胃癌患者化疗期间症状群与生活质量相关性的纵向研究
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摘要
背景对症状群的纵向发展变化进行研究,可以得出症状群变化规律和稳定的症状群,从而有利于延续性地管理症状。目前,尚未见有关胃癌症状群的纵向研究报道。目的纵向研究胃癌患者化疗期间症状群与生活质量的相关性,旨在为指导临床进行延续性症状管理、提高患者生活质量奠定基础。方法采用纵向调查法,选取2016年9月——2017年5月在郑州大学第二附属医院就诊的行胃癌手术治疗及术后化疗的患者为调查对象。获得患者知情同意后由研究者向其发放一般资料调查表,在患者术后拟行化疗前1 d(T1)、第3次化疗后(第3次化疗结束第2天,T2)和第6次化疗后(第6次化疗结束第2天,T3)采用中文版记忆症状评估量表(MSAS)评估患者症状,并采用对应分析提取症状群,采用中文版癌症治疗功能评价-普适性量表(FACT-G)评估患者生活质量。T1时共发放问卷228份,回收有效问卷224份,有效回收率为98.2%;T2时,失访4例,死亡1例,共发放问卷223份,回收有效问卷221份,有效回收率为99.1%;T3时,失访3例,死亡2例,共发放问卷218份,回收有效问卷214份,有效回收率为98.2%。分析症状群与生活质量之间的相关性。结果 T1时患者症状数量为28.9(27.2,30.7)个,症状发生率前3位分别为体质量下降、口干、疼痛(如腹痛、腰痛),症状严重程度得分前3位分别为难以集中注意力、身体肿胀/腹胀、手臂或腿部肿胀;T2时患者症状数量为17.8(15.7,20.4)个,症状发生率前3位分别为乏力、疼痛(如腹痛、腰痛)、咳嗽,症状严重程度得分前3位分别为乏力、出汗、疼痛(如腹痛、腰痛);T3时患者症状数量为21.8(20.7,22.9)个,症状发生率前3位分别为乏力、体质量下降、没有食欲,症状严重程度得分前3位分别为乏力、没有食欲、出汗。T1、T2时患者共有能量不足症状群、消化道症状群、身心症状群、手术相关症状群和神经症状群5个症状群,T3时患者共有能量不足症状群、消化道症状群、身心症状群及神经症状群4个症状群,各时间点症状群内症状组成有所不同。胃癌患者不同时间点生理状况、社会/家庭状况、情绪状况、功能状况得分及生活质量总得分比较,差异有统计学意义(P<0.05)。T1、T2、T3时,胃癌患者症状群严重程度得分与生理状况、社会/家庭状况、情绪状况、功能状况得分及生活质量总得分均呈负相关(P<0.05)。结论胃癌患者化疗期间存在多个稳定的症状群,如消化道症状群、能量不足症状群、身心症状群、神经症状群,且这些症状越严重,患者生活质量越低。
Background Studying the longitudinal developmental changes of the symptom cluster can obtain the pattern of symptom cluster changes and stable symptom cluster,which is conducive to the continuous management of symptoms.At present,there is no longitudinal study report on the symptom cluster of gastric cancer.Objective To longitudinally study the symptom clusters and quality of life(QOL)in patients with gastric cancer during chemotherapy in order to lay the foundation for guiding clinical management of continuous symptoms and improving patients' QOL.Methods A longitudinal study was conducted among patients who underwent gastric cancer surgery and postoperative chemotherapy at the Second Affiliated Hospital of Zhengzhou University from September 2016 to May 2017.After completing the written informed consent form,they received questionnaire surveys for collecting the general clinical data with a self-developed General Clinical Data Questionnaire,investigating the symptom clusters with the Chinese version of Memorial Symptom Assessment Scale(MSAS)on the day prior to chemotherapy(T1),on the second day following the 3 rd cycle of chemotherapy (T2),and on the second day following the 6th cycle of chemotherapy(T3),and obtaining the status of QOF with the Chinese version of Functional Assessment of Cancer Therapy-General(FACT-G)at T1,T2,T3.The latter two types of surveys achieved a response rate of 98.2%(224/228)at T1,a response rate of 99.1%(221/223)at T2[the total number(223)of participants dropped by 5 cases(4 were lost to follow up,and 1 died)compared with at T1(228)],and a response rate of 98.2% (214/218) at T3 [the total number(218) of participants dropped by 5 cases (3 were lost to follow up,and 2 died)compared with at T2(223)].The correlations between symptom clusters and QOL were analyzed.Results At T1,the average number of symptom clusters was 28.9(27.2,30.7),and the top three symptoms with the highest frequency were weight loss,dry mouth,pain(such as abdominal pain and low back pain);and the top three symptoms with the highest severity scores were difficult concentrating,body swelling/bloated/abdominal distention,and swelling of arms or legs.At T2,the average number of symptom clusters was 17.8(15.7,20.4),the top three symptoms with the highest frequency were lack of energy,pain(such as abdominal pain,low back pain),and cough;and the top three symptoms with the highest severity scores were lack of energy,sweats,and pain(such as abdominal pain and low back pain).At T3,the average number of symptom clusters was 21.8(20.7,22.9),and the top three symptoms with the highest frequency were lack of energy,weight loss,and lack of appetite,and the top three symptoms with the highest severity scores were lack of energy,lack of appetite,and sweats.Five symptom clusters(lack of energy,gastrointestinal,psychosomatic,surgery-related,neurological)were found in all the respondents at T2,and 4(lack of energy,gastrointestinal,psychosomatic,neurological)were found in them at T3.The symptoms included in the corresponding symptom clusters differed significantly over the treatment time.At different treatment time points,the differences in physical wellbeing,social/family well-being,emotional well-being,functional well-being scores and quality of life scores of gastric cancer patients were significant(P<0.05).At T1,T2 and T3,the severity scores of symptom clusters were negatively correlated with physical well-being,social/family well-being,emotional well-being,functional well-being scores and total quality of life score(P<0.05).Conclusion Gastric cancer patients have multiple stable symptom clusters during chemotherapy,such as gastrointestinal symptom cluster,lack of energy symptom cluster,psychosomatic symptom cluster,and neurological symptom cluster,and the more serious these symptoms are,the lower the patients' quality of life will be.
