肿瘤化疗消化道症状负荷的评估工具构建和临床研究
|
摘要
消化道反应是化疗中最常见的毒性反应,患者常表现为食欲减退、恶心、呕吐等症状。这些症状不仅影响患者的躯体功能和生活质量,也影响患者的治疗耐受性,并与生存周期密切相关。为了提升患者的生存质量和治疗依从性,化疗消化道症状管理一直是医护人员关注和研究的重点课题之一。目前还存在以下问题:①已有研究多集中于单症状的现象描述和治疗干预,没有把消化道症状作为一个整体进行探讨;多数只关注症状发生一个维度,忽略了一定时间内症状对患者生活的影响,没有把症状负荷作为一个整体概念贯穿到症状的评估和管理中。②缺乏化疗消化道整体症状负荷的专用评估工具。③虽然化疗常见的单个症状如恶心呕吐的发生率和影响因素已有许多研究,但对于化疗消化道整体症状负荷的发生、分布,以及随时间的变化趋势和影响因素等未见系统的研究和报道。上述不足一定程度制约了临床消化道症状的有效管理。
本研究拟将化疗消化道症状负荷作为一个整体,①研发包括症状发生、症状影响两个维度的化疗消化道症状量表;②并以量表为工具,对肿瘤患者化疗消化道症状负荷的横断面调查资料进行分析,了解消化道症状负荷的发生和分布概况;③进一步实施化疗期间不同时间点症状负荷的纵向调查研究,探讨不同时间点化疗消化道症状负荷的变化趋势和影响因素,为临床症状管理提供参考和依据。
第一部分肿瘤化疗消化道症状负荷评估工具的构建和评价
一、目的
编制肿瘤化疗消化道症状负荷的评估工具:化疗消化道症状量表(Chemotherapy- Related Gastrointestinal Symptoms Inventory, CGISI),并评价其信度效度。
二、程序与方法
第一阶段,通过文献复习提出化疗消化道症状负荷的条目池,经过对79位临床肿瘤和消化专业的医护人员、63例化疗患者的调研进行条目筛选优化和修改,构建量表第一稿CGISI-1,含21个条目。第二阶段,以CGISI-1为工具,对1116例化疗患者进行消化道症状负荷的横断面调查。采用临界比值、相关分析、内部一致性信度、主成分因素分析方法对量表进行项目分析,共删除口腔/咽喉疼痛、睡眠2个条目。采用探索性因素分析、各因素与总量表相关矩阵结构评价量表的效度,共删除饮食1个条目;通过患者化疗前后消化道症状负荷的差异比较、CGISI-1与QLQ-C30中消化道症状条目等层面的相关分析评价量表的效标关联效度。采用内部一致性信度Cronbachα系数和重测信度考核的量表信度。结果各指标均符合要求,保留18个条目,构建量表第二稿CGISI-2。第三阶段,以CGISI-2为工具调查579例患者,继续精简和修订量表,删除吞咽不适、呃逆、嗳气、烧心/胃灼热4个条目,形成量表第三稿CGISI-3,含14个条目。第四阶段,以CGISI-3的因素结构为基础,对第二阶段的数据进行交叉验证,通过各条目、各因素的验证性因素分析提出量表的结构,完成化疗消化道症状负荷评估工具CGISI的研发工作。
三、结果
CGISI由症状发生和症状影响两个维度组成。症状发生包括10个消化道症状条目,评估最近24小时消化道症状最重的程度,症状影响包括4个症状影响条目,评估最近24小时消化道症状对患者生活的影响。10个症状条目分为两个因子:饮食摄入因子,含食欲减退、恶心、呕吐、味觉异常、反酸5个条目;消化排泄因子,含胃/腹胀、胃/腹痛、口腔/咽喉干燥、便秘、腹泻5个条目;症状严重程度分为0～4级,分别是没有、轻度、中度、较重、非常重,10个条目总评分范围0～40分。0分表示没有消化道症状;分值越高表示消化道症状越重。症状影响程度分为0～4级,分别是“毫无影响、有一点影响、有一些影响、有较大影响、有极大影响”,4个条目总评分范围0～16分;0分表示对生活没有影响,分值越高表示症状对生活的影响越大。量表总的Cronbachα系数是0.887,两维度Cronbachα系数分别是0.832、0.914,症状发生维度中两因子Cronbachα系数分别是0.844、0.621。
四、结论
课题组研发的CGISI具有较好的信度和效度,可以作为化疗消化道症状负荷的有效评估工具。
第二部分肿瘤化疗消化道症状负荷的发生与分布
一、目的
了解肿瘤化疗患者消化道症状负荷的总体发生与分布情况。
二、方法
以CGISI为工具,对1116例肿瘤住院静脉化疗患者消化道症状负荷的横断面调查资料进行分析。了解化疗消化道各症状的发生率、影响率和程度分布、症状发生和症状影响维度之间的关系、患者同时存在的症状个数、常见的症状组合等;分析不同性别、年龄、疾病种类、体力状况患者的症状负荷发生和分布特点。
三、结果
化疗消化道各症状的发生率波动在8%至61.1%;发生率最高的是食欲减退,最低的是腹泻;症状程度分布中,以轻度多见。患者同时存在3.16±2.61项消化道症状,≥2种症状者占66.5%(742例)。食欲减退、口腔/咽喉干燥、恶心、味觉异常、呕吐、便秘是患者发生率最高、评分最重的前6项症状。症状对生活4个方面的影响率均>40%,其中体力影响率最大(50.9%),并且程度最重(0.93±1.11)。
食欲减退、味觉异常、便秘、腹泻、口腔/咽喉干燥、胃/腹胀6项症状的程度评分对症状影响大小有显著的预测力。在不同人群的症状负荷评分中,女性评分显著高于男性;不同年龄组中,30～岁组评分最高,其次是40～岁组,<30岁组最低;30～岁到70～岁组随着年龄的增加,饮食摄入因子各条目评分有降低的趋势;不同疾病组中,女性生殖系统肿瘤组评分最高,其次是乳腺癌、胃肠道肿瘤、头颈部肿瘤;不同体力状况组患者中,体力状况差的患者消化道症状负荷重;随ECOG分值增加症状评分总体呈上升趋势。
四、结论
1.化疗消化道症状非常普遍,常数个症状并存,影响患者生活的多个方面;临床应重视对化疗消化道症状负荷的整体管理。
2.不同的性别、年龄、肿瘤种类、体力状况的患者,症状负荷的发生与分布存在显著差异;根据这些特点,可以在临床症状管理中更好的识别高危人群、筛选重点观察对象。
第三部分肿瘤化疗消化道症状负荷的纵向调查
一、目的
探讨化疗期间不同时间点消化道症状负荷的整体变化趋势和影响因素。
二、方法
以CGISI为工具,对631例肿瘤住院患者化疗期间消化道症状负荷进行纵向调查,了解症状负荷随时间的总体变化趋势;以第1天到第5天为重复测量时间点,疾病种类和化疗方案为处理因素,对其中356例患者的症状发生维度、症状影响维度评分分别进行重复测量方差分析,探讨症状负荷的时间效应。以不同时间点的症状负荷为反应变量,以16个影响因素为自变量,进行多元方差分析,了解症状负荷的影响因素。
三、结果
症状负荷整体随时间呈波浪形变化,第1天最低,第2天到第5天症状呈上升状态,第6天、第7天开始回落;但各条目中,味觉异常、口腔/咽喉干燥、胃/腹痛、胃/腹胀、腹泻、体力影响在第7天仍继续加重。重复测量方差分析显示:症状发生维度、症状影响维度均有显著的时间变化趋势;时间与疾病种类有明显的的交互效应;时间与化疗方案、化疗方案与疾病种类无交互效应。多元方差分析最后显示,对不同时间点消化道症状负荷总体有显著影响的因素有:疾病种类、体能评分、孕期消化道反应程度、化疗紧张情况、以前用药消化道反应程度、有无其他胃肠道疾病6个因素。疾病种类中,恶性黑色素瘤、大肠癌、胃癌患者的症状发生维度评分最高;女性生殖系统肿瘤患者的症状影响评分最高;体能评分差、孕期胃肠道反应重、面对化疗时紧张、以前用药胃肠道反应重、有其他胃肠道疾病的患者症状负荷明显高与其他组。
四、结论
1.化疗期间不同时间点消化道症状负荷有明显的变化,总体趋势呈波浪形;但不同症状的发展轨迹不完全一致。
2.对不同时间点症状负荷总体有显著意义的影响因素有:疾病种类、体能评分、孕期消化道反应程度、化疗紧张情况、以前用药消化道反应程度、有无其他胃肠道疾病。临床症状管理应结合症状的时间变化趋势和影响因素制定切合时机的、具有针对性的症状管理方案。
Gastrointestinal reactions are the most common toxicity of chemotherapy, which usually manifest with anorexia, nausea, vomiting and other symptoms. These symptoms not only affect the patients’physical function and quality of life, but also influence patients’treatment tolerance, and are closely related with the survival period. The management of gastrointestinal symptoms has always been the focus of medical attention and study. There are still a few problems in the study:①The previous invetigations mostly focused on the phenomenon description and treatment interventions on single symptom, but did not discuss gastrointestinal symptoms as a whole; most concerned only one dimension about symptom occurrence, ignoring the impact on patients’lives in a certain period: not taking symptom burden as a whole concept into the assessment and management of symptoms.②Specific tools needed to be developed for assessing the burden of overall gastrointestinal symptoms during chemotherapy.③Although the prevalence and influence factors of single symptom, such as nausea and vomiting, which is normal in chemotherapy have been investigated, few systemic studies and reports on the occurrence and the distribution of the whole digestive tract symptoms burden, development trends over time and the related influence factors could be found.
This study intends to take chemotherapy-related gastrointestinal symptoms burden as a whole, constructing a symptoms inventory including two dimensions-symptoms occurrence and impact, using this tool to analyze the cancer patient’s chemotherapy-related gastrointestinal symptoms burden on cross section and investigate the prevalance and distribution of symptoms burden, and taking the further longitudinal study on the symptoms at different time points to explore the chemotherapy-related gastrointestinal symptoms burden’s trend and the impact factors at different time for clinical management reference.
PartⅠThe Construction and Evaluation of the Tool for Assessing the Chemotherapy–Related Gastrointestinal Symptoms Burden
Objective
To construct an assessment tool for the chemotherapy-related gastrointestinal symptoms burden: Chemotherapy-Related Gastrointestinal Symptoms Inventory(CGISI), and evaluate the reliability and validity.
Methods
Stage one, the item pool was compiled through the literature review on chemotherapy- related gastrointestinal symptoms burden, then being selected, optimized and modified through a research on 79 professional staff who major in Oncology and Digestion, and 63 patients treated with chemotherapy, being developed into the first draft of CGISI-1, containing 21 items. Stage two, taking a cross-sectional study on the chemotherapy-related gastrointestinal symptoms burden of 1116 cases by CGISI-1, analyzing the inventory through the critical ratio, correlation analysis, internal consistent reliability, principal components factor methods, two items of mouth/throat pain and sleep were deleted. The inventory’s validity was evaluated through exploratory factor analysis and the factors and total scale correlation matrix structure, diet being deleted as a result. Comparison between the difference of gastrointestinal symptoms burden before and after chemotherapy, and the correlation analysis of symptom inventory and the QLQ-C30 symptom scale were used to to evaluate the criterion validity. The scale reliability was tested by the index of internal consistency reliability coefficients Cronbachαand test-retest reliability. The results are all in line with the target requirements, so 18 items were retained to build the second draft of CGISI-2. The third stage, the third draft of CGISI-3 containing 14 items was formed on the basis of investigating 579 cases of patients by using the CGISI-2 and deleting 4 items including the swallowing discomfort, hiccups, belching, heartburn. The fourth stage, based on the factors of CGISI-3, the data of the second stage was cross-validated. Then the scale structure was proposed through the confirmatory factor analysis of each factor, and finish the construcion of the tool for the assessment of chemotherapy-related gastrointestinal symptoms burden: CGISI .
