Department of Solid Tumor Oncology, Section of Palliative Medicine and Supportive Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA The Harry R. Horvitz Center for Palliative Medicine, Cleveland, Ohio, USA.
Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA.
BMJ Support Palliat Care. 2016 Jun;6(2):210-8. doi: 10.1136/bmjspcare-2015-000896. Epub 2016 Jan 14.
'Depression, fatigue, pain' (DFP) and 'depression, insomnia, pain' (DIP) symptom clusters (SCs) have been proposed in cancer. These symptoms are common and co-occur, that is, they constitute clusters of patients rather than symptoms.
The following research questions were addressed: (1) What is the frequency of co-occurrence of two symptom groups (DFP and DIP) in advanced cancer? (2) What is the degree of symptom item association within each symptom group? (3) Were either of these symptom trios associated with prognosis?
We reanalysed a symptom data set of 1000 patients with advanced cancer. We identified the frequency of co-occurrence of two symptom groups: DFP and DIP, using both prevalence and severity data. The symptom associations were tested by χ(2) and Spearman correlations. We also determined whether either of these symptom trios were associated with a major biological outcome, that is, survival by time-to-event analyses.
(1) Although DFP and DIP co-occured in about a quarter of the population, they were not SCs, but rather patient clusters. (2) Many persons had only one symptom from any symptom pair, and correlation coefficients were low for all symptom pairs. (3) Neither DFP nor DIP were associated with survival.
Neither DFP nor DIP symptom item combinations constituted a specific cancer SC contrary to prior reports. DFP co-occurred in 27% and DIP in only 20%. Additionally, these symptom combinations were not associated with a biological outcome, that is, poor prognosis. Patient subgroups identified by shared symptom experiences alone do not identify SCs.
“抑郁、疲劳、疼痛”（DFP）和“抑郁、失眠、疼痛”（DIP）症状群已在癌症中提出。这些症状很常见且同时存在，也就是说，它们构成了患者群体而非症状。
本研究旨在解决以下问题：（1）在晚期癌症中，两个症状群（DFP 和 DIP）同时出现的频率是多少？（2）每个症状群中症状项目之间的关联程度如何？（3）这些症状三联征中的任何一种是否与预后相关？
我们重新分析了 1000 例晚期癌症患者的症状数据集。我们使用患病率和严重程度数据来识别两个症状群（DFP 和 DIP）同时出现的频率。通过卡方检验和斯皮尔曼相关系数来检验症状关联。我们还通过生存时间分析来确定这两个症状三联征中的任何一个是否与主要生物学结局（即生存）相关。
（1）虽然 DFP 和 DIP 在大约四分之一的人群中同时出现，但它们不是症状群，而是患者群体。（2）许多人只有一个症状来自任何一对症状，而且所有症状对的相关系数都较低。（3）DFP 和 DIP 均与生存无关。
与之前的报告相反，DFP 和 DIP 症状项目组合并未构成特定的癌症症状群。DFP 同时出现的比例为 27%，而 DIP 仅为 20%。此外，这些症状组合与生物学结局（即预后不良）无关。仅通过共同的症状体验识别的患者亚组并不能识别症状群。
