School of Medicine, University of Pittsburgh, 5115 Centre Ave, Suite 140, Pittsburgh, PA, USA,
Support Care Cancer. 2014 Jan;22(1):173-80. doi: 10.1007/s00520-013-1968-3. Epub 2013 Sep 10.
Pain, fatigue, dyspnea, and distress are commonly reported cancer-related symptoms, but few studies have examined the effects of multiple concurrent symptoms in longer-term cancer survivors. We examined the impact of varying degrees of symptom burden on health-related quality of life (HRQOL) and performance status in surgically treated non-small cell lung cancer (NSCLC) survivors.
A sample of 183 NSCLC survivors 1-6 years post-surgical treatment completed questionnaires assessing five specific symptoms (pain, fatigue, dyspnea, depression, and anxiety), HRQOL, and performance status. The number of concurrent clinically significant symptoms was calculated as an indicator of symptom burden.
Most survivors (79.8 %) had some degree of symptom burden, with 30.6 % reporting one clinically significant symptom, 27.9 % reporting two symptoms, and 21.3 % reporting three or more symptoms. Physical HRQOL significantly decreased as the degree of symptom burden increased, but mental HRQOL was only significantly decreased in those with three or more symptoms. Receiver-operating characteristic (ROC) curves showed that having multiple concurrent symptoms (two or more) was most likely associated with limitations in functioning (area under a ROC curve = 0.75, sensitivity = 0.81, specificity = 0.54).
Two or more clinically significant symptoms are identified as the "tipping point" for showing adverse effects on HRQOL and functioning. This highlights the need for incorporating multiple-symptom assessment into routine clinical practice. Comprehensive symptom management remains an important target of intervention for improved post-treatment HRQOL and functioning among lung cancer survivors.
疼痛、疲劳、呼吸困难和苦恼是常见的癌症相关症状，但很少有研究探讨长期癌症幸存者中多种同时存在的症状的影响。我们研究了不同程度的症状负担对手术治疗的非小细胞肺癌（NSCLC）幸存者的健康相关生活质量（HRQOL）和表现状态的影响。
一组 183 名 NSCLC 幸存者在手术后 1-6 年完成了问卷，评估了五种特定的症状（疼痛、疲劳、呼吸困难、抑郁和焦虑）、HRQOL 和表现状态。同时存在的临床显著症状的数量被计算为症状负担的指标。
大多数幸存者（79.8%）有一定程度的症状负担，30.6%报告有一个临床显著的症状，27.9%报告有两个症状，21.3%报告有三个或更多症状。随着症状负担程度的增加，身体 HRQOL 显著下降，但只有在有三个或更多症状的情况下，心理 HRQOL 才显著下降。受试者工作特征（ROC）曲线显示，同时存在多种（两个或更多）症状最有可能与功能受限相关（ROC 曲线下面积=0.75，灵敏度=0.81，特异性=0.54）。
两个或更多的临床显著症状被确定为表现出对 HRQOL 和功能产生不利影响的“临界点”。这强调了需要将多症状评估纳入常规临床实践。全面的症状管理仍然是提高肺癌幸存者治疗后 HRQOL 和功能的重要干预目标。