Results
CGISI consists of symptoms occurrence and symptoms impacts. Symptoms occurrence includes 10 items of gastrointestinal symptoms, to assess the most serious degree of gastrointestinal symptoms within the last 24 hours. Symptoms impact, including four items, was used to assess the influence of gastrointestinal symptoms on patients’lives within the last 24 hours. The 10 symptoms items are divided into two factors: dietary intake factor, which includes 5 items of losing appetite, nausea, vomiting, dysgeusia, acid reflux; and digestion excretion factor, including stomach/abdominal distension, stomach/abdominal pain, dry mouth/throat, constipation, diarrhea. The level of symptom severity is from 0 to 4, which represents none, mild, moderate, much severe, extremely severe. The total score of 10 items ranges from 0 to 40. 0 means no gastrointestinal symptoms. The higher the score was, the more serious the gastrointestinal symptoms indicate. Symptoms impact is divided into 0～4 level, namely "no impact, little impact, some impact, great impact, extreme impact ". The total score ranges 0～16; 0 means no effect on life, higher score indicates greater impact on life. The scale’s overall Cronbachαcoefficient was 0.887, and the two-dimension Cronbachαcoefficients were 0.832 and 0.914, respectively. The two factors’s Cronbachαcoefficients of the symptoms occurrence dimension were 0.844 and 0.621.
Conclusions
CGISI, which has good reliability and validity, can be used as an effective assessment tool for the chemotherapy -related gastrointestinal symptoms burden.
PartⅡ: The Prevalance and Distribution of Chemotherapy-Related Gastrointe- stinal Symptoms Burden
Objective
Study the overall prevalance and distribution of gastrointestinal symptoms burden in cancer patients after Chemotherapy.
Methods
We analyzed the data of 1116 hospitalized cancer patients under venous chemotherapy with CGISI, which collected by cross-sectional surveying on the gastrointestinal symptom burden to learn the prevalence, the influential rate, the distribution of different levels of sevirity, the relation between symptom occurrence and its effects, and the number of symptoms one patient have concurrently and the common symptoms combination. And we analyzed the features of the symptom occurrence and symptom distribution on genders, age, types of disease and physical status.
Results
The prevalence of chemotherapy-related gastrointestinal symptoms fluctuates from 8% to 61.1%; the highest is in anorexia, and the lowest is diarrhea, and the mild severity is very common in symptoms distribution degrees. We find that 3.16±2.61 kinds of gastrointestinal symptoms often occur in a patient at the same time; patients with more than 2 kinds of symptoms account 66.5% (742 cases). And Loss of appetite, mouth/throat dry, nausea, dysgeusia, vomiting, constipation are the top six symptoms with the highest occurrence and count the most score. The influences of the symptoms on life were all more than 40%, among which the maximum rate is physical strenth (50.9%), with the highest degree scores (0.93±1.11).
The severity score of the following six symptoms, that is, loss of appetite, unusual taste, constipation, diarrhea, mouth/throat dry, stomach/abdominal distension have significant predictive power on the degree of symptoms impact. In the symptom scoring of different genders, females score significantly higher than males. In the group at different ages, the group whose members are in their 30s score the highest, followed by the 40s, and the group whose members are younger than 30 years old group is the lowest; and in the group whose members are aged 30 years old to 70, the score of dietary intake of each factor is apt to decrease with the age increases. Between the different diseases groups, the female reproductive system tumor group score the highest, followed by breast tumor, gastrointestinal tumor, head and neck tumor. Patients in different physical conditions, the poorer physical status have heavier gastrointestinal symptoms burden was; and it is apt to increase with the ECOG score increasing.
Conclusions
Chemotherapy–related gastrointestinal symptoms are very common, and often with coexistence of multiple symptoms and affect many aspects of patients’life. Hence, clinical attention should be payed to the overall management of chemotherapy-related gastrointestinal symptoms burden. The symptom burden occurrence and distribution are significantly different among gender, age, different tumor type, and physical status of patients. Combining these characteristics, we can do it better to discern high risk group and select key observation patients in clinical symptoms management.
PartⅢLongitudinal Survey on the Gastrointestinal Symptom Burden of Cancer Chemotherapy
Objective
To explore the entire variation tendency and impact factors of gastrointestinal symptom burden at different time points during chemotherapy.
Methods
Longitudinal survey on the gastrointestinal symptom burdens during chemotherapy was performed on 631 hospitalized patients with CGISI to know the overall tendency of symptom burden at different time. The 1st day and 5th day were the repeated measurement time points, while the types of diseases and chemotherapy programs were addressed to be treatment factors. Repeated measure of variance analysis was conducted on the symptom occurring dimensionality and symptom impact dimensionality in 356 cases to explore the time effect of symptom burden. Symptom burden at different time point was measured as response variable, while 16 impact factors as independent variables. Multivariate analysis was conducted to understand the impact factors of symptom burden.
Results
Symptom burden entirely changed wavily with the time. The lowest is on day 1, while symptom increased on day 2 to day 5, and it began to fall on the day 6 and day 7. In various symptoms, abnormal taste, mouth/throat dry, stomach/abdominal pain, stomach/abdominal distension, diarrhea, physical impact continued to increase on day 7. Repeated measures of variance analysis showed that time variation trends existed significantly in symptom occurring and impact dimensions. Time and types of diseases had significant interaction effect, while time and chemotherapy programs types of diseases and chemotherapy had no interaction effects. Finally, multivariate analysis of variance showed that six significant factors on gastrointestinal symptoms burden at different time points are types of diseases, physical performance, degree of gastrointestinal symptoms during pregnancy, tension degree about chemotherapy, gastrointestinal symptoms in former drug usage, whether having other gastrointestinal tract diseases. In types of diseases, the malignant melanoma, colorectal cancer, gastric cancer patients had the highest scores of the symptom occurring dimensions, while female reproductive system symptoms had the highest scores in symptom impact dimensions. Patients, with poor physical performance, high gastrointestinal reactions during pregnancy, high degree of intense about chemotherapy, heavy gastrointestinal reaction in previous drug usage, having other gastrointestinal diseases, have significantly higher symptom burden than patients in other groups.
Conclusions
Gastrointestinal symptom burden at different time points during chemotherapy changed significantly, with the wavy trend entirely. But the development pathway of different symptoms was not exactly same. The significant factors on gastrointestinal symptoms burden at different time points are types of diseases, physical performance score, degree of gastrointestinal symptoms during pregnancy, tension degree about chemotherapy, gastrointestinal symptoms in former drug usage, whether having other gastrointestinal tract diseases. Management of clinical symptoms should be combined with the time trends and impact factors to formulate pertinence management programs according with time.
本研究拟将化疗消化道症状负荷作为一个整体,①研发包括症状发生、症状影响两个维度的化疗消化道症状量表;②并以量表为工具,对肿瘤患者化疗消化道症状负荷的横断面调查资料进行分析,了解消化道症状负荷的发生和分布概况;③进一步实施化疗期间不同时间点症状负荷的纵向调查研究,探讨不同时间点化疗消化道症状负荷的变化趋势和影响因素,为临床症状管理提供参考和依据。
第一部分肿瘤化疗消化道症状负荷评估工具的构建和评价
一、目的
编制肿瘤化疗消化道症状负荷的评估工具:化疗消化道症状量表(Chemotherapy- Related Gastrointestinal Symptoms Inventory, CGISI),并评价其信度效度。
二、程序与方法
第一阶段,通过文献复习提出化疗消化道症状负荷的条目池,经过对79位临床肿瘤和消化专业的医护人员、63例化疗患者的调研进行条目筛选优化和修改,构建量表第一稿CGISI-1,含21个条目。第二阶段,以CGISI-1为工具,对1116例化疗患者进行消化道症状负荷的横断面调查。采用临界比值、相关分析、内部一致性信度、主成分因素分析方法对量表进行项目分析,共删除口腔/咽喉疼痛、睡眠2个条目。采用探索性因素分析、各因素与总量表相关矩阵结构评价量表的效度,共删除饮食1个条目;通过患者化疗前后消化道症状负荷的差异比较、CGISI-1与QLQ-C30中消化道症状条目等层面的相关分析评价量表的效标关联效度。采用内部一致性信度Cronbachα系数和重测信度考核的量表信度。结果各指标均符合要求,保留18个条目,构建量表第二稿CGISI-2。第三阶段,以CGISI-2为工具调查579例患者,继续精简和修订量表,删除吞咽不适、呃逆、嗳气、烧心/胃灼热4个条目,形成量表第三稿CGISI-3,含14个条目。第四阶段,以CGISI-3的因素结构为基础,对第二阶段的数据进行交叉验证,通过各条目、各因素的验证性因素分析提出量表的结构,完成化疗消化道症状负荷评估工具CGISI的研发工作。
三、结果
CGISI由症状发生和症状影响两个维度组成。症状发生包括10个消化道症状条目,评估最近24小时消化道症状最重的程度,症状影响包括4个症状影响条目,评估最近24小时消化道症状对患者生活的影响。10个症状条目分为两个因子:饮食摄入因子,含食欲减退、恶心、呕吐、味觉异常、反酸5个条目;消化排泄因子,含胃/腹胀、胃/腹痛、口腔/咽喉干燥、便秘、腹泻5个条目;症状严重程度分为0～4级,分别是没有、轻度、中度、较重、非常重,10个条目总评分范围0～40分。0分表示没有消化道症状;分值越高表示消化道症状越重。症状影响程度分为0～4级,分别是“毫无影响、有一点影响、有一些影响、有较大影响、有极大影响”,4个条目总评分范围0～16分;0分表示对生活没有影响,分值越高表示症状对生活的影响越大。量表总的Cronbachα系数是0.887,两维度Cronbachα系数分别是0.832、0.914,症状发生维度中两因子Cronbachα系数分别是0.844、0.621。
四、结论
课题组研发的CGISI具有较好的信度和效度,可以作为化疗消化道症状负荷的有效评估工具。
第二部分肿瘤化疗消化道症状负荷的发生与分布
一、目的
了解肿瘤化疗患者消化道症状负荷的总体发生与分布情况。
二、方法
以CGISI为工具,对1116例肿瘤住院静脉化疗患者消化道症状负荷的横断面调查资料进行分析。了解化疗消化道各症状的发生率、影响率和程度分布、症状发生和症状影响维度之间的关系、患者同时存在的症状个数、常见的症状组合等;分析不同性别、年龄、疾病种类、体力状况患者的症状负荷发生和分布特点。
三、结果
化疗消化道各症状的发生率波动在8%至61.1%;发生率最高的是食欲减退,最低的是腹泻;症状程度分布中,以轻度多见。患者同时存在3.16±2.61项消化道症状,≥2种症状者占66.5%(742例)。食欲减退、口腔/咽喉干燥、恶心、味觉异常、呕吐、便秘是患者发生率最高、评分最重的前6项症状。症状对生活4个方面的影响率均>40%,其中体力影响率最大(50.9%),并且程度最重(0.93±1.11)。
食欲减退、味觉异常、便秘、腹泻、口腔/咽喉干燥、胃/腹胀6项症状的程度评分对症状影响大小有显著的预测力。在不同人群的症状负荷评分中,女性评分显著高于男性;不同年龄组中,30～岁组评分最高,其次是40～岁组,<30岁组最低;30～岁到70～岁组随着年龄的增加,饮食摄入因子各条目评分有降低的趋势;不同疾病组中,女性生殖系统肿瘤组评分最高,其次是乳腺癌、胃肠道肿瘤、头颈部肿瘤;不同体力状况组患者中,体力状况差的患者消化道症状负荷重;随ECOG分值增加症状评分总体呈上升趋势。
四、结论
1.化疗消化道症状非常普遍,常数个症状并存,影响患者生活的多个方面;临床应重视对化疗消化道症状负荷的整体管理。
2.不同的性别、年龄、肿瘤种类、体力状况的患者,症状负荷的发生与分布存在显著差异;根据这些特点,可以在临床症状管理中更好的识别高危人群、筛选重点观察对象。
第三部分肿瘤化疗消化道症状负荷的纵向调查
一、目的
探讨化疗期间不同时间点消化道症状负荷的整体变化趋势和影响因素。
二、方法
以CGISI为工具,对631例肿瘤住院患者化疗期间消化道症状负荷进行纵向调查,了解症状负荷随时间的总体变化趋势;以第1天到第5天为重复测量时间点,疾病种类和化疗方案为处理因素,对其中356例患者的症状发生维度、症状影响维度评分分别进行重复测量方差分析,探讨症状负荷的时间效应。以不同时间点的症状负荷为反应变量,以16个影响因素为自变量,进行多元方差分析,了解症状负荷的影响因素。
三、结果
症状负荷整体随时间呈波浪形变化,第1天最低,第2天到第5天症状呈上升状态,第6天、第7天开始回落;但各条目中,味觉异常、口腔/咽喉干燥、胃/腹痛、胃/腹胀、腹泻、体力影响在第7天仍继续加重。重复测量方差分析显示:症状发生维度、症状影响维度均有显著的时间变化趋势;时间与疾病种类有明显的的交互效应;时间与化疗方案、化疗方案与疾病种类无交互效应。多元方差分析最后显示,对不同时间点消化道症状负荷总体有显著影响的因素有:疾病种类、体能评分、孕期消化道反应程度、化疗紧张情况、以前用药消化道反应程度、有无其他胃肠道疾病6个因素。疾病种类中,恶性黑色素瘤、大肠癌、胃癌患者的症状发生维度评分最高;女性生殖系统肿瘤患者的症状影响评分最高;体能评分差、孕期胃肠道反应重、面对化疗时紧张、以前用药胃肠道反应重、有其他胃肠道疾病的患者症状负荷明显高与其他组。
四、结论
1.化疗期间不同时间点消化道症状负荷有明显的变化,总体趋势呈波浪形;但不同症状的发展轨迹不完全一致。
2.对不同时间点症状负荷总体有显著意义的影响因素有:疾病种类、体能评分、孕期消化道反应程度、化疗紧张情况、以前用药消化道反应程度、有无其他胃肠道疾病。临床症状管理应结合症状的时间变化趋势和影响因素制定切合时机的、具有针对性的症状管理方案。
Gastrointestinal reactions are the most common toxicity of chemotherapy, which usually manifest with anorexia, nausea, vomiting and other symptoms. These symptoms not only affect the patients’physical function and quality of life, but also influence patients’treatment tolerance, and are closely related with the survival period. The management of gastrointestinal symptoms has always been the focus of medical attention and study. There are still a few problems in the study:①The previous invetigations mostly focused on the phenomenon description and treatment interventions on single symptom, but did not discuss gastrointestinal symptoms as a whole; most concerned only one dimension about symptom occurrence, ignoring the impact on patients’lives in a certain period: not taking symptom burden as a whole concept into the assessment and management of symptoms.②Specific tools needed to be developed for assessing the burden of overall gastrointestinal symptoms during chemotherapy.③Although the prevalence and influence factors of single symptom, such as nausea and vomiting, which is normal in chemotherapy have been investigated, few systemic studies and reports on the occurrence and the distribution of the whole digestive tract symptoms burden, development trends over time and the related influence factors could be found.
