Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Eur J Oncol Nurs. 2019 Oct;42:14-20. doi: 10.1016/j.ejon.2019.07.004. Epub 2019 Jul 10.
Symptoms experienced by breast cancer patients often cluster together in groups known as "symptom clusters". The aim was to determine the symptom clusters in women with non-metastatic breast cancer treated by radiation therapy (RT).
Edmonton Symptom Assessment Scale (ESAS) scores were taken from breast cancer patients receiving RT before, at completion of RT, and after RT. Exploratory factor analysis (EFA), principal component analysis (PCA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the nine ESAS items at all three time points.
This study included 1224 patients. The PCA and EFA identified the same two symptom clusters before the start of RT: 1) pain, tiredness, nausea, drowsiness, appetite, and dyspnea; 2) depression, anxiety, and wellbeing. The HCA further split the symptoms into three clusters. Wellbeing, depression, and anxiety consistently clustered together. Among the ESAS scores collected at the end of and after RT, each statistical method identified different symptom clusters. For the symptom clusters experienced at the end of RT, the following symptoms were always in the same cluster: wellbeing, depression, and anxiety; nausea and appetite; drowsiness and dyspnea. Following RT, depression and anxiety consistently clustered together, with nausea and appetite in a second cluster.
Among the symptom clusters derived before, at the end of RT, and after RT, the following symptoms consistently presented together: depression and anxiety, nausea and appetite, pain and tiredness, and drowsiness, dyspnea, and tiredness. Understanding symptom clusters in this population can improve management of symptoms.
乳腺癌患者常出现以症状群形式聚集在一起的症状。本研究旨在确定接受放射治疗（RT）的非转移性乳腺癌女性的症状群。
在接受 RT 前、完成 RT 时和 RT 后，从接受 RT 的乳腺癌患者中获取 Edmonton 症状评估量表（ESAS）评分。采用探索性因子分析（EFA）、主成分分析（PCA）和层次聚类分析（HCA），在所有三个时间点的 9 个 ESAS 项目中识别症状群。
本研究纳入了 1224 例患者。PCA 和 EFA 在 RT 开始前识别出相同的两个症状群：1）疼痛、疲劳、恶心、嗜睡、食欲和呼吸困难；2）抑郁、焦虑和幸福感。HCA 进一步将症状分为三个集群。幸福感、抑郁和焦虑始终聚类在一起。在 RT 结束时和之后收集的 ESAS 评分中，每种统计方法都识别出不同的症状群。对于 RT 结束时经历的症状群，以下症状总是在同一集群中：幸福感、抑郁和焦虑；恶心和食欲；嗜睡和呼吸困难。在 RT 后，抑郁和焦虑始终聚类在一起，恶心和食欲则在第二集群中。
在 RT 前、结束时和结束后得出的症状群中，以下症状始终同时出现：抑郁和焦虑、恶心和食欲、疼痛和疲劳以及嗜睡、呼吸困难和疲劳。了解该人群的症状群可以改善症状管理。
