Chow Edward, James Jennifer, Barsevick Andrea, Hartsell William, Ratcliffe Sarah, Scarantino Charles, Ivker Robert, Suh John, Petersen Ivy, Konski Andre, Demas William, Bruner Deborah
Odette Cancer Centre, Toronto, Canada.
J Pain Manag. 2010;3(3):247-253.
To determine which of the previously proposed functional interference cluster models is most appropriate in patients with bone metastases and to determine if the cluster structures identified at baseline differed between responders and non-responders following palliative radiotherapy. METHODS: The confirmatory test data set consists of breast and prostate cancer patients treated with palliative radiotherapy between May 2003 to January 2007. Worst pain and functional interference scores were assessed using Brief Pain Inventory at baseline, 4, 8 and 12 weeks post radiation treatment. The baseline cluster structure of the confirmatory dataset was compared to each of the previously proposed baseline cluster models. Maximum likelihood CFA was used to account for possible correlation amongst the factor components. A MIMIC model was used to determine the invariance of the cluster models between responders and non-responders during follow-up. RESULTS: A total of 169 eligible patients were analysed. There were 91 male and 78 female patients with a median age of 68 years. The median KPS was 70. A single 8 Gy and 20 Gy in 5 fractions were used in 97% of all analysed patients. The RTOG model, in which relationships with others and sleep comprised the mood-related interference cluster and walking ability and normal work comprised the physical-interference cluster, provides the best fit for the sample data. The follow-up cluster structure is not similar across the responder groups indicating that cluster structures shift following radiation treatment, as evidenced by pain response. CONCLUSION: Although differing slightly this analysis confirms pretreatment symptom clusters exist for patients with bone metastases from breast or prostate cancer based on the RTOG 9714 data. This could help formulate symptom management interventions at initial diagnosis. Symptom clusters dissolve or change after treatment which may be a function of the treatment or population and requires further study.
确定之前提出的哪种功能干扰聚类模型最适用于骨转移患者，并确定姑息性放疗后，基线时确定的聚类结构在反应者和无反应者之间是否存在差异。方法：验证性测试数据集包括2003年5月至2007年1月接受姑息性放疗的乳腺癌和前列腺癌患者。在放疗前基线、放疗后4周、8周和12周，使用简明疼痛量表评估最严重疼痛和功能干扰评分。将验证性数据集的基线聚类结构与之前提出的每个基线聚类模型进行比较。使用最大似然验证性因子分析来考虑因子成分之间可能的相关性。使用多指标多原因模型来确定随访期间反应者和无反应者之间聚类模型的不变性。结果：共分析了169例符合条件的患者。其中男性91例，女性78例，中位年龄68岁。中位KPS为70。97%的分析患者采用单次8 Gy和分5次给予20 Gy的放疗方案。RTOG模型中，与他人的关系和睡眠构成情绪相关干扰聚类，步行能力和正常工作构成身体干扰聚类，该模型最适合样本数据。各反应者组的随访聚类结构不相似，表明放疗后聚类结构发生了变化，疼痛反应证明了这一点。结论：尽管略有不同，但该分析证实，基于RTOG 9714数据，乳腺癌或前列腺癌骨转移患者存在治疗前症状聚类。这有助于在初始诊断时制定症状管理干预措施。治疗后症状聚类溶解或改变，这可能是治疗或人群的作用，需要进一步研究。
