Jing Feng, Zhu Zheng, Qiu Jiajia, Tang Lichen, Xu Lei, Xing Weijie, Hu Yan
School of Nursing, Fudan University, Shanghai, China.
Department of Nursing Administration, Shanghai Cancer Center, Fudan University, Shanghai, China.
Front Oncol. 2023 Mar 31;13:1081786. doi: 10.3389/fonc.2023.1081786. eCollection 2023.
Endocrine therapy-related symptoms are associated with early discontinuation and quality of life among breast cancer survivors. Although previous studies have examined these symptoms and clinical covariates, little is known about the interactions among different symptoms and correlates. This study aimed to explore the complex relationship of endocrine therapy-related symptoms and to identify the core symptoms among breast cancer patients.
This is a secondary data analysis conducted based on a multicenter cross-sectional study of 613 breast cancer patients in China. All participants completed the 19-item Chinese version of the Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES). Multivariate linear regression analysis was performed to identify significant factors. A contemporaneous network with 15 frequently occurring symptoms was constructed after controlling for age, payment, use of aromatase inhibitors, and history of surgery. Network comparison tests were used to assess differences in network structure across demographic and treatment characteristics.
All 613 participants were female, with an average age of 49 years (SD = 9.4). The average duration of endocrine therapy was 3.6 years (SD = 2.3) and the average symptom score was 18.99 (SD = 11.43). Irritability (n = 512, 83.52%) and mood swings (n = 498, 81.24%) were the most prevalent symptoms. Lost interest in sex (mean = 1.95, SD = 1.39) and joint pain (mean = 1.57, SD = 1.18) were the most severe symptoms. The edges in the clusters of emotional symptoms ("irritability-mood swings"), vasomotor symptoms ("hot flashes-cold sweats-night sweats"), vaginal symptoms ("vaginal discharge-vaginal itching"), sexual symptoms ("pain or discomfort with intercourse-lost interest in sex-vaginal dryness"), and neurological symptoms ("headaches-dizziness") were the thickest in the network. There were no significant differences in network structure (P = 0.088), and global strength (P = 0.330) across treatment types (selective estrogen receptor modulators vs. aromatase inhibitors). Based on an evaluation of the centrality indices, irritability and mood swings appeared to be structurally important nodes after adjusting for the clinical covariates and after performing subgroup comparisons.
Endocrine therapy-related symptoms are frequently reported issues among breast cancer patients. Our findings demonstrated that developing targeted interventions focused on emotional symptoms may relieve the overall symptom burden for breast cancer patients during endocrine therapy.
内分泌治疗相关症状与乳腺癌幸存者的早期停药及生活质量相关。尽管既往研究已对这些症状及临床协变量进行了探讨，但对于不同症状之间的相互作用及其关联因素知之甚少。本研究旨在探讨内分泌治疗相关症状的复杂关系，并确定乳腺癌患者的核心症状。
这是一项基于对中国613例乳腺癌患者进行的多中心横断面研究的二次数据分析。所有参与者均完成了19项中文版癌症治疗功能评估-内分泌亚量表（FACT-ES）。进行多变量线性回归分析以确定显著因素。在控制年龄、付费方式、芳香化酶抑制剂的使用及手术史后，构建了一个包含15种常见症状的同期网络。采用网络比较检验评估不同人口统计学和治疗特征的网络结构差异。
613名参与者均为女性，平均年龄49岁（标准差=9.4）。内分泌治疗的平均持续时间为3.6年（标准差=2.3），平均症状评分为18.99（标准差=11.43）。易怒（n=512，83.52%）和情绪波动（n=498，81.24%）是最常见的症状。对性生活失去兴趣（均值=1.95，标准差=1.39）和关节疼痛（均值=1.57，标准差=1.18）是最严重的症状。情绪症状集群（“易怒-情绪波动”）、血管舒缩症状集群（“潮热-冷汗-盗汗”）、阴道症状集群（“白带-阴道瘙痒”）、性症状集群（“性交疼痛或不适-对性生活失去兴趣-阴道干涩”）和神经症状集群（“头痛-头晕”）中的边在网络中最粗。不同治疗类型（选择性雌激素受体调节剂与芳香化酶抑制剂）之间的网络结构（P=0.088）和全局强度（P=0.330）无显著差异。基于中心性指标的评估，在调整临床协变量并进行亚组比较后，易怒和情绪波动似乎是结构上重要的节点。
内分泌治疗相关症状是乳腺癌患者中经常报告的问题。我们的研究结果表明，针对情绪症状制定有针对性的干预措施可能会减轻乳腺癌患者内分泌治疗期间的总体症状负担。
