Rha Sun Young, Lee Jiyeon
College of Medicine and Songdang Institute for Cancer Research, Yonsei University, Seoul, South Korea.
Yonsei Cancer Center, Seoul, South Korea.
Support Care Cancer. 2017 May;25(5):1519-1527. doi: 10.1007/s00520-016-3545-z. Epub 2016 Dec 28.
Symptom management in patients undergoing palliative chemotherapy is challenging, as patients may suffer from cancer symptoms as well as symptoms related to chemotherapy. Symptom clusters are interrelated symptoms occurring simultaneously that exert a negative impact on survival. Identification of symptom clusters and effective symptom management for patients receiving palliative chemotherapy is crucial.
The purpose of this study was to identify symptom clusters among cancer patients undergoing palliative chemotherapy and examine the relationship between symptom clusters and functioning and quality of life (QOL) in these patients.
A total of 300 patients undergoing palliative chemotherapy participated in the study. Symptom experience during previous palliative chemotherapy was evaluated using a symptom questionnaire including 20 symptoms. The European Organization for Research and Treatment of Cancer Quality of Life-C30 was used to measure patients' symptoms, functioning and QOL. Factor and hierarchical cluster analyses were performed to identify symptom clusters. Structural equation modeling was used to identify relationships between symptom clusters, functioning and QOL in patients.
Four symptoms clusters including 14 symptoms were identified of the 20 symptoms experienced by patients undergoing palliative chemotherapy. The emotional cluster had negative influence on role and social functioning. The nausea and vomiting/appetite/taste change cluster had a negative impact on role functioning. The fatigue/cognitive and other cluster (dyspnea, pain, constipation, neuropathy, and sleep disturbance) negatively influenced physical functioning. Among the functioning subscales, only role functioning had a direct influence on QOL. Indirect relationships between symptom clusters and QOL were mediated by physical and role functioning. The final model, which consisted of four symptom clusters and three functioning subscales, accounted for 23.3% of the variance in the QOL.
Four symptom clusters occurring during palliative chemotherapy demonstrated negative influences on functioning and QOL. Differential contributions of symptom clusters to functioning were identified that eventually contributed to QOL through role functioning. The identified symptom clusters and their relationships with functioning and QOL may help guide approaches to symptom management. Implementation of interventions targeting symptom clusters would contribute to improving functioning and QOL in patients.
姑息化疗患者的症状管理具有挑战性，因为患者可能会遭受癌症症状以及与化疗相关的症状。症状群是同时出现的相互关联的症状，对生存产生负面影响。识别症状群并对接受姑息化疗的患者进行有效的症状管理至关重要。
本研究的目的是识别接受姑息化疗的癌症患者中的症状群，并研究这些症状群与这些患者的功能及生活质量（QOL）之间的关系。
共有300名接受姑息化疗的患者参与了本研究。使用包括20种症状的症状问卷评估先前姑息化疗期间的症状体验。欧洲癌症研究与治疗组织生活质量问卷C30用于测量患者的症状、功能及生活质量。进行因子分析和层次聚类分析以识别症状群。采用结构方程模型来识别患者症状群、功能及生活质量之间的关系。
在接受姑息化疗的患者经历的20种症状中，识别出包括14种症状的四个症状群。情绪症状群对角色和社会功能有负面影响。恶心呕吐/食欲/味觉改变症状群对角色功能有负面影响。疲劳/认知及其他症状群（呼吸困难、疼痛、便秘、神经病变和睡眠障碍）对身体功能有负面影响。在功能子量表中，只有角色功能对生活质量有直接影响。症状群与生活质量之间的间接关系由身体功能和角色功能介导。由四个症状群和三个功能子量表组成的最终模型解释了生活质量变异的23.3%。
姑息化疗期间出现的四个症状群对功能和生活质量有负面影响。确定了症状群对功能的不同影响，这些影响最终通过角色功能对生活质量产生作用。识别出的症状群及其与功能和生活质量的关系可能有助于指导症状管理方法。实施针对症状群的干预措施将有助于改善患者的功能和生活质量。