Background Studying the longitudinal developmental changes of the symptom cluster can obtain the pattern of symptom cluster changes and stable symptom cluster,which is conducive to the continuous management of symptoms.At present,there is no longitudinal study report on the symptom cluster of gastric cancer.Objective To longitudinally study the symptom clusters and quality of life(QOL)in patients with gastric cancer during chemotherapy in order to lay the foundation for guiding clinical management of continuous symptoms and improving patients' QOL.Methods A longitudinal study was conducted among patients who underwent gastric cancer surgery and postoperative chemotherapy at the Second Affiliated Hospital of Zhengzhou University from September 2016 to May 2017.After completing the written informed consent form,they received questionnaire surveys for collecting the general clinical data with a self-developed General Clinical Data Questionnaire,investigating the symptom clusters with the Chinese version of Memorial Symptom Assessment Scale(MSAS)on the day prior to chemotherapy(T1),on the second day following the 3 rd cycle of chemotherapy (T2),and on the second day following the 6th cycle of chemotherapy(T3),and obtaining the status of QOF with the Chinese version of Functional Assessment of Cancer Therapy-General(FACT-G)at T1,T2,T3.The latter two types of surveys achieved a response rate of 98.2%(224/228)at T1,a response rate of 99.1%(221/223)at T2[the total number(223)of participants dropped by 5 cases(4 were lost to follow up,and 1 died)compared with at T1(228)],and a response rate of 98.2% (214/218) at T3 [the total number(218) of participants dropped by 5 cases (3 were lost to follow up,and 2 died)compared with at T2(223)].The correlations between symptom clusters and QOL were analyzed.Results At T1,the average number of symptom clusters was 28.9(27.2,30.7),and the top three symptoms with the highest frequency were weight loss,dry mouth,pain(such as abdominal pain and low back pain);and the top three symptoms with the highest severity scores were difficult concentrating,body swelling/bloated/abdominal distention,and swelling of arms or legs.At T2,the average number of symptom clusters was 17.8(15.7,20.4),the top three symptoms with the highest frequency were lack of energy,pain(such as abdominal pain,low back pain),and cough;and the top three symptoms with the highest severity scores were lack of energy,sweats,and pain(such as abdominal pain and low back pain).At T3,the average number of symptom clusters was 21.8(20.7,22.9),and the top three symptoms with the highest frequency were lack of energy,weight loss,and lack of appetite,and the top three symptoms with the highest severity scores were lack of energy,lack of appetite,and sweats.Five symptom clusters(lack of energy,gastrointestinal,psychosomatic,surgery-related,neurological)were found in all the respondents at T2,and 4(lack of energy,gastrointestinal,psychosomatic,neurological)were found in them at T3.The symptoms included in the corresponding symptom clusters differed significantly over the treatment time.At different treatment time points,the differences in physical wellbeing,social/family well-being,emotional well-being,functional well-being scores and quality of life scores of gastric cancer patients were significant(P<0.05).At T1,T2 and T3,the severity scores of symptom clusters were negatively correlated with physical well-being,social/family well-being,emotional well-being,functional well-being scores and total quality of life score(P<0.05).Conclusion Gastric cancer patients have multiple stable symptom clusters during chemotherapy,such as gastrointestinal symptom cluster,lack of energy symptom cluster,psychosomatic symptom cluster,and neurological symptom cluster,and the more serious these symptoms are,the lower the patients' quality of life will be.
