Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
Health Outcomes & Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
Cancer Med. 2017 Sep;6(9):2034-2041. doi: 10.1002/cam4.1125. Epub 2017 Aug 4.
Patient-reported outcomes regarding symptom burden may provide valuable information in addition to physician assessment. Systematic collection of patient-reported outcomes may be an important metric to identify unmet needs and improve quality of patient care. To understand common symptoms of patients seen in radiation oncology clinic, we examined the prospectively collected modified Edmonton Symptom Assessment Scale (ESAS-r) data to explore symptom clusters. Our clinic established use of a modified Edmonton Symptom Assessment Scale in August 2015. All outpatients presenting for radiation oncology services completed the form at each clinic visit. Symptom clusters are defined by two or more symptoms that are interrelated and occur simultaneously with a high degree of predictability. A sample of 916 de-identified surveys was assessed statistically using principal component analysis (PCA) with varimax rotation to determine independent clustering between the symptoms queried. We found four major clusters of symptoms: Tiredness (tired, drowsiness; PC1), Loss of Appetite (nausea, lack of appetite; PC2), Low Well-Being (overall & spiritual well-being; PC3), and Depression (depression, anxiety; PC4). These accounted for 46%, 9.2%, 7.6%, and 7% of total variance, respectively. Internal consistency using Cronbach's alpha was 0.87, 0.7, 0.82, and 0.87, respectively. The most frequent write-in item was itchiness, present in 24% of the 148 patients responding. Assessment of patients seen in a large radiation oncology clinic revealed several symptom clusters. {Tiredness and drowsiness} represents a major symptom cluster. Itchiness may be underrecognized.
患者报告的结局（PROs）可能除了医生评估外，还提供有价值的信息。系统收集患者报告的结局可能是识别未满足需求和改善患者护理质量的重要指标。为了了解在放射肿瘤学诊所就诊的患者的常见症状，我们检查了前瞻性收集的改良 Edmonton 症状评估量表（ESAS-r）数据，以探讨症状群。我们的诊所于 2015 年 8 月开始使用改良 Edmonton 症状评估量表。所有因放射肿瘤学服务就诊的门诊患者在每次就诊时都完成该表格。症状群是指两个或两个以上相互关联且同时发生的症状，具有高度可预测性。使用主成分分析（PCA）和方差极大旋转对 916 份经过去识别的调查样本进行了统计学评估，以确定所查询症状之间的独立聚类。我们发现了四个主要的症状群：疲倦（疲倦、昏昏欲睡；PC1）、食欲不振（恶心、缺乏食欲；PC2）、低幸福感（整体和精神幸福感；PC3）和抑郁（抑郁、焦虑；PC4）。这些分别占总方差的 46%、9.2%、7.6%和 7%。使用 Cronbach's alpha 的内部一致性分别为 0.87、0.7、0.82 和 0.87。最常见的写入项目是瘙痒，在 148 名有反应的患者中有 24%出现。对大型放射肿瘤学诊所就诊患者的评估显示出几个症状群。{疲倦和昏昏欲睡}代表一个主要的症状群。瘙痒可能未被充分认识。