This study intends to take chemotherapy-related gastrointestinal symptoms burden as a whole, constructing a symptoms inventory including two dimensions-symptoms occurrence and impact, using this tool to analyze the cancer patient’s chemotherapy-related gastrointestinal symptoms burden on cross section and investigate the prevalance and distribution of symptoms burden, and taking the further longitudinal study on the symptoms at different time points to explore the chemotherapy-related gastrointestinal symptoms burden’s trend and the impact factors at different time for clinical management reference.
PartⅠThe Construction and Evaluation of the Tool for Assessing the Chemotherapy–Related Gastrointestinal Symptoms Burden
Objective
To construct an assessment tool for the chemotherapy-related gastrointestinal symptoms burden: Chemotherapy-Related Gastrointestinal Symptoms Inventory(CGISI), and evaluate the reliability and validity.
Methods
Stage one, the item pool was compiled through the literature review on chemotherapy- related gastrointestinal symptoms burden, then being selected, optimized and modified through a research on 79 professional staff who major in Oncology and Digestion, and 63 patients treated with chemotherapy, being developed into the first draft of CGISI-1, containing 21 items. Stage two, taking a cross-sectional study on the chemotherapy-related gastrointestinal symptoms burden of 1116 cases by CGISI-1, analyzing the inventory through the critical ratio, correlation analysis, internal consistent reliability, principal components factor methods, two items of mouth/throat pain and sleep were deleted. The inventory’s validity was evaluated through exploratory factor analysis and the factors and total scale correlation matrix structure, diet being deleted as a result. Comparison between the difference of gastrointestinal symptoms burden before and after chemotherapy, and the correlation analysis of symptom inventory and the QLQ-C30 symptom scale were used to to evaluate the criterion validity. The scale reliability was tested by the index of internal consistency reliability coefficients Cronbachαand test-retest reliability. The results are all in line with the target requirements, so 18 items were retained to build the second draft of CGISI-2. The third stage, the third draft of CGISI-3 containing 14 items was formed on the basis of investigating 579 cases of patients by using the CGISI-2 and deleting 4 items including the swallowing discomfort, hiccups, belching, heartburn. The fourth stage, based on the factors of CGISI-3, the data of the second stage was cross-validated. Then the scale structure was proposed through the confirmatory factor analysis of each factor, and finish the construcion of the tool for the assessment of chemotherapy-related gastrointestinal symptoms burden: CGISI .
Results
CGISI consists of symptoms occurrence and symptoms impacts. Symptoms occurrence includes 10 items of gastrointestinal symptoms, to assess the most serious degree of gastrointestinal symptoms within the last 24 hours. Symptoms impact, including four items, was used to assess the influence of gastrointestinal symptoms on patients’lives within the last 24 hours. The 10 symptoms items are divided into two factors: dietary intake factor, which includes 5 items of losing appetite, nausea, vomiting, dysgeusia, acid reflux; and digestion excretion factor, including stomach/abdominal distension, stomach/abdominal pain, dry mouth/throat, constipation, diarrhea. The level of symptom severity is from 0 to 4, which represents none, mild, moderate, much severe, extremely severe. The total score of 10 items ranges from 0 to 40. 0 means no gastrointestinal symptoms. The higher the score was, the more serious the gastrointestinal symptoms indicate. Symptoms impact is divided into 0～4 level, namely "no impact, little impact, some impact, great impact, extreme impact ". The total score ranges 0～16; 0 means no effect on life, higher score indicates greater impact on life. The scale’s overall Cronbachαcoefficient was 0.887, and the two-dimension Cronbachαcoefficients were 0.832 and 0.914, respectively. The two factors’s Cronbachαcoefficients of the symptoms occurrence dimension were 0.844 and 0.621.
Conclusions
CGISI, which has good reliability and validity, can be used as an effective assessment tool for the chemotherapy -related gastrointestinal symptoms burden.
PartⅡ: The Prevalance and Distribution of Chemotherapy-Related Gastrointe- stinal Symptoms Burden
Objective
Study the overall prevalance and distribution of gastrointestinal symptoms burden in cancer patients after Chemotherapy.
Methods
We analyzed the data of 1116 hospitalized cancer patients under venous chemotherapy with CGISI, which collected by cross-sectional surveying on the gastrointestinal symptom burden to learn the prevalence, the influential rate, the distribution of different levels of sevirity, the relation between symptom occurrence and its effects, and the number of symptoms one patient have concurrently and the common symptoms combination. And we analyzed the features of the symptom occurrence and symptom distribution on genders, age, types of disease and physical status.
Results
The prevalence of chemotherapy-related gastrointestinal symptoms fluctuates from 8% to 61.1%; the highest is in anorexia, and the lowest is diarrhea, and the mild severity is very common in symptoms distribution degrees. We find that 3.16±2.61 kinds of gastrointestinal symptoms often occur in a patient at the same time; patients with more than 2 kinds of symptoms account 66.5% (742 cases). And Loss of appetite, mouth/throat dry, nausea, dysgeusia, vomiting, constipation are the top six symptoms with the highest occurrence and count the most score. The influences of the symptoms on life were all more than 40%, among which the maximum rate is physical strenth (50.9%), with the highest degree scores (0.93±1.11).
The severity score of the following six symptoms, that is, loss of appetite, unusual taste, constipation, diarrhea, mouth/throat dry, stomach/abdominal distension have significant predictive power on the degree of symptoms impact. In the symptom scoring of different genders, females score significantly higher than males. In the group at different ages, the group whose members are in their 30s score the highest, followed by the 40s, and the group whose members are younger than 30 years old group is the lowest; and in the group whose members are aged 30 years old to 70, the score of dietary intake of each factor is apt to decrease with the age increases. Between the different diseases groups, the female reproductive system tumor group score the highest, followed by breast tumor, gastrointestinal tumor, head and neck tumor. Patients in different physical conditions, the poorer physical status have heavier gastrointestinal symptoms burden was; and it is apt to increase with the ECOG score increasing.
Conclusions
Chemotherapy–related gastrointestinal symptoms are very common, and often with coexistence of multiple symptoms and affect many aspects of patients’life. Hence, clinical attention should be payed to the overall management of chemotherapy-related gastrointestinal symptoms burden. The symptom burden occurrence and distribution are significantly different among gender, age, different tumor type, and physical status of patients. Combining these characteristics, we can do it better to discern high risk group and select key observation patients in clinical symptoms management.
PartⅢLongitudinal Survey on the Gastrointestinal Symptom Burden of Cancer Chemotherapy
Objective
To explore the entire variation tendency and impact factors of gastrointestinal symptom burden at different time points during chemotherapy.
Methods
Longitudinal survey on the gastrointestinal symptom burdens during chemotherapy was performed on 631 hospitalized patients with CGISI to know the overall tendency of symptom burden at different time. The 1st day and 5th day were the repeated measurement time points, while the types of diseases and chemotherapy programs were addressed to be treatment factors. Repeated measure of variance analysis was conducted on the symptom occurring dimensionality and symptom impact dimensionality in 356 cases to explore the time effect of symptom burden. Symptom burden at different time point was measured as response variable, while 16 impact factors as independent variables. Multivariate analysis was conducted to understand the impact factors of symptom burden.
Results
Symptom burden entirely changed wavily with the time. The lowest is on day 1, while symptom increased on day 2 to day 5, and it began to fall on the day 6 and day 7. In various symptoms, abnormal taste, mouth/throat dry, stomach/abdominal pain, stomach/abdominal distension, diarrhea, physical impact continued to increase on day 7. Repeated measures of variance analysis showed that time variation trends existed significantly in symptom occurring and impact dimensions. Time and types of diseases had significant interaction effect, while time and chemotherapy programs types of diseases and chemotherapy had no interaction effects. Finally, multivariate analysis of variance showed that six significant factors on gastrointestinal symptoms burden at different time points are types of diseases, physical performance, degree of gastrointestinal symptoms during pregnancy, tension degree about chemotherapy, gastrointestinal symptoms in former drug usage, whether having other gastrointestinal tract diseases. In types of diseases, the malignant melanoma, colorectal cancer, gastric cancer patients had the highest scores of the symptom occurring dimensions, while female reproductive system symptoms had the highest scores in symptom impact dimensions. Patients, with poor physical performance, high gastrointestinal reactions during pregnancy, high degree of intense about chemotherapy, heavy gastrointestinal reaction in previous drug usage, having other gastrointestinal diseases, have significantly higher symptom burden than patients in other groups.
Conclusions
Gastrointestinal symptom burden at different time points during chemotherapy changed significantly, with the wavy trend entirely. But the development pathway of different symptoms was not exactly same. The significant factors on gastrointestinal symptoms burden at different time points are types of diseases, physical performance score, degree of gastrointestinal symptoms during pregnancy, tension degree about chemotherapy, gastrointestinal symptoms in former drug usage, whether having other gastrointestinal tract diseases. Management of clinical symptoms should be combined with the time trends and impact factors to formulate pertinence management programs according with time.
引文
1. Cleeland CS. Symptom burden: multiple symptoms and their impact as patient-reported outcomes[J]. J Natl Cancer Inst Monogr, 2007, (37):16-21.
2. Gapstur RL. Symptom burden: a concept analysis and implications for oncology nurses[J]. Oncol Nurs Forum, 2007, 34(3):673-680.
3. Fu MR, McDaniel RW, Rhodes VA. Measuring symptom occurrence and symptom distress: development of the symptom experience index[J]. J Adv Nurs, 2007, 59(6):623-634.
4. Shoemaker LK, Estfan B, Induru R, et al. Symptom management: an important part of cancer care[J]. Cleve Clin J Med, 2011, 78(1):25-34.
5. Lee YH, Chiou PY, Chang PH, et al. A systematic review of the effectiveness of problem-solving approaches towards symptom management in cancer care[J]. J Clin Nurs, 2011, 20(1-2):73-85.
6. Griffin-Sobel JP. Symptom management of advanced colorectal cancer[J]. Surg Oncol Clin N Am, 2006, 15(1):213-222.
7. Twycross RG, Wilcock A. Symptom management in advanced cancer. 3rd edition ed. Oxford: Radcliffe Medical Press; 2001.
8. Spirig R, Fierz K. Symptom management in HIV infections[J]. Krankenpfl Soins Infirm, 2008, 101(3):30-31.
9. Hughes A. Symptom management in HIV-infected patients[J]. J Assoc Nurses AIDS Care, 2004, 15(5 Suppl):7S-13S.
10. Warwick M, Gallagher R, Chenoweth L, et al. Self-management and symptom monitoring among older adults with chronic obstructive pulmonary disease[J]. J Adv Nurs, 2010, 66(4):784-793.