引文
[1]吴一龙,秦叔逵,马军.中国临床肿瘤学进展2016[M].北京:人民卫生出版社,2016:193-195.
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[8]何明喻,刘桂红,徐继承.宫颈癌患者同步放化疗期间症状群的调查研究[J].中国全科医学,2017,20(9):1110-1116.DOI:10.3969/j.issn.1007-9572.2017.09.017.HE M Y,LIU G H,XU J C.Symptom clusters of patients with cervical cancer during concurrent chemoradiation therapy[J].Chinese General Practice,2017,20(9):1110-1116.DOI:10.3969/j.issn.1007-9572.2017.09.017.
[9]朱宇,王维利,周利华,等.胃肠道肿瘤患者术后一周内症状群的调查研究[J].中国全科医学,2015,18(21):2568-2572.DOI:10.3969/j.issn.1007-9572.2015.21.016.ZHU Y,WANG W L,ZHOU L H,et al.An investigation of symptom clusters of gastrointestinal cancer patients within one week after operation[J].Chinese General Practice,2015,18(21):2568-2572.DOI:10.3969/j.issn.1007-9572.2015.21.016.
[10]胡月,段培蓓,侯庆海,等.胃癌术后化疗患者症状严重度与困扰度调查研究[J].护理学杂志,2017,32(20):18-21.DOI:10.3870/j.issn.1001-4152.2017.20.018.HU Y,DUAN P B,HOU Q H,et al.Symptom severity and distress in patients with gastric cancer undergoing chemotherapy[J].Journal of Nursing Science,2017,32(20):18-21.DOI:10.3870/j.issn.1001-4152.2017.20.018.
[11]WOOD L J,WEYMANN K.Inflammation and neural signaling:etiologic mechanisms of the cancer treatment-related symptom cluster[J].Curr Opin Support Palliat Care,2013,7(1):54-59.DOI:10.1097/SPC.0b013e32835dabe3.
[12]汪丹丹,郑蔚,乔婷婷,等.胃癌术后患者参与饮食管理对其营养状态影响的研究[J].中华护理杂志,2017,52(4):389-394.DOI:10.3761/j.issn.0254-1769.2017.04.001.
[13]陈丹丹,乔婷婷,郑蔚,等.胃肠道肿瘤患者首次辅助化疗后症状群的调查研究[J].中国全科医学,2016,19(26):3215-3218.DOI:10.3969/j.issn.1007-9572.2016.26.017.CHEN D D,QIAO T T,ZHENG W,et al.Symptom clusters of patients with gastroenteric tumor after first adjuvant chemotherapy[J].Chinese General Practice,2016,19(26):3215-3218.DOI:10.3969/j.issn.1007-9572.2016.26.017.
[14]LIN S,CHEN Y,YANG L,et al.Pain,fatigue,disturbed sleep and distress comprised a symptom cluster that related to quality of life and functional status of lung cancer surgery patients[J].J Clin Nurs,2013,22(9/10):1281-1290.DOI:10.1111/jocn.12228.
