Kim Hee-Ju, McDermott Paul A, Barsevick Andrea M
Author Affiliations: College of Nursing, Catholic University of Korea, Seoul, Republic of Korea (Dr Kim); Graduate School of Education, University of Pennsylvania, Philadelphia (Dr McDermott); and Department of Medical Oncology, Thomas Jefferson University (Dr Barsevick), Philadelphia, Pennsylvania.
Cancer Nurs. 2014 Mar-Apr;37(2):88-96. doi: 10.1097/NCC.0b013e31828293e0.
Comparing subgroups with different patterns of change in symptom intensity would assist in sorting out individuals at risk for more severe symptoms and worse functional outcomes.
The objectives of this study were to identify and compare subgroups of breast cancer patients with different patterns of change in a psychoneurological symptom cluster intensity across the treatment trajectory.
This secondary analysis used the data from 160 breast cancer patients undergoing chemotherapy or radiation treatment. Psychoneurological symptom cluster intensity was a composite score of 5 symptoms (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) in a psychoneurological cluster at each of 3 time points (ie, at baseline and at 2 follow-ups after chemotherapy or radiation treatment).
Five distinct subgroups representing different patterns of psychoneurological symptom cluster intensity during breast cancer treatment were identified: the gradually increasing pattern subgroup (group 1), the constantly low pattern subgroup (group 2), the start low with dramatic increase and decrease pattern subgroup (group 3), the constantly high pattern subgroup (group 4), and the start high with dramatic decrease and leveling pattern subgroup (group 5). Patients without previous cancer treatment experience, with higher level of education, treated with chemotherapy, and/or with more limitations at the baseline were more likely to follow the pattern group 4. Patients in group 4 had the most serious functional limitations measured at the second follow-up time point.
The results suggest the need to evaluate interventions for specific subgroups and to examine the causal mechanisms underlying a psychoneurological symptom cluster.
Clinicians should consider these diverse symptom experiences for assessment/management.
比较症状强度变化模式不同的亚组，将有助于找出有出现更严重症状和更差功能结局风险的个体。
本研究的目的是识别和比较乳腺癌患者在整个治疗过程中心理神经症状群强度变化模式不同的亚组。
这项二次分析使用了160名接受化疗或放疗的乳腺癌患者的数据。心理神经症状群强度是在3个时间点（即基线时以及化疗或放疗后的2次随访时），心理神经症状群中5种症状（情绪低落、认知障碍、疲劳、失眠和疼痛）的综合评分。
识别出了5个不同的亚组，它们代表了乳腺癌治疗期间心理神经症状群强度的不同模式：逐渐增加模式亚组（第1组）、持续低水平模式亚组（第2组）、开始时低水平随后急剧上升和下降模式亚组（第3组）、持续高水平模式亚组（第4组）以及开始时高水平随后急剧下降并趋于平稳模式亚组（第5组）。既往无癌症治疗经历、教育水平较高、接受化疗和/或基线时功能受限更多的患者更有可能属于第4组模式。在第二次随访时间点测量时，第4组患者的功能受限最为严重。
结果表明需要针对特定亚组评估干预措施，并研究心理神经症状群背后的因果机制。
临床医生在评估/管理时应考虑这些不同的症状经历。
