Kenne Sarenmalm Elisabeth, Browall Maria, Gaston-Johansson Fannie
Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Johns Hopkins University, Baltimore, Maryland, USA.
Johns Hopkins University, Baltimore, Maryland, USA; School of Life Sciences, University of Skövde, Skövde, Sweden; Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
J Pain Symptom Manage. 2014 Apr;47(4):731-41. doi: 10.1016/j.jpainsymman.2013.05.012. Epub 2013 Aug 3.
Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters.
To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer.
In this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups.
Three clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with "change in the way food tastes" as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden.
This study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients.
尽管人们对癌症症状群的兴趣日益浓厚，但对症状负担群的了解却较少。
探讨乳腺癌患者随时间推移出现的负担性症状群、对健康状况和生活质量的影响以及应对能力。
在这项纵向研究中，206名患者在原发性或复发性乳腺癌诊断时以及在1个月、3个月和6个月随访时完成了纪念症状评估量表、欧洲癌症研究与治疗组织生活质量问卷和连贯感量表。
确定了三类负担性症状：情绪症状负担、胃肠道症状负担和不适症状负担。最具负担性的是情绪症状，核心或定义症状为担忧、悲伤和紧张。随着时间的推移，其他症状加剧了情绪症状负担。以“食物味道改变”为核心症状的胃肠道症状负担更常与化疗相关。不适症状负担随时间变化不太稳定，可解释为激素治疗的短期和长期副作用。在这些症状群中，只有情绪症状负担群显著降低了健康状况和生活质量。应对能力较低的患者症状负担水平较高。
本研究提供了随时间推移症状负担群的相关见解。临床肿瘤学中一种具有挑战性的症状管理方法是针对症状群的负担，并认识到需要进行个性化设计的干预措施以减轻癌症患者的症状负担。