11.林秋菊,張淑真,吳佳珍. Leventhal疾病詮釋概念於臨床之應用[J].護理雜誌, 2009, 56(5):87-92.
12. Allison SE. Self-care requirements for activity and rest: an Orem nursing focus[J]. Nurs Sci Q, 2007, 20(1):68-76.
13. The University of California, San Francisco School of Nursing Symptom Management Faculty Group. A model for symptom management. [J]. Image J Nurs Sch, 1994,26(4):272-276.
14. Berry DL, Trigg LJ, Lober WB, et al. Computerized symptom and quality-of-life assessment for patients with cancer part I: development and pilot testing[J]. Oncol Nurs Forum, 2004, 31(5):E75-83.
15. McDaniel RW, Rhodes VA. Symptom experience[J]. Semin Oncol Nurs, 1995, 11(4):232-234.
16. Kirkova J, Davis MP, Walsh D, et al. Cancer symptom assessment instruments: a systematic review[J]. J Clin Oncol, 2006, 24(9):1459-1473.
17. McColl E. Best practice in symptom assessment: a review[J]. Gut, 2004, 53 Suppl 4:iv49-54.
18. Hesketh PJ. Chemotherapy-induced nausea and vomiting[J]. N Engl J Med, 2008, 358(23):2482-2494.
19. Mitchell EP. Gastrointestinal toxicity of chemotherapeutic agents[J]. Semin Oncol, 2006, 33(1):106-120.
20. Wiser W, Berger A. Practical management of chemotherapy-induced nausea and vomiting[J]. Oncology-NY, 2005, 19(5):637-645.
21. Naeim A, Dy SM, Lorenz KA, et al. Evidence-based recommendations for cancer nausea and vomiting[J]. J Clin Oncol, 2008, 26(23):3903-3910.
22. Muehlbauer PM, Thorpe D, Davis A, et al. Putting Evidence Into Practice: Evidence-Based Interventions to Prevent, Manage, and Treat Chemotherapy- and Radiotherapy-Induced Diarrhea[J]. Clin J Oncol Nurs, 2009, 13(3):336-341.
23. Sharma R, Tobin P, Clarke SJ. Management of chemotherapy-induced nausea, vomiting, oral mucositis, and diarrhoea[J]. Lancet Oncol, 2005, 6(2):93-102.
24. Dranitsaris G, Maroun J, Shah A. Severe chemotherapy-induced diarrhea in patients with colorectal cancer: a cost of illness analysis[J]. Support Care Cancer, 2005, 13(5):318-324.
25. Gibson RJ, Keefe DMK. Cancer chemotherapy-induced diarrhoea and constipation: mechanisms of damage and prevention strategies[J]. Support Care Cancer, 2006, 14(9):890-900.
26. Abernethy AP, Wheeler JL, Zafar SY. Detailing of gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, new insights, and a proposedapproach[J]. Curr Opin Support Palliat Care, 2009, 3(1):41-49.
27. Fan G, Filipczak L, Chow E. Symptom clusters in cancer patients: a review of the literature[J]. Curr Oncol, 2007, 14(5):173-179.
28. Miaskowski C, Dodd M, Lee K. Symptom clusters: the new frontier in symptom management research[J]. J Natl Cancer Inst Monogr, 2004, (32):17-21.
29. Bovio G, Montagna G, Bariani C, et al. Upper gastrointestinal symptoms in patients with advanced cancer: relationship to nutritional and performance status[J]. Support Care Cancer, 2009, 17(10):1317-1324.
30. Abernethy AP, Wheeler JL, Zafar SY. Management of gastrointestinal symptoms in advanced cancer patients: the rapid learning cancer clinic model[J]. Curr Opin Support Palliat Care, 2010, 4(1):36-45.
31. Pilotto A, Maggi S, Noale M, et al. Development and validation of a new questionnaire for the evaluation of upper gastrointestinal symptoms in the elderly population: a multicenter study[J]. J Gerontol A Biol Sci Med Sci, 2010, 65(2):174-178.
32. Bovenschen HJ, Janssen MJ, van Oijen MG, et al. Evaluation of a gastrointestinal symptoms questionnaire[J]. Dig Dis Sci, 2006, 51(9):1509-1515.
33. Bardhan KD, Stanghellini V, Armstrong D, et al. International validation of ReQuest in patients with endoscopy-negative gastro-oesophageal reflux disease[J]. Digestion, 2007, 75 Suppl 1:48-54.
34. Bardhan KD, Stanghellini V, Armstrong D, et al. International validation of ReQuest in patients with endoscopy-negative gastro-oesophageal reflux disease[J]. Aliment Pharmacol Ther, 2004, 20(8):891-898.
35. Bardhan KD, Stanghellini V, Armstrong D, et al. Evaluation of GERD symptoms during therapy. Part I. Development of the new GERD questionnaire ReQuest[J]. Digestion, 2007, 75 Suppl 1:32-40.
36. Bardhan KD, Stanghellini V, Armstrong D, et al. Evaluation of GERD symptoms during therapy. Part I. Development of the new GERD questionnaire ReQuest[J]. Digestion, 2004, 69(4):229-237.
37. Sonis ST. Regimen-related gastrointestinal toxicities in cancer patients[J]. Curr Opin Support Palliat Care, 2010, 4(1):26-30.
38. Clark JA, Talcott JA. Symptom indexes to assess outcomes of treatment for earlyprostate cancer[J]. Med Care, 2001, 39(10):1118-1130.
39. Goldner G, Wachter-Gerstner N, Wachter S, et al. Acute side effects during 3-D-planned conformal radiotherapy of prostate cancer. Differences between patient's self-reported questionnaire and the corresponding doctor's report[J]. Strahlenther Onkol, 2003, 179(5):320-327.
40. Wang XS, Williams LA, Eng C, et al. Validation and application of a module of the M. D. Anderson Symptom Inventory for measuring multiple symptoms in patients with gastrointestinal cancer (the MDASI-GI)[J]. Cancer, 2010, 116(8):2053-2063.
41. Nejmi M, Wang XS, Mendoza TR, et al. Validation and application of the Arabic version of the M. D. Anderson symptom inventory in Moroccan patients with cancer[J]. J Pain Symptom Manage, 2010, 40(1):75-86.
42. Mendoza TR, Wang XS, Lu C, et al. Measuring the symptom burden of lung cancer: the validity and utility of the lung cancer module of the M. D. Anderson Symptom Inventory[J]. Oncologist, 2011, 16(2):217-227.
43. Guirimand F, Buyck JF, Lauwers-Allot E, et al. Cancer-related symptom assessment in France: validation of the French M. D. Anderson Symptom Inventory[J]. J Pain Symptom Manage, 2010, 39(4):721-733.
44. Armstrong TS, Vera-Bolanos E, Gning I, et al. The impact of symptom interference using the MD Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT) on prediction of recurrence in primary brain cancer patients[J]. Cancer, 2011.
45. Armstrong TS, Gning I, Mendoza TR, et al. Reliability and validity of the M. D. Anderson Symptom Inventory-Spine Tumor Module[J]. J Neurosurg Spine, 2010, 12(4):421-430.
46. Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory[J]. Cancer, 2000, 89(7):1634-1646.
47. Brown V, Sitzia J, Richardson A, et al. The development of the Chemotherapy Symptom Assessment Scale (C-SAS): a scale for the routine clinical assessment of the symptom experiences of patients receiving cytotoxic chemotherapy[J]. Int J Nurs Stud, 2001, 38(5):497-510.
48. Sitzia J, Dikken C, Hughes J. Psychometric evaluation of a questionnaire to document side-effects of chemotherapy[J]. J Adv Nurs, 1997, 25(5):999-1007.
49. Kearney N, McCann L, Norrie J, et al. Evaluation of a mobile phone-based, advanced symptom management system (ASyMS) in the management of chemotherapy-related toxicity[J]. Support Care Cancer, 2009, 17(4):437-444.
50.吴明隆.问卷统计分析实务-SPSS操作与应用[M].第一版.重庆:重庆大学出版社; 2010.
51.戴海崎,张锋,陈雪枫.心理与教育测量[M].第一版.广州:暨南大学出版社; 2007.
52.吴明隆.结构方程模型-AMOS的操作与应用[M].第一版.重庆:重庆大学出版社; 2010.
53. Wang XS, Wang Y, Guo H, et al. Chinese version of the M. D. Anderson Symptom Inventory: validation and application of symptom measurement in cancer patients[J]. Cancer, 2004, 101(8):1890-1901.
54.马玲.乳腺癌患者疼痛、相关症状与生活质量的调查研究[D].成都:四川大学; 2006.
55.万崇华,罗家洪,杨铮, et al.癌症患者生命质量测定与应用[M].第一版.北京:科学出版社; 2007.
56. Barresi MJ, Shadbolt B, Byrne D, et al. The development of the Canberra symptom scorecard: a tool to monitor the physical symptoms of patients with advanced tumours[J]. BMC Cancer, 2003, 3:32.
57. Edwards P, Roberts I, Clarke M, et al. Increasing response rates to postal questionnaires: systematic review[J]. BMJ, 2002, 324(7347):1183.
58.裴磊磊,张岩波,仇丽霞, et al.量表分析中的缺失值估算[J].现代疾病医学, 2009, 36(1):15-18.
59. Jimenez A, Madero R, Alonso A, et al. Symptom Clusters in Advanced Cancer[J]. J Pain Symptom Manage, 2011.
60. Xiao C. The state of science in the study of cancer symptom clusters[J]. Eur J Oncol Nurs, 2010, 14(5):417-434.
61. Kirkova J, Aktas A, Walsh D, et al. Consistency of symptom clusters in advanced cancer[J]. Am J Hosp Palliat Care, 2010, 27(5):342-346.
62. Karabulu N, Erci B, Ozer N, et al. Symptom clusters and experiences of patients with cancer[J]. J Adv Nurs, 2010, 66(5):1011-1021.
63. Hunter MS, Grunfeld EA, Mittal S, et al. Menopausal symptoms in women with breast cancer: prevalence and treatment preferences[J]. Psychooncology, 2004, 13(11): 769-778.
64. Komurcu S, Nelson KA, Walsh D, et al. Gastrointestinal symptoms among inpatients with advanced cancer[J]. Am J Hosp Palliat Care, 2002, 19(5):351-355.
65. Hsiao CP, Loescher LJ, Moore IM. Symptoms and symptom distress in localized prostate cancer[J]. Cancer Nurs, 2007, 30(6):E19-32.
66.罗兰,斯基尔,于世英.癌症化疗手册[M].第六版.北京:科学出版社; 2005.
67. Komurcu S, Nelson KA, Walsh D. The gastrointestinal symptoms of advanced cancer[J]. Support Care Cancer, 2001, 9(1):32-39.
68. Carpenter JS, Rawl S, Porter J, et al. Oncology outpatient and provider responses to a computerized symptom assessment system[J]. Oncol Nurs Forum, 2008, 35(4): 661-669.
69. Jensen AA, Davies PA, Brauner-Osborne H, et al. 3B but which 3B? And that's just one of the questions: the heterogeneity of human 5-HT3 receptors[J]. Trends in pharmacological sciences, 2008, 29(9):437-444.
70. Booth C, Clemons M, Dranitsaris G, et al. Chemotherapy induced nausea and vomiting (CINV) in breast cancer patients: a prospective observational study[J]. Breast Cancer Res Treat, 2006, 100:S285-S285.
71. Arnold RJ, Gabrail N, Raut M, et al. Clinical implications of chemotherapy-induced diarrhea in patients with cancer[J]. J Support Oncol, 2005, 3(3):227-232.
72. Keefe DM. Mucositis management in patients with cancer[J]. Support Cancer Ther, 2006, 3(3):154-157.
73. Nelson K, Walsh D, Sheehan F. Cancer and chemotherapy-related upper gastrointestinal symptoms: the role of abnormal gastric motor function and its evaluation in cancer patients[J]. Support Care Cancer, 2002, 10(6):455-461.
74. Riezzo G, Clemente C, Leo S, et al. The role of electrogastrography and gastrointestinal hormones in chemotherapy-related dyspeptic symptoms[J]. J Gastroenterol, 2005, 40(12):1107-1115.