[15]王千心,孙田杰,刘叶,等.乳腺癌术后化疗病人症状群及其影响因素分析[J].护理研究,2015,29(5):556-560.DOI:10.3969/j.issn.10096493.2015.05.014.WANG Q X,SUN T J,LIU Y,et al.Analysis on symptom clusters of breast cancer patients receiving postoperative chemotherapy and its influencing factors[J].Chinese Nursing Research,2015,29(5):556-560.DOI:10.3969/j.issn.10096493.2015.05.014.
[16]BENDER C M,ERG?N F S,ROSENZWEIG M Q,et al.Symptom clusters in breast cancer across 3 phases of the disease[J].Cancer Nurs,2005,28(3):219-225.
[17]申思,吕春梅,马海燕,等.奥沙利铂神经毒性反应的防治及护理进展[J].实用临床医药杂志,2016,20(10):197-200.DOI:10.7619/jcmp.201610069.SHEN S,LYU C M,MA H Y,et al.Prevention and nursing progress of Oxaliplatin Neurotoxicity[J].Journal of Clinical Medicine in Practice,2016,20(10):197-200.DOI:10.7619/jcmp.201610069.
[18]NHO J H,REUL KIM S,NAM J H.Symptom clustering and quality of life in patients with ovarian cancer undergoing chemotherapy[J].Eur J Oncol Nurs,2017,30:8-14.DOI:10.1016/j.ejon.2017.07.007.
[19]PUD D,BEN AMI S,COOPER B A,et al.The symptom experience of oncology outpatients has a different impact on qualityof-life outcomes[J].J Pain Symptom Manage,2008,35(2):162-170.DOI:10.1016/j.jpainsymman.2007.03.010.
[20]DONG S T,COSTA D S,BUTOW P N,et al.Symptom clusters in advanced cancer patients:an empirical comparison of statistical methods and the impact on quality of life[J].J Pain Symptom Manage,2016,51(1):88-98.DOI:10.1016/j.jpainsymman.2015.07.013.
[2]GIVEN C W,GIVEN B,AZZOUZ F,et al.Predictors of pain and fatigue in the year following diagnosis among elderly cancer patients[J].J Pain Symptom Manage,2001,21(6):456-466.
[3]王丹丹.肺癌患者化疗期间症状群与生活质量研究[D].西安:第四军医大学,2013.
[4]XU S,THOMPSON W,ANCOLI-ISRAEL S,et al.Cognition,quality-of-life,and symptom clusters in breast cancer:using Bayesian networks to elucidate complex relationships[J].P s y c h o o n c o l o g y,2 0 1 8,2 7(3):8 0 2-8 0 9.D O I:10.1002/pon.4571.
[5]张华,顾凡,董银凤,等.胃癌患者症状群及其生活质量的相关性研究[J].重庆医学,2016,45(32):4593-4596.DOI:10.3969/j.issn.1671-8348.2016.32.043.ZHANG H,GU F,DONG Y F,et al.Study on the correlation between symptom groups and quality of life in patients with gastric cancer[J].Chongqing Medical,2016,45(32):4593-4596.DOI:10.3969/j.issn.1671-8348.2016.32.043.
[6]李楠楠,吴静,周洁.癌症患者症状群纵向研究现状综述[J].中华护理杂志,2017,52(1):24-28.DOI:10.3761/j.issn.0254-1769.2017.01.005.LI N N,WU J,ZHOU J.A summary of the current situation of longitudinal research on symptom cluster of cancer patients[J].Chin J Nurs,2017,52(1):24-28.DOI:10.3761/j.issn.0254-1769.2017.01.005.
[7]李楠楠.乳腺癌患者不同时间点症状群水平对生活质量的影响研究[D].郑州:郑州大学,2016.
[8]何明喻,刘桂红,徐继承.宫颈癌患者同步放化疗期间症状群的调查研究[J].中国全科医学,2017,20(9):1110-1116.DOI:10.3969/j.issn.1007-9572.2017.09.017.HE M Y,LIU G H,XU J C.Symptom clusters of patients with cervical cancer during concurrent chemoradiation therapy[J].Chinese General Practice,2017,20(9):1110-1116.DOI:10.3969/j.issn.1007-9572.2017.09.017.
