Nursing School, Second Military Medical University, Room 314, No.800 Xiangyin Road, Yangpu District, Shanghai, 200433, People's Republic of China.
Support Care Cancer. 2013 Feb;21(2):475-83. doi: 10.1007/s00520-012-1541-5. Epub 2012 Jul 20.
The aim of this study was to investigate the symptom and symptom clusters of patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE), and to discuss the relationship between symptoms, symptom clusters, and symptom interference.
Patients with HCC who received TACE were asked to rate their symptoms using the M. D. Anderson Symptom Inventory and the symptom checklist particularly for HCC. To determine the interrelationships among symptoms and identify the symptom clusters, a principal component analysis with varimax rotation was carried out on the symptom items. Spearman correlation analysis was done to assess the relationship between symptom clusters and symptom interference.
A total of 155 patients finished the whole procedure between November 2010 and May 2011. Before TACE, the five most severe symptoms, ranked in order, were fatigue (3.40 ± 2.26), distress (3.35 ± 2.60), sadness (3.01 ± 2.66), sleep disturbance (2.63 ± 2.57), and lack of appetite (2.26 ± 2.38). After TACE, fatigue (4.88 ± 2.31) was the most serious symptom, followed by sleep disturbance (4.80 ± 2.25), distress (4.59 ± 2.32), sadness (4.45 ± 2.16), lack of appetite (4.25 ± 2.51). Two symptom clusters were found before TACE: psychological symptom cluster and sickness symptom cluster. Two new symptom clusters were found after TACE: upper gastrointestinal symptom cluster and liver function impairment symptom cluster, with the two original symptom clusters remained relatively stable. The highest symptom interference items pre- and post-TACE were work and enjoyment of life, followed by mood. The symptoms of distress, sadness, fatigue, sleep disturbance, and lack of appetite were all significantly associated with the total interference (r = 0.443-0.615, p < 0.01 or p < 0.05). Symptom clusters were significantly correlated with the total symptom interference before and after TACE (r = 0.176-0.638, p < 0.01 or p < 0.05).
Psychological symptom cluster and sickness symptom cluster are common for HCC patients before and after TACE. Liver function impairment and upper gastrointestinal symptom clusters are directly related to TACE treatment. Both the symptoms and symptom clusters have significant interference on the daily life of HCC patients undergoing TACE. However, more work is needed to further clarify the symptom clusters associated with TACE and to test the effectiveness of TACE in easing symptoms and improving quality of life of HCC patients.
本研究旨在探讨肝癌患者经肝动脉化疗栓塞术（TACE）前后的症状和症状群，并探讨症状、症状群与症状干扰之间的关系。
对 2010 年 11 月至 2011 年 5 月接受 TACE 的肝癌患者使用 M. D.安德森症状评估量表和肝癌症状检查表进行症状评估。采用主成分分析和最大方差旋转法对症状条目进行分析，以确定症状之间的相互关系并识别症状群。采用 Spearman 相关分析评估症状群与症状干扰之间的关系。
共有 155 例患者完成了整个研究过程。TACE 前，按严重程度排序的前 5 个最严重症状依次为：乏力（3.40±2.26）、苦恼（3.35±2.60）、悲伤（3.01±2.66）、睡眠障碍（2.63±2.57）和食欲不振（2.26±2.38）。TACE 后，乏力（4.88±2.31）是最严重的症状，其次是睡眠障碍（4.80±2.25）、苦恼（4.59±2.32）、悲伤（4.45±2.16）和食欲不振（4.25±2.51）。TACE 前发现了两个症状群：心理症状群和疾病症状群。TACE 后发现了两个新的症状群：上消化道症状群和肝功能损害症状群，两个原始症状群相对稳定。TACE 前后症状干扰最高的项目是工作和生活享受，其次是情绪。苦恼、悲伤、乏力、睡眠障碍和食欲不振与总干扰均显著相关（r=0.443-0.615，p<0.01 或 p<0.05）。TACE 前后症状群与总症状干扰显著相关（r=0.176-0.638，p<0.01 或 p<0.05）。
肝癌患者 TACE 前后常见心理症状群和疾病症状群。肝功能损害和上消化道症状群与 TACE 治疗直接相关。症状和症状群对接受 TACE 的肝癌患者的日常生活有显著干扰。然而，需要进一步研究 TACE 相关的症状群，并验证 TACE 缓解症状和提高肝癌患者生活质量的有效性。