75. Sharma R, Tobin P, Clarke SJ. Management of chemotherapy-induced nausea, vomiting, oral mucositis, and diarrhoea[J]. Lancet Oncol, 2005, 6(2):93-102.
76. Jordan K, Sippel C, Schmoll HJ. Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations [J]. Oncologist, 2007, 12(9):1143-1150.
77. Hickok JT, Roscoe JA, Morrow GR, et al. Nausea and emesis remain significant problems of chemotherapy despite prophylaxis with 5-hydroxytryptamine-3 antiemetics -A University of Rochester James P. Wilmot Cancer Center community clinical oncology program study of 360 cancer patients treated in the community[J]. Cancer, 2003, 97(11):2880-2886.
78. Gibson RJ, Keefe DM. Cancer chemotherapy-induced diarrhoea and constipation: mechanisms of damage and prevention strategies[J]. Support Care Cancer, 2006, 14(9):890-900.
79. Andreyev HJ. A physiological approach to modernize the management of cancer chemotherapy-induced gastrointestinal toxicity[J]. Curr Opin Support Palliat Care, 2010, 4(1):19-25.
80. Munro AJ, Potter S. A quantitative approach to the distress caused by symptoms in patients treated with radical radiotherapy[J]. Br J Cancer, 1996, 74(4):640-647.
81. Hesketh P. Drug Therapy: Chemotherapy-Induced Nausea and Vomiting[J]. N Engl J Med, 2008, 358(23):2482-2494.
82. Jakobsen JN, Herrstedt J. Prevention of chemotherapy-induced nausea and vomiting in elderly cancer patients[J]. Crit Rev Oncol/Hematol, 2009, 71(3):214-221.
83. Wilson JA. Constipation in the elderly[J]. Clin Geriatr Med, 1999, 15(3):499-510.
84. Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options[J]. Clin Interv Aging, 2010, 5:163-171.
85.姚云云,胡佩诚.积极综合训练对妇科肿瘤患者的心理干预效果[J]. Zxws, 2009, 23(11):780-783.
86.张新,王伊洵.妇科肿瘤与激素[J].中国实用妇科与产科杂志, 2000, 16(6).
87. Molassiotis A, Coventry PA, Stricker CT, et al. Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: The MASCC antiemesis tool[J]. J Pain Symptom Manage, 2007, 34(2):148-159.
88. Ng WL, Della-Fiorentina SA. The efficacy of oral ondansetron and dexamethasone forthe prevention of acute chemotherapy-induced nausea and vomiting associated with moderately emetogenic chemotherapy - a retrospective audit[J]. Eur J Cancer Care, 19(3):403-407.
89. Schnell FM. Chemotherapy-induced nausea and vomiting: the importance of acute antiemetic control[J]. Oncologist, 2003, 8(2):187-198.
90.张毓武,刘桂芬.重复测量资料的设计与分析[J].山西医药杂志, 1999, 28(2):167-168.
91.周际昌.实用肿瘤内科学[M].第二版.北京:人民卫生出版社; 2010.
92.董英,赵耐青.重复测量资料方差分析中主效应意义的探讨[J].复旦学报, 2005, 32(6):682-686.
93.字传华. SPSS与统计分析[M].第一版.北京:电子工业出版社; 2007.
94.邱宏,金如锋,赵玲, et al.用SPSS11.0实现对重复测量资料的方差分析[J].数理医药学杂志, 2006, 19(2):162-165.
95. Ihbe-Heffinger A, Ehlken B, Bernard R, et al. The impact of delayed chemotherapy-induced nausea and vomiting on patients, health resource utilization and costs in German cancer centers[J]. Ann Oncol, 2004, 15(3):526-536.
96. Bloechl-Daum B, Deuson RR, Mavros P, et al. Delayed nausea and vomiting continue to reduce patients' quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment[J]. J Clin Oncol, 2006, 24(27):4472-4478.
97. Miller M, Kearney N. Chemotherapy-related nausea and vomiting - past reflections, present practice and future management[J]. Eur J Cancer Care, 2004, 13(1):71-81.
98. Oo TH, Hesketh PJ. Drug insight: New antiemetics in the management of chemotherapy-induced nausea and vomiting[J]. Nat Clin Pract Oncol, 2005, 2(4):196-201.
99. Logan RM, Stringer AM, Bowen JM, et al. Is the pathobiology of chemotherapy-induced alimentary tract mucositis influenced by the type of mucotoxic drug administered[J]. Cancer Chemother Pharmacol, 2009, 63(2):239-251.
100. Sonis ST. The pathobiology of mucositis[J]. Nat Rev Cancer, 2004, 4(4):277-284.
101. Van Glabbeke M, Verweij J, Casali PG, et al. Predicting toxicities for patients with advanced gastrointestinal stromal tumours treated with imatinib: a study of the European Organisation for Research and Treatment of Cancer, the Italian SarcomaGroup, and the Australasian Gastro-Intestinal Trials Group (EORTC-ISG-AGITG)[J]. Eur J Cancer, 2006, 42(14):2277-2285.
102. Nomura H, Kawakami H, Nagai S, et al. Predictive factors of nausea/vomiting of breast cancer patients receiving FEC and AC chemotherapy[J]. Gan To Kagaku Ryoho, 2008, 35(6):941-946.
103. Perez Ruixo J, Llopis Garcia M, Casabo Alos V, et al. Risk Factors associated with post-chemotherapy vomiting in patients with breast cancer (II): analysis of the duration of emesis[J]. Farm Hosp, 2002, 26(5):275-282.
104. Watson M, Meyer L, Thomson A, et al. Psychological factors predicting nausea and vomiting in breast cancer patients on chemotherapy[J]. Eur J Cancer, 1998, 34(6):831-837.
105. Goodman M. Risk factors and antiemetic management of chemotherapy-induced nausea and vomiting[J]. Oncol Nurs Forum, 1997, 24(7 Suppl):20-32.
1. Yarbro CH, Frogge MH, Goodman M. Cancer Symptom Management[M].Third Edition. Jones and Bartlett Publishers, Inc; 2004.
2. Worcester M, Pesznecker B, Albert M, et al. Cancer symptom management in the elderly[J]. Home Health Care Serv Q, 1991, 12(2):53-169.
3. Sloan JA, Berk L, Roscoe J, et al. Integrating patient-reported outcomes into cancer symptom management clinical trials supported by the National Cancer Institute-sponsored clinical trials networks[J]. J Clin Oncol, 2007, 25(32):5070-5077.
4. Fu MR, McDaniel RW, Rhodes VA. Measuring symptom occurrence and symptom distress: development of the symptom experience index[J]. J Adv Nurs, 2007, 59(6):623-634.
5.林秋菊,張淑真,吳佳珍. Leventhal疾病詮釋概念於臨床之應用[J].護理雜誌, 2009, 56(5):87-92.
6. Allison SE. Self-care requirements for activity and rest: an Orem nursing focus[J]. NursSci Q, 2007, 20(1):68-76.
7. The University of California, San Francisco School of Nursing Symptom Management Faculty Group. A model for symptom management. [J]. Image J Nurs Sch, 1994, 26(4):272-276.
8. Bruner DW. Outcomes research in cancer symptom management trials: the Radiation Therapy Oncology Group (RTOG) conceptual model[J]. J Natl Cancer Inst Monogr, 2007, (37):12-15.
9. Tang PL, Wang C, Hung MF, et al. Assessment of Symptom Distress in Cancer Patients Before and After Radiotherapy[J]. Cancer Nurs, 2010. [Epub ahead of print]
10. Pieters BR, Rezaie E, Geijsen ED, et al. Development of Late Toxicity and International Prostate Symptom Score Resolution After External-Beam Radiotherapy Combined with Pulsed Dose Rate Brachytherapy for Prostate Cancer[J]. Int J Radiat Oncol Biol Phys, 2010. [Epub ahead of print]
11. Malik R, Jani AB, Liauw SL. External Beam Radiotherapy for Prostate Cancer: Urinary Outcomes for Men with High International Prostate Symptom Scores (IPSS)[J]. Int J Radiat Oncol Biol Phys, 2010. [Epub ahead of print]
12. Yost KJ, Yount SE, Eton DT, et al. Validation of the Functional Assessment of Cancer Therapy-Breast Symptom Index (FBSI)[J]. Breast Cancer Res Treat, 2005, 90(3):295-298.
13. Hollen PJ, Gralla RJ, Liepa AM, et al. Adapting the Lung Cancer Symptom Scale (LCSS) to mesothelioma: using the LCSS-Meso conceptual model for validation[J]. Cancer, 2004, 101(3):587-595.
14. Fallowfield LJ, Leaity SK, Howell A, et al. Assessment of quality of life in women undergoing hormonal therapy for breast cancer: validation of an endocrine symptom subscale for the FACT-B[J]. Breast Cancer Res Treat, 1999, 55(2):189-199.
15. Stanton AL, Bernaards CA, Ganz PA. The BCPT symptom scales: a measure of physical symptoms for women diagnosed with or at risk for breast cancer[J]. J Natl Cancer Inst, 2005, 97(6):448-456.
16. Rao D, Butt Z, Rosenbloom S, et al. A Comparison of the Renal Cell Carcinoma-Symptom Index (RCC-SI) and the Functional Assessment of Cancer Therapy-Kidney Symptom Index (FKSI)[J]. J Pain Symptom Manage, 2009,38(2):291-298.
17. Koensgen D, Oskay-Oezcelik G, Katsares I, et al. Development of the Berlin Symptom Checklist Ovary (BSCL-O) for the measurement of quality of life of patients with primary and recurrent ovarian cancer: results of a phase I and II study[J]. Support Care Cancer, 2010, 18(8):931-942.
18. Cella D. The Functional Assessment of Cancer Therapy-Lung and Lung Cancer Subscale assess quality of life and meaningful symptom improvement in lung cancer[J]. Semin Oncol, 2004, 31(3 Suppl 9):11-15.
19. Potter J, Higginson IJ, Scadding JW, et al. Identifying neuropathic pain in patients with head and neck cancer: use of the Leeds Assessment of Neuropathic Symptoms and Signs Scale[J]. J R Soc Med, 2003, 96(8):379-383.
20. Batista-Miranda JE, Molinuevo B, Pardo Y. Impact of lower urinary tract symptoms on quality of life using Functional Assessment Cancer Therapy scale[J]. Urology, 2007, 69(2):285-288.
21. Kirkova J, Davis MP, Walsh D, et al. Cancer symptom assessment instruments: a systematic review[J]. J Clin Oncol, 2006, 24(9):1459-1473.
22. Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory[J]. Cancer, 2000, 89(7):1634-1646.
23. Sarna L. Effectiveness of structured nursing assessment of symptom distress in advanced lung cancer[J]. Oncol Nurs Forum, 1998, 25(6):1041-1048.
24. Boehmke MM. Measurement of symptom distress in women with early-stage breast cancer[J]. Cancer Nurs, 2004, 27(2):144-152.
25. Shelby RA, Golden-Kreutz DM, Andersen BL. Mismatch of posttraumatic stress disorder (PTSD) symptoms and DSM-IV symptom clusters in a cancer sample: exploratory factor analysis of the PTSD Checklist-Civilian Version[J]. J Trauma Stress, 2005, 18(4):347-357.
26. Hockenberry M, Hooke MC. Symptom clusters in children with cancer[J]. Semin Oncol Nurs, 2007, 23(2):152-157.
27. Collins JJ, Devine TD, Dick GS, et al. The measurement of symptoms in young children with cancer: the validation of the Memorial Symptom Assessment Scale in children aged 7-12[J]. J Pain Symptom Manage, 2002, 23(1):10-16.
28. Collins JJ, Byrnes ME, Dunkel IJ, et al. The measurement of symptoms in children with cancer[J]. J Pain Symptom Manage, 2000, 19(5):363-377.
29. Rao A, Cohen HJ. Symptom management in the elderly cancer patient: fatigue, pain, and depression[J]. J Natl Cancer Inst Monogr, 2004, (32):150-157.
30. Winell J, Roth AJ. Psychiatric assessment and symptom management in elderly cancer patients[J]. Oncology (Williston Park), 2005, 19(11):1479-1490; discussion 1492, 1497, 1501-1477.
31. Maestu I, Munoz J, Gomez-Aldaravi L, et al. Assessment of functional status, symptoms and comorbidity in elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with gemcitabine and vinorelbine[J]. Clin Transl Oncol, 2007, 9(2):99-105.
32. Lowe KA, Andersen MR, Urban N, et al. The temporal stability of the Symptom Index among women at high-risk for ovarian cancer[J]. Gynecol Oncol, 2009, 114(2): 225-230.
