 2011 Feb 4.
The aim of this secondary data analysis was to investigate symptom clusters over time for symptom management of a patient group after commencing adjuvant chemotherapy.
A prospective longitudinal study of 219 cancer outpatients conducted within 1 month of commencing chemotherapy (T1), 6 months (T2), and 12 months (T3) later. Patients' distress levels were assessed for 42 physical symptoms on a clinician-modified Rotterdam Symptom Checklist. Symptom clusters were identified in exploratory factor analyses at each time. Symptom inclusion in clusters was determined from structure coefficients. Symptoms could be associated with multiple clusters. Stability over time was determined from symptom cluster composition and the proportion of symptoms in the initial symptom clusters replicated at later times.
Fatigue and daytime sleepiness were the most prevalent distressing symptoms over time. The median number of concurrent distressing symptoms approximated 7, over time. Five consistent clusters were identified at T1, T2, and T3. An additional two clusters were identified at 12 months, possibly due to less variation in distress levels. Weakness and fatigue were each associated with two, four, and five symptom clusters at T1, T2, and T3, respectively, potentially suggesting different causal mechanisms.
Stability is a necessary attribute of symptom clusters, but definitional clarification is required. We propose that a core set of concurrent symptoms identifies each symptom cluster, signifying a common cause. Additional related symptoms may be included over time. Further longitudinal investigation is required to identify symptom clusters and the underlying causes.
本二次数据分析的目的是调查辅助化疗开始后患者群体的症状管理随时间的变化情况。
对 219 名癌症门诊患者进行前瞻性纵向研究，在化疗开始后 1 个月（T1）、6 个月（T2）和 12 个月（T3）进行评估。采用临床医生改良的鹿特丹症状清单评估患者的 42 种躯体症状的困扰程度。在每个时间点进行探索性因子分析，确定症状群。从结构系数确定症状在聚类中的纳入。一个症状可能与多个聚类相关。从症状聚类组成和初始症状聚类中在后续时间复制的症状比例确定随时间的稳定性。
疲劳和白天嗜睡是随时间推移最常见的困扰症状。随时间推移，并发困扰症状的中位数约为 7 个。在 T1、T2 和 T3 时分别确定了 5 个一致的聚类。在 12 个月时还确定了另外 2 个聚类，这可能是由于困扰程度的变化较小。虚弱和疲劳分别与 T1、T2 和 T3 时的两个、四个和五个症状聚类相关，这可能表明存在不同的因果机制。
稳定性是症状聚类的必要属性，但需要明确定义。我们提出，一组同时存在的症状确定了每个症状聚类，代表一个共同的原因。随着时间的推移，可能会纳入更多相关的症状。需要进一步进行纵向研究以确定症状聚类和潜在原因。
