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晚期癌症的症状群。

Symptom clusters in advanced cancer.

机构信息

Getafe University Hospital, Getafe, Spain.

出版信息

J Pain Symptom Manage. 2011 Jul;42(1):24-31. doi: 10.1016/j.jpainsymman.2010.10.266. Epub 2011 Mar 12.

Abstract

CONTEXT

Patients with advanced cancer often experience multiple concurrent symptoms. Few studies have explored symptom clusters (SCs) in this population.

OBJECTIVES

The aim of the present study was to explore SCs in advanced cancer, evaluate the characteristics associated with various clusters, and determine their relationship to survival.

METHODS

This study included patients in the palliative care program of the Hospital Universitario La Paz from 2003 to 2005. The Edmonton Symptom Assessment System and a supplement including 13 other symptoms were used to detect symptoms. Principal component analysis was performed to determine symptom relationships and compare SCs with associated parameters.

RESULTS

In total, 406 patients were included, 61% men and 39% women. The median age was 66.4 (range 18-95). The most common primaries were gastrointestinal (35%), lung (25%), genitourinary (8%), breast (5%), and head and neck (5%) carcinomas. The following clusters were identified: confusion (cognitive impairment, agitation, urinary incontinence), neuropsychological (anxiety, depression, and insomnia), anorexia-cachexia (anorexia, weight loss, and tiredness), and gastrointestinal (nausea and vomiting). The presence of these SCs was influenced by primary cancer site, gender, age, and performance status. Survival was related to the number of SCs present in a given patient: zero SC, 52 days; one SC, 38 days; two SCs, 23 days; and three to four SCs, 19 days; P < 0.001.

CONCLUSION

Different SCs can be identified in patients with advanced cancer. These SCs are influenced by primary cancer site, gender, age, and Eastern Cooperative Oncology Group performance status, and they can have prognostic value.

摘要

背景

晚期癌症患者常同时出现多种症状。鲜有研究探讨此类患者的症状群。

目的

本研究旨在探讨晚期癌症患者的症状群,评估与各症状群相关的特征,并确定其与生存的关系。

方法

本研究纳入了 2003 年至 2005 年期间在拉巴斯大学医院姑息治疗项目中的患者。采用埃德蒙顿症状评估系统(Edmonton Symptom Assessment System)及其包含 13 种其他症状的补充内容来检测症状。采用主成分分析(principal component analysis)确定症状之间的关系并比较症状群与相关参数。

结果

共纳入 406 例患者,其中 61%为男性,39%为女性。中位年龄为 66.4 岁(范围 18-95 岁)。最常见的原发肿瘤为胃肠道(35%)、肺(25%)、泌尿生殖系统(8%)、乳腺(5%)和头颈部(5%)癌。确定了以下症状群:意识混乱(认知障碍、激越、尿失禁)、神经心理(焦虑、抑郁和失眠)、厌食-恶病质(厌食、体重减轻和乏力)和胃肠道(恶心和呕吐)。这些症状群的出现受到原发肿瘤部位、性别、年龄和体力状况的影响。生存与患者中存在的症状群数量相关:无症状群的患者中位生存时间为 52 天,有 1 个症状群的患者为 38 天,有 2 个症状群的患者为 23 天,有 3-4 个症状群的患者为 19 天;P<0.001。

结论

晚期癌症患者可识别出不同的症状群。这些症状群受到原发肿瘤部位、性别、年龄和东部肿瘤协作组体力状况的影响,具有预后价值。

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