33. Cella D, Land SR, Chang CH, et al. Symptom measurement in the Breast Cancer Prevention Trial (BCPT) (P-1): psychometric properties of a new measure of symptoms for midlife women[J]. Breast Cancer Res Treat, 2008, 109(3):515-526.
34. Janz NK, Mujahid M, Chung LK, et al. Symptom experience and quality of life of women following breast cancer treatment[J]. J Womens Health (Larchmt), 2007, 16(9):1348-1361.
35. Gupta P, Sturdee DW, Palin SL, et al. Menopausal symptoms in women treated for breast cancer: the prevalence and severity of symptoms and their perceived effects on quality of life[J]. Climacteric, 2006, 9(1):49-58.
36. McColl E. Best practice in symptom assessment: a review[J]. Gut, 2004, 53 Suppl 4:iv49-54.
37. Wilkie DJ, Kim YO, Suarez ML, et al. Extending computer technology to hospice research: interactive pentablet measurement of symptoms by hospice cancer patients in their homes[J]. J Palliat Med, 2009, 12(7):599-602.
38. Ruland CM, White T, Stevens M, et al. Effects of a computerized system to support shared decision making in symptom management of cancer patients: preliminary results[J]. J Am Med Inform Assoc, 2003, 10(6):573-579.
39. Mullen KH, Berry DL, Zierler BK. Computerized symptom and quality-of-life assessment for patients with cancer part II: acceptability and usability[J]. Oncol Nurs Forum, 2004, 31(5):E84-89.
40. Berry DL, Trigg LJ, Lober WB, et al. Computerized symptom and quality-of-life assessment for patients with cancer part I: development and pilot testing[J]. Oncol Nurs Forum, 2004, 31(5):E75-83.
41. Fortner B, Okon T, Schwartzberg L, et al. The Cancer Care Monitor: psychometric content evaluation and pilot testing of a computer administered system for symptom screening and quality of life in adult cancer patients[J]. J Pain Symptom Manage, 2003, 26(6):1077-1092.
42. Tseng TH, Cleeland CS, Wang XS, et al. Assessing cancer symptoms in adolescents with cancer using the Taiwanese version of the M. D. Anderson Symptom Inventory[J]. Cancer Nurs, 2008, 31(3):E9-16.
43. Guirimand F, Buyck JF, Lauwers-Allot E, et al. Cancer-related symptom assessment in France: validation of the French M. D. Anderson Symptom Inventory[J]. J Pain Symptom Manage, 2010, 39(4):721-733.
44. Ivanova MO, Ionova TI, Kalyadina SA, et al. Cancer-related symptom assessment in Russia: validation and utility of the Russian M. D. Anderson Symptom Inventory[J]. J Pain Symptom Manage, 2005, 30(5):443-453.
45. Lin CC, Chang AP, Cleeland CS, et al. Taiwanese version of the M. D. Anderson symptom inventory: symptom assessment in cancer patients[J]. J Pain Symptom Manage, 2007, 33(2):180-188.
46. Nejmi M, Wang XS, Mendoza TR, et al. Validation and application of the Arabic version of the M. D. Anderson symptom inventory in Moroccan patients with cancer[J]. J Pain Symptom Manage, 2010, 40(1):75-86.
47. Cheng KK, Wong EM, Ling WM, et al. Measuring the symptom experience of Chinese cancer patients: a validation of the Chinese version of the memorial symptom assessment scale[J]. J Pain Symptom Manage, 2009, 37(1):44-57.
48. Wang XS, Wang Y, Guo H, et al. Chinese version of the M. D. Anderson Symptom Inventory: validation and application of symptom measurement in cancer patients[J]. Cancer, 2004, 101(8):1890-1901.
49. Tseng TH, Cleeland CS, Wang XS, et al. Assessing cancer symptoms in adolescents with cancer using the Taiwanese version of the M. D. Anderson Symptom Inventory[J]. Cancer Nurs, 2008, 31(3):E9-16.
50. Rheingans JI. A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer[J]. J Pediatr Oncol Nurs, 2007, 24(2):81-94.
51. Lorenz KA, Lynn J, Dy S, et al. Quality measures for symptoms and advance care planning in cancer: a systematic review[J]. J Clin Oncol, 2006, 24(30):4933-4938.
52. Fan G, Filipczak L, Chow E. Symptom clusters in cancer patients: a review of the literature[J]. Curr Oncol, 2007, 14(5):173-179.
53. Paice JA. Assessment of symptom clusters in people with cancer[J]. J Natl Cancer Inst Monogr, 2004, (32):98-102.
54. Heedman PA, Strang P. Symptom assessment in advanced palliative home care for cancer patients using the ESAS: clinical aspects[J]. Anticancer Res, 2001, 21(6A): 4077-4082.
55. Naughton M, Homsi J. Symptom assessment in cancer patients[J]. Curr Oncol Rep, 2002, 4(3):256-263.
56. Pautex S, Berger A, Chatelain C, et al. Symptom assessment in elderly cancer patients receiving palliative care[J]. Crit Rev Oncol Hematol, 2003, 47(3):281-286.
57. Sherman DW, Ye XY, Beyer McSherry C, et al. Symptom assessment of patients with advanced cancer and AIDS and their family caregivers: the results of a quality-of-life pilot study[J]. Am J Hosp Palliat Care, 2007, 24(5):350-365.
58. de Haes JC, van Knippenberg FC, Neijt JP. Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist[J]. Br J Cancer, 1990, 62(6):1034-1038.
59. Lobchuk MM. The memorial symptom assessment scale: modified for use in understanding family caregivers' perceptions of cancer patients' symptom experiences[J]. J Pain Symptom Manage, 2003, 26(1):644-654.
2. Gapstur RL. Symptom burden: a concept analysis and implications for oncology nurses[J]. Oncol Nurs Forum, 2007, 34(3):673-680.
3. Fu MR, McDaniel RW, Rhodes VA. Measuring symptom occurrence and symptom distress: development of the symptom experience index[J]. J Adv Nurs, 2007, 59(6):623-634.
4. Shoemaker LK, Estfan B, Induru R, et al. Symptom management: an important part of cancer care[J]. Cleve Clin J Med, 2011, 78(1):25-34.
5. Lee YH, Chiou PY, Chang PH, et al. A systematic review of the effectiveness of problem-solving approaches towards symptom management in cancer care[J]. J Clin Nurs, 2011, 20(1-2):73-85.
6. Griffin-Sobel JP. Symptom management of advanced colorectal cancer[J]. Surg Oncol Clin N Am, 2006, 15(1):213-222.
7. Twycross RG, Wilcock A. Symptom management in advanced cancer. 3rd edition ed. Oxford: Radcliffe Medical Press; 2001.
8. Spirig R, Fierz K. Symptom management in HIV infections[J]. Krankenpfl Soins Infirm, 2008, 101(3):30-31.
9. Hughes A. Symptom management in HIV-infected patients[J]. J Assoc Nurses AIDS Care, 2004, 15(5 Suppl):7S-13S.
10. Warwick M, Gallagher R, Chenoweth L, et al. Self-management and symptom monitoring among older adults with chronic obstructive pulmonary disease[J]. J Adv Nurs, 2010, 66(4):784-793.
11.林秋菊,張淑真,吳佳珍. Leventhal疾病詮釋概念於臨床之應用[J].護理雜誌, 2009, 56(5):87-92.
12. Allison SE. Self-care requirements for activity and rest: an Orem nursing focus[J]. Nurs Sci Q, 2007, 20(1):68-76.
13. The University of California, San Francisco School of Nursing Symptom Management Faculty Group. A model for symptom management. [J]. Image J Nurs Sch, 1994,26(4):272-276.
14. Berry DL, Trigg LJ, Lober WB, et al. Computerized symptom and quality-of-life assessment for patients with cancer part I: development and pilot testing[J]. Oncol Nurs Forum, 2004, 31(5):E75-83.
15. McDaniel RW, Rhodes VA. Symptom experience[J]. Semin Oncol Nurs, 1995, 11(4):232-234.
16. Kirkova J, Davis MP, Walsh D, et al. Cancer symptom assessment instruments: a systematic review[J]. J Clin Oncol, 2006, 24(9):1459-1473.
17. McColl E. Best practice in symptom assessment: a review[J]. Gut, 2004, 53 Suppl 4:iv49-54.
18. Hesketh PJ. Chemotherapy-induced nausea and vomiting[J]. N Engl J Med, 2008, 358(23):2482-2494.
19. Mitchell EP. Gastrointestinal toxicity of chemotherapeutic agents[J]. Semin Oncol, 2006, 33(1):106-120.
20. Wiser W, Berger A. Practical management of chemotherapy-induced nausea and vomiting[J]. Oncology-NY, 2005, 19(5):637-645.
21. Naeim A, Dy SM, Lorenz KA, et al. Evidence-based recommendations for cancer nausea and vomiting[J]. J Clin Oncol, 2008, 26(23):3903-3910.
22. Muehlbauer PM, Thorpe D, Davis A, et al. Putting Evidence Into Practice: Evidence-Based Interventions to Prevent, Manage, and Treat Chemotherapy- and Radiotherapy-Induced Diarrhea[J]. Clin J Oncol Nurs, 2009, 13(3):336-341.
23. Sharma R, Tobin P, Clarke SJ. Management of chemotherapy-induced nausea, vomiting, oral mucositis, and diarrhoea[J]. Lancet Oncol, 2005, 6(2):93-102.
24. Dranitsaris G, Maroun J, Shah A. Severe chemotherapy-induced diarrhea in patients with colorectal cancer: a cost of illness analysis[J]. Support Care Cancer, 2005, 13(5):318-324.
25. Gibson RJ, Keefe DMK. Cancer chemotherapy-induced diarrhoea and constipation: mechanisms of damage and prevention strategies[J]. Support Care Cancer, 2006, 14(9):890-900.
26. Abernethy AP, Wheeler JL, Zafar SY. Detailing of gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, new insights, and a proposedapproach[J]. Curr Opin Support Palliat Care, 2009, 3(1):41-49.
27. Fan G, Filipczak L, Chow E. Symptom clusters in cancer patients: a review of the literature[J]. Curr Oncol, 2007, 14(5):173-179.
28. Miaskowski C, Dodd M, Lee K. Symptom clusters: the new frontier in symptom management research[J]. J Natl Cancer Inst Monogr, 2004, (32):17-21.
29. Bovio G, Montagna G, Bariani C, et al. Upper gastrointestinal symptoms in patients with advanced cancer: relationship to nutritional and performance status[J]. Support Care Cancer, 2009, 17(10):1317-1324.
30. Abernethy AP, Wheeler JL, Zafar SY. Management of gastrointestinal symptoms in advanced cancer patients: the rapid learning cancer clinic model[J]. Curr Opin Support Palliat Care, 2010, 4(1):36-45.
31. Pilotto A, Maggi S, Noale M, et al. Development and validation of a new questionnaire for the evaluation of upper gastrointestinal symptoms in the elderly population: a multicenter study[J]. J Gerontol A Biol Sci Med Sci, 2010, 65(2):174-178.
32. Bovenschen HJ, Janssen MJ, van Oijen MG, et al. Evaluation of a gastrointestinal symptoms questionnaire[J]. Dig Dis Sci, 2006, 51(9):1509-1515.
33. Bardhan KD, Stanghellini V, Armstrong D, et al. International validation of ReQuest in patients with endoscopy-negative gastro-oesophageal reflux disease[J]. Digestion, 2007, 75 Suppl 1:48-54.
34. Bardhan KD, Stanghellini V, Armstrong D, et al. International validation of ReQuest in patients with endoscopy-negative gastro-oesophageal reflux disease[J]. Aliment Pharmacol Ther, 2004, 20(8):891-898.
35. Bardhan KD, Stanghellini V, Armstrong D, et al. Evaluation of GERD symptoms during therapy. Part I. Development of the new GERD questionnaire ReQuest[J]. Digestion, 2007, 75 Suppl 1:32-40.
36. Bardhan KD, Stanghellini V, Armstrong D, et al. Evaluation of GERD symptoms during therapy. Part I. Development of the new GERD questionnaire ReQuest[J]. Digestion, 2004, 69(4):229-237.
37. Sonis ST. Regimen-related gastrointestinal toxicities in cancer patients[J]. Curr Opin Support Palliat Care, 2010, 4(1):26-30.
38. Clark JA, Talcott JA. Symptom indexes to assess outcomes of treatment for earlyprostate cancer[J]. Med Care, 2001, 39(10):1118-1130.
