Kim Hee-Ju, Barsevick Andrea M, Beck Susan L, Dudley William
College of Nursing, Catholic University of Korea, Seoul.
Oncol Nurs Forum. 2012 Jan;39(1):E20-30. doi: 10.1188/12.ONF.E20-E30.
PURPOSE/OBJECTIVES: To investigate clinical subgroups using an empirically identified psychoneurologic symptom cluster (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) and to examine the differences among subgroups in the selected demographic and clinical variables, as well as in patient outcome (i.e., functional performance).
Secondary analysis.
A university health science center in Salt Lake City, UT, and a National Cancer Institute-designated comprehensive cancer center in Philadelphia, PA.
282 patients with breast cancer undergoing chemotherapy or radiotherapy.
Cluster analyses were conducted to identify subgroups. Multinomial logistic regression and one-way analyses of variance were used to examine the differences among subgroups.
Depressed mood, cognitive disturbance, fatigue, insomnia, pain, and functional performance.
Patients were classified into four distinct subgroups based on their symptom cluster experience: all low symptom, high fatigue and low pain, high pain, and all high symptom. Such patient classification patterns were consistent across the treatment trajectory, although group memberships were inconsistent. After initiating treatment, two additional subgroups emerged: high depressed mood and cognitive disturbance, and high fatigue and insomnia. Subgroups differed in physical performance status at baseline, symptom burden, and treatment modality in a relatively consistent pattern across time points. Patients in the all-high-symptom subgroup experienced the most serious limitations in activities across all time points.
Patient subgroups exist that share the unique experience of psychoneurologic symptoms.
Findings are useful to determine who needs more intensive symptom management during cancer treatment. Future studies should examine whether specific symptom management strategies are more efficient for certain subgroups.
目的/目标：使用经验证的精神神经症状群（情绪低落、认知障碍、疲劳、失眠和疼痛）来研究临床亚组，并检验亚组在选定的人口统计学和临床变量以及患者结局（即功能表现）方面的差异。
二次分析。
犹他州盐湖城的一所大学健康科学中心以及宾夕法尼亚州费城的一家美国国立癌症研究所指定的综合癌症中心。
282例正在接受化疗或放疗的乳腺癌患者。
进行聚类分析以确定亚组。使用多项逻辑回归和单因素方差分析来检验亚组之间的差异。
情绪低落、认知障碍、疲劳、失眠、疼痛和功能表现。
根据患者的症状群经历，将其分为四个不同的亚组：所有症状均低、高疲劳和低疼痛、高疼痛以及所有症状均高。尽管组内成员不一致，但这种患者分类模式在整个治疗过程中是一致的。开始治疗后，又出现了另外两个亚组：高情绪低落和认知障碍，以及高疲劳和失眠。亚组在基线时的身体表现状态、症状负担和治疗方式方面存在差异，且在各个时间点的模式相对一致。所有症状均高的亚组患者在所有时间点的活动中都经历了最严重的限制。
存在具有精神神经症状独特经历的患者亚组。
研究结果有助于确定在癌症治疗期间谁需要更强化的症状管理。未来的研究应检验特定的症状管理策略对某些亚组是否更有效。
