Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Pain Symptom Manage. 2011 Aug;42(2):213-21. doi: 10.1016/j.jpainsymman.2010.11.005. Epub 2011 Mar 12.
Aggregates of concurrent symptoms, known as symptom clusters (SxCls), are reported to have prognostic capabilities beyond that of single symptom alone. A SxCl of fatigue, dyspnea, and cough has been delineated in a number of lung cancer cohorts.
The objective of this study was to characterize this SxCl's predictive value for important clinical outcomes relative to that of its component symptoms.
Analysis of an eight-year prospective cohort study that assessed 2405 patients with LC for self-reported symptom burden, employment status, and physical activity with the Baecke questionnaire, and overall quality of life (QoL) was undertaken using nested Cox and generalized linear multilevel mixed models. Models were adjusted for longitudinally assessed demographics, cancer progression and tobacco use, and cancer progression.
The SxCl, as well as its individual symptoms and symptom pairs, were all negatively associated with survival in Cox models of Years 1-3 after diagnosis. Only in Year 3 did the SxCl prognosticate survival (and then marginally) better than single symptoms or symptom pairs; fatigue was strongly associated (P≤0.0005) with survival at all time points. The SxCl was not predictive of participants' employment status, physical activity, or QoL, whereas the presence of fatigue, dyspnea, or their combination was strongly associated with these outcomes.
Fatigue and dyspnea are strongly associated with poor clinical outcomes in LC survivors; however, a SxCl that includes fatigue, dyspnea, and cough as part as its components does not appear to significantly improve their predictive capability.
同时出现的症状集合，称为症状群（SxCls），据报道其预后能力超出了单个症状的能力。在许多肺癌队列中已经描述了疲劳、呼吸困难和咳嗽的 SxCl。
本研究的目的是描述该 SxCl 相对于其组成症状对重要临床结局的预测价值。
分析了一项为期八年的前瞻性队列研究，该研究评估了 2405 名患有 LC 的患者的自我报告症状负担、就业状况和体力活动情况，使用 Baecke 问卷评估整体生活质量（QoL），使用嵌套 Cox 和广义线性多层混合模型进行分析。模型根据纵向评估的人口统计学、癌症进展和吸烟情况以及癌症进展进行了调整。
在诊断后 1-3 年的 Cox 模型中，SxCl 及其各个症状和症状对均与生存呈负相关。只有在第 3 年，SxCl 才对生存具有更好的预测作用（但仅略为显著），比单个症状或症状对更好；在所有时间点，疲劳都与生存强烈相关（P≤0.0005）。SxCl 不能预测参与者的就业状况、体力活动或 QoL，而疲劳、呼吸困难或它们的组合的存在与这些结果强烈相关。
在 LC 幸存者中，疲劳和呼吸困难与不良临床结局密切相关；然而，包含疲劳、呼吸困难和咳嗽作为其组成部分的 SxCl 似乎并没有显著提高其预测能力。