39. Goldner G, Wachter-Gerstner N, Wachter S, et al. Acute side effects during 3-D-planned conformal radiotherapy of prostate cancer. Differences between patient's self-reported questionnaire and the corresponding doctor's report[J]. Strahlenther Onkol, 2003, 179(5):320-327.
40. Wang XS, Williams LA, Eng C, et al. Validation and application of a module of the M. D. Anderson Symptom Inventory for measuring multiple symptoms in patients with gastrointestinal cancer (the MDASI-GI)[J]. Cancer, 2010, 116(8):2053-2063.
41. Nejmi M, Wang XS, Mendoza TR, et al. Validation and application of the Arabic version of the M. D. Anderson symptom inventory in Moroccan patients with cancer[J]. J Pain Symptom Manage, 2010, 40(1):75-86.
42. Mendoza TR, Wang XS, Lu C, et al. Measuring the symptom burden of lung cancer: the validity and utility of the lung cancer module of the M. D. Anderson Symptom Inventory[J]. Oncologist, 2011, 16(2):217-227.
43. Guirimand F, Buyck JF, Lauwers-Allot E, et al. Cancer-related symptom assessment in France: validation of the French M. D. Anderson Symptom Inventory[J]. J Pain Symptom Manage, 2010, 39(4):721-733.
44. Armstrong TS, Vera-Bolanos E, Gning I, et al. The impact of symptom interference using the MD Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT) on prediction of recurrence in primary brain cancer patients[J]. Cancer, 2011.
45. Armstrong TS, Gning I, Mendoza TR, et al. Reliability and validity of the M. D. Anderson Symptom Inventory-Spine Tumor Module[J]. J Neurosurg Spine, 2010, 12(4):421-430.
46. Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory[J]. Cancer, 2000, 89(7):1634-1646.
47. Brown V, Sitzia J, Richardson A, et al. The development of the Chemotherapy Symptom Assessment Scale (C-SAS): a scale for the routine clinical assessment of the symptom experiences of patients receiving cytotoxic chemotherapy[J]. Int J Nurs Stud, 2001, 38(5):497-510.
48. Sitzia J, Dikken C, Hughes J. Psychometric evaluation of a questionnaire to document side-effects of chemotherapy[J]. J Adv Nurs, 1997, 25(5):999-1007.
49. Kearney N, McCann L, Norrie J, et al. Evaluation of a mobile phone-based, advanced symptom management system (ASyMS) in the management of chemotherapy-related toxicity[J]. Support Care Cancer, 2009, 17(4):437-444.
50.吴明隆.问卷统计分析实务-SPSS操作与应用[M].第一版.重庆:重庆大学出版社; 2010.
51.戴海崎,张锋,陈雪枫.心理与教育测量[M].第一版.广州:暨南大学出版社; 2007.
52.吴明隆.结构方程模型-AMOS的操作与应用[M].第一版.重庆:重庆大学出版社; 2010.
53. Wang XS, Wang Y, Guo H, et al. Chinese version of the M. D. Anderson Symptom Inventory: validation and application of symptom measurement in cancer patients[J]. Cancer, 2004, 101(8):1890-1901.
54.马玲.乳腺癌患者疼痛、相关症状与生活质量的调查研究[D].成都:四川大学; 2006.
55.万崇华,罗家洪,杨铮, et al.癌症患者生命质量测定与应用[M].第一版.北京:科学出版社; 2007.
56. Barresi MJ, Shadbolt B, Byrne D, et al. The development of the Canberra symptom scorecard: a tool to monitor the physical symptoms of patients with advanced tumours[J]. BMC Cancer, 2003, 3:32.
57. Edwards P, Roberts I, Clarke M, et al. Increasing response rates to postal questionnaires: systematic review[J]. BMJ, 2002, 324(7347):1183.
58.裴磊磊,张岩波,仇丽霞, et al.量表分析中的缺失值估算[J].现代疾病医学, 2009, 36(1):15-18.
59. Jimenez A, Madero R, Alonso A, et al. Symptom Clusters in Advanced Cancer[J]. J Pain Symptom Manage, 2011.
60. Xiao C. The state of science in the study of cancer symptom clusters[J]. Eur J Oncol Nurs, 2010, 14(5):417-434.
61. Kirkova J, Aktas A, Walsh D, et al. Consistency of symptom clusters in advanced cancer[J]. Am J Hosp Palliat Care, 2010, 27(5):342-346.
62. Karabulu N, Erci B, Ozer N, et al. Symptom clusters and experiences of patients with cancer[J]. J Adv Nurs, 2010, 66(5):1011-1021.
63. Hunter MS, Grunfeld EA, Mittal S, et al. Menopausal symptoms in women with breast cancer: prevalence and treatment preferences[J]. Psychooncology, 2004, 13(11): 769-778.
64. Komurcu S, Nelson KA, Walsh D, et al. Gastrointestinal symptoms among inpatients with advanced cancer[J]. Am J Hosp Palliat Care, 2002, 19(5):351-355.
65. Hsiao CP, Loescher LJ, Moore IM. Symptoms and symptom distress in localized prostate cancer[J]. Cancer Nurs, 2007, 30(6):E19-32.
66.罗兰,斯基尔,于世英.癌症化疗手册[M].第六版.北京:科学出版社; 2005.
67. Komurcu S, Nelson KA, Walsh D. The gastrointestinal symptoms of advanced cancer[J]. Support Care Cancer, 2001, 9(1):32-39.
68. Carpenter JS, Rawl S, Porter J, et al. Oncology outpatient and provider responses to a computerized symptom assessment system[J]. Oncol Nurs Forum, 2008, 35(4): 661-669.
69. Jensen AA, Davies PA, Brauner-Osborne H, et al. 3B but which 3B? And that's just one of the questions: the heterogeneity of human 5-HT3 receptors[J]. Trends in pharmacological sciences, 2008, 29(9):437-444.
70. Booth C, Clemons M, Dranitsaris G, et al. Chemotherapy induced nausea and vomiting (CINV) in breast cancer patients: a prospective observational study[J]. Breast Cancer Res Treat, 2006, 100:S285-S285.
71. Arnold RJ, Gabrail N, Raut M, et al. Clinical implications of chemotherapy-induced diarrhea in patients with cancer[J]. J Support Oncol, 2005, 3(3):227-232.
72. Keefe DM. Mucositis management in patients with cancer[J]. Support Cancer Ther, 2006, 3(3):154-157.
73. Nelson K, Walsh D, Sheehan F. Cancer and chemotherapy-related upper gastrointestinal symptoms: the role of abnormal gastric motor function and its evaluation in cancer patients[J]. Support Care Cancer, 2002, 10(6):455-461.
74. Riezzo G, Clemente C, Leo S, et al. The role of electrogastrography and gastrointestinal hormones in chemotherapy-related dyspeptic symptoms[J]. J Gastroenterol, 2005, 40(12):1107-1115.
75. Sharma R, Tobin P, Clarke SJ. Management of chemotherapy-induced nausea, vomiting, oral mucositis, and diarrhoea[J]. Lancet Oncol, 2005, 6(2):93-102.
76. Jordan K, Sippel C, Schmoll HJ. Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations [J]. Oncologist, 2007, 12(9):1143-1150.
77. Hickok JT, Roscoe JA, Morrow GR, et al. Nausea and emesis remain significant problems of chemotherapy despite prophylaxis with 5-hydroxytryptamine-3 antiemetics -A University of Rochester James P. Wilmot Cancer Center community clinical oncology program study of 360 cancer patients treated in the community[J]. Cancer, 2003, 97(11):2880-2886.
78. Gibson RJ, Keefe DM. Cancer chemotherapy-induced diarrhoea and constipation: mechanisms of damage and prevention strategies[J]. Support Care Cancer, 2006, 14(9):890-900.
79. Andreyev HJ. A physiological approach to modernize the management of cancer chemotherapy-induced gastrointestinal toxicity[J]. Curr Opin Support Palliat Care, 2010, 4(1):19-25.
80. Munro AJ, Potter S. A quantitative approach to the distress caused by symptoms in patients treated with radical radiotherapy[J]. Br J Cancer, 1996, 74(4):640-647.
81. Hesketh P. Drug Therapy: Chemotherapy-Induced Nausea and Vomiting[J]. N Engl J Med, 2008, 358(23):2482-2494.
82. Jakobsen JN, Herrstedt J. Prevention of chemotherapy-induced nausea and vomiting in elderly cancer patients[J]. Crit Rev Oncol/Hematol, 2009, 71(3):214-221.
83. Wilson JA. Constipation in the elderly[J]. Clin Geriatr Med, 1999, 15(3):499-510.
84. Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options[J]. Clin Interv Aging, 2010, 5:163-171.
85.姚云云,胡佩诚.积极综合训练对妇科肿瘤患者的心理干预效果[J]. Zxws, 2009, 23(11):780-783.
86.张新,王伊洵.妇科肿瘤与激素[J].中国实用妇科与产科杂志, 2000, 16(6).
87. Molassiotis A, Coventry PA, Stricker CT, et al. Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: The MASCC antiemesis tool[J]. J Pain Symptom Manage, 2007, 34(2):148-159.
88. Ng WL, Della-Fiorentina SA. The efficacy of oral ondansetron and dexamethasone forthe prevention of acute chemotherapy-induced nausea and vomiting associated with moderately emetogenic chemotherapy - a retrospective audit[J]. Eur J Cancer Care, 19(3):403-407.
89. Schnell FM. Chemotherapy-induced nausea and vomiting: the importance of acute antiemetic control[J]. Oncologist, 2003, 8(2):187-198.
90.张毓武,刘桂芬.重复测量资料的设计与分析[J].山西医药杂志, 1999, 28(2):167-168.
91.周际昌.实用肿瘤内科学[M].第二版.北京:人民卫生出版社; 2010.
92.董英,赵耐青.重复测量资料方差分析中主效应意义的探讨[J].复旦学报, 2005, 32(6):682-686.
93.字传华. SPSS与统计分析[M].第一版.北京:电子工业出版社; 2007.
94.邱宏,金如锋,赵玲, et al.用SPSS11.0实现对重复测量资料的方差分析[J].数理医药学杂志, 2006, 19(2):162-165.
95. Ihbe-Heffinger A, Ehlken B, Bernard R, et al. The impact of delayed chemotherapy-induced nausea and vomiting on patients, health resource utilization and costs in German cancer centers[J]. Ann Oncol, 2004, 15(3):526-536.
96. Bloechl-Daum B, Deuson RR, Mavros P, et al. Delayed nausea and vomiting continue to reduce patients' quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment[J]. J Clin Oncol, 2006, 24(27):4472-4478.
97. Miller M, Kearney N. Chemotherapy-related nausea and vomiting - past reflections, present practice and future management[J]. Eur J Cancer Care, 2004, 13(1):71-81.
98. Oo TH, Hesketh PJ. Drug insight: New antiemetics in the management of chemotherapy-induced nausea and vomiting[J]. Nat Clin Pract Oncol, 2005, 2(4):196-201.
99. Logan RM, Stringer AM, Bowen JM, et al. Is the pathobiology of chemotherapy-induced alimentary tract mucositis influenced by the type of mucotoxic drug administered[J]. Cancer Chemother Pharmacol, 2009, 63(2):239-251.
100. Sonis ST. The pathobiology of mucositis[J]. Nat Rev Cancer, 2004, 4(4):277-284.
101. Van Glabbeke M, Verweij J, Casali PG, et al. Predicting toxicities for patients with advanced gastrointestinal stromal tumours treated with imatinib: a study of the European Organisation for Research and Treatment of Cancer, the Italian SarcomaGroup, and the Australasian Gastro-Intestinal Trials Group (EORTC-ISG-AGITG)[J]. Eur J Cancer, 2006, 42(14):2277-2285.
102. Nomura H, Kawakami H, Nagai S, et al. Predictive factors of nausea/vomiting of breast cancer patients receiving FEC and AC chemotherapy[J]. Gan To Kagaku Ryoho, 2008, 35(6):941-946.
103. Perez Ruixo J, Llopis Garcia M, Casabo Alos V, et al. Risk Factors associated with post-chemotherapy vomiting in patients with breast cancer (II): analysis of the duration of emesis[J]. Farm Hosp, 2002, 26(5):275-282.
104. Watson M, Meyer L, Thomson A, et al. Psychological factors predicting nausea and vomiting in breast cancer patients on chemotherapy[J]. Eur J Cancer, 1998, 34(6):831-837.