[9]朱宇,王维利,周利华,等.胃肠道肿瘤患者术后一周内症状群的调查研究[J].中国全科医学,2015,18(21):2568-2572.DOI:10.3969/j.issn.1007-9572.2015.21.016.ZHU Y,WANG W L,ZHOU L H,et al.An investigation of symptom clusters of gastrointestinal cancer patients within one week after operation[J].Chinese General Practice,2015,18(21):2568-2572.DOI:10.3969/j.issn.1007-9572.2015.21.016.
[10]胡月,段培蓓,侯庆海,等.胃癌术后化疗患者症状严重度与困扰度调查研究[J].护理学杂志,2017,32(20):18-21.DOI:10.3870/j.issn.1001-4152.2017.20.018.HU Y,DUAN P B,HOU Q H,et al.Symptom severity and distress in patients with gastric cancer undergoing chemotherapy[J].Journal of Nursing Science,2017,32(20):18-21.DOI:10.3870/j.issn.1001-4152.2017.20.018.
[11]WOOD L J,WEYMANN K.Inflammation and neural signaling:etiologic mechanisms of the cancer treatment-related symptom cluster[J].Curr Opin Support Palliat Care,2013,7(1):54-59.DOI:10.1097/SPC.0b013e32835dabe3.
[12]汪丹丹,郑蔚,乔婷婷,等.胃癌术后患者参与饮食管理对其营养状态影响的研究[J].中华护理杂志,2017,52(4):389-394.DOI:10.3761/j.issn.0254-1769.2017.04.001.
[13]陈丹丹,乔婷婷,郑蔚,等.胃肠道肿瘤患者首次辅助化疗后症状群的调查研究[J].中国全科医学,2016,19(26):3215-3218.DOI:10.3969/j.issn.1007-9572.2016.26.017.CHEN D D,QIAO T T,ZHENG W,et al.Symptom clusters of patients with gastroenteric tumor after first adjuvant chemotherapy[J].Chinese General Practice,2016,19(26):3215-3218.DOI:10.3969/j.issn.1007-9572.2016.26.017.
[14]LIN S,CHEN Y,YANG L,et al.Pain,fatigue,disturbed sleep and distress comprised a symptom cluster that related to quality of life and functional status of lung cancer surgery patients[J].J Clin Nurs,2013,22(9/10):1281-1290.DOI:10.1111/jocn.12228.
[15]王千心,孙田杰,刘叶,等.乳腺癌术后化疗病人症状群及其影响因素分析[J].护理研究,2015,29(5):556-560.DOI:10.3969/j.issn.10096493.2015.05.014.WANG Q X,SUN T J,LIU Y,et al.Analysis on symptom clusters of breast cancer patients receiving postoperative chemotherapy and its influencing factors[J].Chinese Nursing Research,2015,29(5):556-560.DOI:10.3969/j.issn.10096493.2015.05.014.
[16]BENDER C M,ERG?N F S,ROSENZWEIG M Q,et al.Symptom clusters in breast cancer across 3 phases of the disease[J].Cancer Nurs,2005,28(3):219-225.
[17]申思,吕春梅,马海燕,等.奥沙利铂神经毒性反应的防治及护理进展[J].实用临床医药杂志,2016,20(10):197-200.DOI:10.7619/jcmp.201610069.SHEN S,LYU C M,MA H Y,et al.Prevention and nursing progress of Oxaliplatin Neurotoxicity[J].Journal of Clinical Medicine in Practice,2016,20(10):197-200.DOI:10.7619/jcmp.201610069.
[18]NHO J H,REUL KIM S,NAM J H.Symptom clustering and quality of life in patients with ovarian cancer undergoing chemotherapy[J].Eur J Oncol Nurs,2017,30:8-14.DOI:10.1016/j.ejon.2017.07.007.
[19]PUD D,BEN AMI S,COOPER B A,et al.The symptom experience of oncology outpatients has a different impact on qualityof-life outcomes[J].J Pain Symptom Manage,2008,35(2):162-170.DOI:10.1016/j.jpainsymman.2007.03.010.
[20]DONG S T,COSTA D S,BUTOW P N,et al.Symptom clusters in advanced cancer patients:an empirical comparison of statistical methods and the impact on quality of life[J].J Pain Symptom Manage,2016,51(1):88-98.DOI:10.1016/j.jpainsymman.2015.07.013.