Mazor Melissa, Cataldo Janine K, Lee Kathryn, Dhruva Anand, Cooper Bruce, Paul Steven M, Topp Kimberly, Smoot Betty J, Dunn Laura B, Levine Jon D, Conley Yvette P, Miaskowski Christine
School of Nursing, University of California, San Francisco, CA, United States.
School of Medicine, United States.
Eur J Oncol Nurs. 2018 Feb;32:63-72. doi: 10.1016/j.ejon.2017.12.003. Epub 2017 Dec 19.
Given the inter-relatedness among symptoms, research efforts are focused on an evaluation of symptom clusters. The purposes of this study were to evaluate for differences in the number and types of menopausal-related symptom clusters assessed prior to and at 12-months after surgery using ratings of occurrence and severity and to evaluate for changes in these symptom clusters over time.
Prior to and at 12 months after surgery, 392 women with breast cancer completed the Menopausal Symptoms Scale. Exploratory factor analyses were used to identify the symptom clusters.
Of the 392 women evaluated, the mean number of symptoms (out of 46) was 13.2 (±8.5) at enrollment and 10.9 (±8.2) at 12 months after surgery. Using occurrence and severity, three symptom clusters were identified prior to surgery. Five symptom clusters were identified at 12 months following surgery. Two symptom clusters (i.e., pain/discomfort and hormonal) were relatively stable across both dimensions and time points. Two symptom clusters were relatively stable across both dimensions either prior to surgery (i.e., sleep/psychological/cognitive) or at 12 months after surgery (i.e., sleep). The other four clusters (i.e., irritability, psychological/cognitive, cognitive, psychological) were identified at one time point using a single dimension.
While some menopausal-related symptom clusters were consistent across time and dimensions, the majority of symptoms clustered together differently depending on whether they were evaluated prior to or at 12 months after breast cancer surgery. An increased understanding of how symptom clusters change over time may assist clinicians to focus their symptom assessments and management strategies.
鉴于症状之间的相互关联性，研究工作聚焦于对症状群的评估。本研究的目的是使用发生率和严重程度评分来评估手术前和术后12个月时评估的绝经相关症状群在数量和类型上的差异，并评估这些症状群随时间的变化。
在手术前和术后12个月，392名乳腺癌女性完成了绝经症状量表。采用探索性因素分析来识别症状群。
在评估的392名女性中，入组时（共46种症状）症状的平均数量为13.2（±8.5），术后12个月时为10.9（±8.2）。根据发生率和严重程度，手术前识别出三个症状群。术后12个月时识别出五个症状群。两个症状群（即疼痛/不适和激素相关）在两个维度和时间点上相对稳定。两个症状群在手术前（即睡眠/心理/认知）或术后12个月（即睡眠）在两个维度上相对稳定。其他四个症状群（即易怒、心理/认知、认知、心理）在一个时间点使用单一维度识别出来。
虽然一些绝经相关症状群在时间和维度上是一致的，但大多数症状根据是在乳腺癌手术前还是术后12个月进行评估而聚集方式不同。对症状群如何随时间变化的进一步了解可能有助于临床医生集中他们的症状评估和管理策略。