105. Goodman M. Risk factors and antiemetic management of chemotherapy-induced nausea and vomiting[J]. Oncol Nurs Forum, 1997, 24(7 Suppl):20-32.
1. Yarbro CH, Frogge MH, Goodman M. Cancer Symptom Management[M].Third Edition. Jones and Bartlett Publishers, Inc; 2004.
2. Worcester M, Pesznecker B, Albert M, et al. Cancer symptom management in the elderly[J]. Home Health Care Serv Q, 1991, 12(2):53-169.
3. Sloan JA, Berk L, Roscoe J, et al. Integrating patient-reported outcomes into cancer symptom management clinical trials supported by the National Cancer Institute-sponsored clinical trials networks[J]. J Clin Oncol, 2007, 25(32):5070-5077.
4. Fu MR, McDaniel RW, Rhodes VA. Measuring symptom occurrence and symptom distress: development of the symptom experience index[J]. J Adv Nurs, 2007, 59(6):623-634.
5.林秋菊,張淑真,吳佳珍. Leventhal疾病詮釋概念於臨床之應用[J].護理雜誌, 2009, 56(5):87-92.
6. Allison SE. Self-care requirements for activity and rest: an Orem nursing focus[J]. NursSci Q, 2007, 20(1):68-76.
7. The University of California, San Francisco School of Nursing Symptom Management Faculty Group. A model for symptom management. [J]. Image J Nurs Sch, 1994, 26(4):272-276.
8. Bruner DW. Outcomes research in cancer symptom management trials: the Radiation Therapy Oncology Group (RTOG) conceptual model[J]. J Natl Cancer Inst Monogr, 2007, (37):12-15.
9. Tang PL, Wang C, Hung MF, et al. Assessment of Symptom Distress in Cancer Patients Before and After Radiotherapy[J]. Cancer Nurs, 2010. [Epub ahead of print]
10. Pieters BR, Rezaie E, Geijsen ED, et al. Development of Late Toxicity and International Prostate Symptom Score Resolution After External-Beam Radiotherapy Combined with Pulsed Dose Rate Brachytherapy for Prostate Cancer[J]. Int J Radiat Oncol Biol Phys, 2010. [Epub ahead of print]
11. Malik R, Jani AB, Liauw SL. External Beam Radiotherapy for Prostate Cancer: Urinary Outcomes for Men with High International Prostate Symptom Scores (IPSS)[J]. Int J Radiat Oncol Biol Phys, 2010. [Epub ahead of print]
12. Yost KJ, Yount SE, Eton DT, et al. Validation of the Functional Assessment of Cancer Therapy-Breast Symptom Index (FBSI)[J]. Breast Cancer Res Treat, 2005, 90(3):295-298.
13. Hollen PJ, Gralla RJ, Liepa AM, et al. Adapting the Lung Cancer Symptom Scale (LCSS) to mesothelioma: using the LCSS-Meso conceptual model for validation[J]. Cancer, 2004, 101(3):587-595.
14. Fallowfield LJ, Leaity SK, Howell A, et al. Assessment of quality of life in women undergoing hormonal therapy for breast cancer: validation of an endocrine symptom subscale for the FACT-B[J]. Breast Cancer Res Treat, 1999, 55(2):189-199.
15. Stanton AL, Bernaards CA, Ganz PA. The BCPT symptom scales: a measure of physical symptoms for women diagnosed with or at risk for breast cancer[J]. J Natl Cancer Inst, 2005, 97(6):448-456.
16. Rao D, Butt Z, Rosenbloom S, et al. A Comparison of the Renal Cell Carcinoma-Symptom Index (RCC-SI) and the Functional Assessment of Cancer Therapy-Kidney Symptom Index (FKSI)[J]. J Pain Symptom Manage, 2009,38(2):291-298.
17. Koensgen D, Oskay-Oezcelik G, Katsares I, et al. Development of the Berlin Symptom Checklist Ovary (BSCL-O) for the measurement of quality of life of patients with primary and recurrent ovarian cancer: results of a phase I and II study[J]. Support Care Cancer, 2010, 18(8):931-942.
18. Cella D. The Functional Assessment of Cancer Therapy-Lung and Lung Cancer Subscale assess quality of life and meaningful symptom improvement in lung cancer[J]. Semin Oncol, 2004, 31(3 Suppl 9):11-15.
19. Potter J, Higginson IJ, Scadding JW, et al. Identifying neuropathic pain in patients with head and neck cancer: use of the Leeds Assessment of Neuropathic Symptoms and Signs Scale[J]. J R Soc Med, 2003, 96(8):379-383.
20. Batista-Miranda JE, Molinuevo B, Pardo Y. Impact of lower urinary tract symptoms on quality of life using Functional Assessment Cancer Therapy scale[J]. Urology, 2007, 69(2):285-288.
21. Kirkova J, Davis MP, Walsh D, et al. Cancer symptom assessment instruments: a systematic review[J]. J Clin Oncol, 2006, 24(9):1459-1473.
22. Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory[J]. Cancer, 2000, 89(7):1634-1646.
23. Sarna L. Effectiveness of structured nursing assessment of symptom distress in advanced lung cancer[J]. Oncol Nurs Forum, 1998, 25(6):1041-1048.
24. Boehmke MM. Measurement of symptom distress in women with early-stage breast cancer[J]. Cancer Nurs, 2004, 27(2):144-152.
25. Shelby RA, Golden-Kreutz DM, Andersen BL. Mismatch of posttraumatic stress disorder (PTSD) symptoms and DSM-IV symptom clusters in a cancer sample: exploratory factor analysis of the PTSD Checklist-Civilian Version[J]. J Trauma Stress, 2005, 18(4):347-357.
26. Hockenberry M, Hooke MC. Symptom clusters in children with cancer[J]. Semin Oncol Nurs, 2007, 23(2):152-157.
27. Collins JJ, Devine TD, Dick GS, et al. The measurement of symptoms in young children with cancer: the validation of the Memorial Symptom Assessment Scale in children aged 7-12[J]. J Pain Symptom Manage, 2002, 23(1):10-16.
28. Collins JJ, Byrnes ME, Dunkel IJ, et al. The measurement of symptoms in children with cancer[J]. J Pain Symptom Manage, 2000, 19(5):363-377.
29. Rao A, Cohen HJ. Symptom management in the elderly cancer patient: fatigue, pain, and depression[J]. J Natl Cancer Inst Monogr, 2004, (32):150-157.
30. Winell J, Roth AJ. Psychiatric assessment and symptom management in elderly cancer patients[J]. Oncology (Williston Park), 2005, 19(11):1479-1490; discussion 1492, 1497, 1501-1477.
31. Maestu I, Munoz J, Gomez-Aldaravi L, et al. Assessment of functional status, symptoms and comorbidity in elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with gemcitabine and vinorelbine[J]. Clin Transl Oncol, 2007, 9(2):99-105.
32. Lowe KA, Andersen MR, Urban N, et al. The temporal stability of the Symptom Index among women at high-risk for ovarian cancer[J]. Gynecol Oncol, 2009, 114(2): 225-230.
33. Cella D, Land SR, Chang CH, et al. Symptom measurement in the Breast Cancer Prevention Trial (BCPT) (P-1): psychometric properties of a new measure of symptoms for midlife women[J]. Breast Cancer Res Treat, 2008, 109(3):515-526.
34. Janz NK, Mujahid M, Chung LK, et al. Symptom experience and quality of life of women following breast cancer treatment[J]. J Womens Health (Larchmt), 2007, 16(9):1348-1361.
35. Gupta P, Sturdee DW, Palin SL, et al. Menopausal symptoms in women treated for breast cancer: the prevalence and severity of symptoms and their perceived effects on quality of life[J]. Climacteric, 2006, 9(1):49-58.
36. McColl E. Best practice in symptom assessment: a review[J]. Gut, 2004, 53 Suppl 4:iv49-54.
37. Wilkie DJ, Kim YO, Suarez ML, et al. Extending computer technology to hospice research: interactive pentablet measurement of symptoms by hospice cancer patients in their homes[J]. J Palliat Med, 2009, 12(7):599-602.
38. Ruland CM, White T, Stevens M, et al. Effects of a computerized system to support shared decision making in symptom management of cancer patients: preliminary results[J]. J Am Med Inform Assoc, 2003, 10(6):573-579.
39. Mullen KH, Berry DL, Zierler BK. Computerized symptom and quality-of-life assessment for patients with cancer part II: acceptability and usability[J]. Oncol Nurs Forum, 2004, 31(5):E84-89.
40. Berry DL, Trigg LJ, Lober WB, et al. Computerized symptom and quality-of-life assessment for patients with cancer part I: development and pilot testing[J]. Oncol Nurs Forum, 2004, 31(5):E75-83.
41. Fortner B, Okon T, Schwartzberg L, et al. The Cancer Care Monitor: psychometric content evaluation and pilot testing of a computer administered system for symptom screening and quality of life in adult cancer patients[J]. J Pain Symptom Manage, 2003, 26(6):1077-1092.
42. Tseng TH, Cleeland CS, Wang XS, et al. Assessing cancer symptoms in adolescents with cancer using the Taiwanese version of the M. D. Anderson Symptom Inventory[J]. Cancer Nurs, 2008, 31(3):E9-16.
43. Guirimand F, Buyck JF, Lauwers-Allot E, et al. Cancer-related symptom assessment in France: validation of the French M. D. Anderson Symptom Inventory[J]. J Pain Symptom Manage, 2010, 39(4):721-733.
44. Ivanova MO, Ionova TI, Kalyadina SA, et al. Cancer-related symptom assessment in Russia: validation and utility of the Russian M. D. Anderson Symptom Inventory[J]. J Pain Symptom Manage, 2005, 30(5):443-453.
45. Lin CC, Chang AP, Cleeland CS, et al. Taiwanese version of the M. D. Anderson symptom inventory: symptom assessment in cancer patients[J]. J Pain Symptom Manage, 2007, 33(2):180-188.
46. Nejmi M, Wang XS, Mendoza TR, et al. Validation and application of the Arabic version of the M. D. Anderson symptom inventory in Moroccan patients with cancer[J]. J Pain Symptom Manage, 2010, 40(1):75-86.
47. Cheng KK, Wong EM, Ling WM, et al. Measuring the symptom experience of Chinese cancer patients: a validation of the Chinese version of the memorial symptom assessment scale[J]. J Pain Symptom Manage, 2009, 37(1):44-57.
48. Wang XS, Wang Y, Guo H, et al. Chinese version of the M. D. Anderson Symptom Inventory: validation and application of symptom measurement in cancer patients[J]. Cancer, 2004, 101(8):1890-1901.
49. Tseng TH, Cleeland CS, Wang XS, et al. Assessing cancer symptoms in adolescents with cancer using the Taiwanese version of the M. D. Anderson Symptom Inventory[J]. Cancer Nurs, 2008, 31(3):E9-16.
50. Rheingans JI. A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer[J]. J Pediatr Oncol Nurs, 2007, 24(2):81-94.
51. Lorenz KA, Lynn J, Dy S, et al. Quality measures for symptoms and advance care planning in cancer: a systematic review[J]. J Clin Oncol, 2006, 24(30):4933-4938.
52. Fan G, Filipczak L, Chow E. Symptom clusters in cancer patients: a review of the literature[J]. Curr Oncol, 2007, 14(5):173-179.
53. Paice JA. Assessment of symptom clusters in people with cancer[J]. J Natl Cancer Inst Monogr, 2004, (32):98-102.
54. Heedman PA, Strang P. Symptom assessment in advanced palliative home care for cancer patients using the ESAS: clinical aspects[J]. Anticancer Res, 2001, 21(6A): 4077-4082.
55. Naughton M, Homsi J. Symptom assessment in cancer patients[J]. Curr Oncol Rep, 2002, 4(3):256-263.
56. Pautex S, Berger A, Chatelain C, et al. Symptom assessment in elderly cancer patients receiving palliative care[J]. Crit Rev Oncol Hematol, 2003, 47(3):281-286.
57. Sherman DW, Ye XY, Beyer McSherry C, et al. Symptom assessment of patients with advanced cancer and AIDS and their family caregivers: the results of a quality-of-life pilot study[J]. Am J Hosp Palliat Care, 2007, 24(5):350-365.
58. de Haes JC, van Knippenberg FC, Neijt JP. Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist[J]. Br J Cancer, 1990, 62(6):1034-1038.
59. Lobchuk MM. The memorial symptom assessment scale: modified for use in understanding family caregivers' perceptions of cancer patients' symptom experiences[J]. J Pain Symptom Manage, 2003, 26(1):644-654.