Knoerl Robert, Chornoby Zach, Smith Ellen M L
Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts.
University of Michigan School of Nursing, Ann Arbor, Michigan.
Pain Manag Nurs. 2018 Aug;19(4):354-365. doi: 10.1016/j.pmn.2018.01.001.
Patients undergoing treatment for cancer commonly experience symptoms such as sleep disturbance, pain, anxiety, depression, and low energy/fatigue (SPADE), subsequently altering physical function and complicating effective symptom management. However, little is known about the frequency, severity, and clustering of SPADE symptoms in individuals with chronic painful chemotherapy-induced peripheral neuropathy (CIPN). Aims/Design: The purpose of this cross-sectional, secondary analysis was to describe the frequency, severity, and clustering of SPADE symptoms and their association with physical function in individuals with chronic painful CIPN. Participants/Subjects: Sixty individuals with chronic painful CIPN were recruited from five academic and community oncology outpatient center to participate in a randomized controlled pilot trial designed to test the efficacy of a cognitive behavioral therapy-based pain management program.
Participants completed the 0-10 Average CIPN Pain Numerical Rating Scale and Patient-Reported Outcome Measurement Information System measures for sleep-related impairment, anxiety, depression, fatigue, and pain interference via tablet before being randomly assigned to a study arm. The frequency, severity, and clustering of SPADE symptoms were calculated via descriptive statistics and Partitioning Around Medoids cluster analysis. Spearman rank correlation was performed to determine the association between number of SPADE symptoms and pain interference severity.
Participants (n = 59) experienced numerous SPADE symptoms. 66.1% of participants experienced at least two SPADE symptoms concurrently. The cluster analysis revealed high (n = 36) and low (n = 23) severity subgroups. There was a moderate correlation (r = 0.48) between the number of SPADE symptoms and pain interference severity. Determining the clustering of SPADE symptoms in individuals with chronic painful CIPN may lead to targeted multifaceted interventions to improve physical function.
接受癌症治疗的患者通常会出现睡眠障碍、疼痛、焦虑、抑郁以及精力不足/疲劳等症状（SPADE），这些症状随后会改变身体功能，并使有效的症状管理变得复杂。然而，对于慢性疼痛性化疗引起的周围神经病变（CIPN）患者中SPADE症状的频率、严重程度和聚类情况知之甚少。目的/设计：本横断面二次分析的目的是描述慢性疼痛性CIPN患者中SPADE症状的频率、严重程度和聚类情况，以及它们与身体功能的关联。参与者/受试者：从五个学术和社区肿瘤门诊中心招募了60名患有慢性疼痛性CIPN的个体，以参与一项随机对照试验，该试验旨在测试基于认知行为疗法的疼痛管理计划的疗效。
参与者在被随机分配到研究组之前，通过平板电脑完成0至10的CIPN平均疼痛数字评分量表以及患者报告结局测量信息系统中关于睡眠相关损害、焦虑、抑郁、疲劳和疼痛干扰的测量。通过描述性统计和围绕中心点划分聚类分析来计算SPADE症状的频率、严重程度和聚类情况。进行Spearman等级相关性分析以确定SPADE症状数量与疼痛干扰严重程度之间的关联。
参与者（n = 59）经历了多种SPADE症状。66.1%的参与者同时经历了至少两种SPADE症状。聚类分析揭示了高严重程度亚组（n = 36）和低严重程度亚组（n = 23）。SPADE症状数量与疼痛干扰严重程度之间存在中度相关性（r = 0.48）。确定慢性疼痛性CIPN患者中SPADE症状的聚类情况可能会带来有针对性的多方面干预措施，以改善身体功能。
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