School of Psychology, Université Laval.
Health Psychol. 2014 Sep;33(9):1012-22. doi: 10.1037/a0033497. Epub 2013 Aug 26.
Cross-sectional studies in cancer have revealed the presence of clusters of symptoms (e.g., gastrointestinal, emotional) and of patients (e.g., low or high levels of symptoms), but not much is known about their longitudinal evolution. In addition, their relationships with medical factors (e.g., cancer sites, treatments) and possible consequences (e.g., functioning) have yet to be established. This prospective study assessed the presence of clusters of patients in 828 participants scheduled to undergo surgery for cancer.
The patients completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, the Multidimensional Fatigue Inventory, the EORTC Quality-of-Life-Questionnaire-C30, and a physical symptoms questionnaire at baseline and 2, 6, 10, 14, and 18 months later.
Cluster analyses identified between five and eight clusters of patients depending on the time point. The "Low Symptoms" cluster was the most common (24.8 to 35.0% of the sample), whereas one with predominant nausea and vomiting symptoms was among the least common (1.6 to 3.5%). Significant differences were found between cancer sites, treatment regimens, quality of life, and functioning scores. Prostate cancer patients and those treated by surgery only were overrepresented in the "Low" cluster, whereas breast cancer patients were more likely to fall into the "Moderate - Night Sweats" cluster. Clusters with more severe psychological symptoms were associated with lower functioning and quality of life.
This study revealed distinct clusters of patients that varied in number during cancer treatments. Findings also identified some clusters associated with lower quality of life and functioning, which should receive more clinical attention.
癌症的横断面研究揭示了存在症状（如胃肠道、情绪）和患者（如低水平或高水平的症状）聚类，但对其纵向演变知之甚少。此外，它们与医学因素（如癌症部位、治疗）和可能的后果（如功能）之间的关系尚未确定。本前瞻性研究评估了 828 名计划接受癌症手术的患者中患者聚类的存在情况。
患者在基线时和 2、6、10、14 和 18 个月后完成了医院焦虑和抑郁量表、失眠严重程度指数、多维疲劳量表、EORTC 生活质量问卷-30 和身体症状问卷。
聚类分析根据时间点确定了 5 到 8 个患者聚类。“低症状”聚类是最常见的（占样本的 24.8%至 35.0%），而以恶心和呕吐症状为主的聚类则是最不常见的（占 1.6%至 3.5%）。癌症部位、治疗方案、生活质量和功能评分之间存在显著差异。前列腺癌患者和仅接受手术治疗的患者在“低”聚类中所占比例较高，而乳腺癌患者更有可能进入“中度-夜间出汗”聚类。具有更严重心理症状的聚类与较低的功能和生活质量相关。
本研究揭示了在癌症治疗过程中数量不同的患者聚类。研究结果还确定了一些与较低生活质量和功能相关的聚类，这些聚类应引起更多的临床关注。
