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OBJECTIVE: Describe differences in pretreatment symptoms and the composition of symptom clusters in older patients with oral and oropharyngeal cancer. METHODS: In this cross-sectional study, quality of life (QoL) assessments for cancer patients (EORCT QLQ-C30 and QLQ-H & N35) were applied to 161 cases of oral and oropharyngeal cancer at the time of enrollment in an outpatient clinic. They were used to evaluate QoL-related symptoms reported by patients, according to their occurrence. To identify symptom clusters, an exploratory factor analysis (EFA) was performed, and the relationships between these clusters and independent variables were assessed with linear regression models. RESULTS: The most prevalent symptoms were pain (52%), worry (48%), and weight loss (44%). Five factors were extracted from the EFA, of which 3 were noteworthy. The dysphagia cluster was common to both cancer sites, although more frequent in oropharyngeal cancer patients, and included symptoms such as difficulty swallowing, pain, and weight loss. The psychological cluster included symptoms related to feeling worried, nervous, and depressed. The asthenia cluster, in addition to being age-related, may represent the advanced stage or progression of the disease. CONCLUSION: The dysphagia cluster loaded the most symptoms and was common to both cancers. In addition to pain (one of the main symptoms of the dysphagia cluster), psychological symptoms were also important in both groups of patients. Adequate and early control of these symptom clusters at diagnosis could favor better management of symptoms during treatment.
OBJETIVO: Descrever diferenças nos sintomas pré-tratamento e na composição de clusters de sintomas em pacientes idosos com câncer oral e orofaríngeo. METODOLOGIA: Neste estudo seccional, avaliações de qualidade de vida (QV) para pacientes com câncer (EORCT QLQ-C30 e QLQ-H & N35) foram aplicadas a 161 casos incidentes de câncer oral e orofaríngeo no momento da inscrição no ambulatório. Essas avaliações foram utilizadas para analisar os sintomas relatados pelos pacientes quanto à QV, de acordo com a ocorrência. Para identificar agrupamentos de sintomas, uma análise fatorial exploratória (AFE) foi realizada, e a relação entre esses agrupamentos de sintomas e variáveis independentes foi avaliada com modelos de regressão linear. RESULTADOS: Os sintomas mais prevalentes foram dor (52%), preocupação (48%) e perda de peso (44%). Cinco fatores foram extraídos do AFE, três dignos de nota. Embora mais relatado por pacientes orofaríngeos, o agrupamento de disfagia foi comum a ambos os locais de câncer e incluiu sintomas como dificuldade para engolir, dor e perda de peso. O agrupamento psicológico incluiu sintomas relacionados a sentir-se preocupado, nervoso e deprimido. O agrupamento da astenia, além de relacionado à idade, pode representar o estágio avançado ou progressão da doença. CONCLUSÕES: O cluster de disfagia carregou a maioria dos sintomas e foi comum a ambos os tipos de câncer. Além da dor, que era um dos principais sintomas desse cluster, os sintomas psicológicos também foram importantes em ambos os grupos de pacientes. O controle adequado e precoce desses grupos de sintomas no diagnóstico pode favorecer o melhor manejo dos sintomas durante o tratamento.
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Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Mouth Neoplasms/diagnosis , Oropharyngeal Neoplasms/diagnosis , Quality of Life , Cluster Analysis , Cross-Sectional Studies , Factor Analysis, Statistical , Sociodemographic FactorsABSTRACT
PURPOSE: It is widely accepted that addressing multiple symptoms together is the preferred approach in assessment and intervention and results in reduced negative patient outcomes. Yet, there are few studies examining symptom clusters and their impacts on quality of life longitudinally in patients after heart valve surgery.METHODS: A total of 101 patients were recruited from a tertiary hospital and were administered questionnaires (at 3, 6, and 10 weeks after the surgery) assessing participants' characteristics, cardiac symptoms, and quality of life. Factor analysis was used to identify symptom clusters. Hierarchical multiple linear regression was used to predict quality of life.RESULTS: Participants were predominantly 70-years old or more with a mean age of 64.34. The two symptom clusters at 3 weeks after the surgery with education, gender, and occupation accounted for 76.3% of variance in quality of life.CONCLUSION: Symptom clusters containing various physical and psychological symptoms in patients after the surgery affected quality of life, and the relationship was significant at 3 weeks after the surgery. Because symptom clusters were identified in all three recovery periods, nurses need to acknowledge these clusters, rather than each symptom separately, and to utilize these in providing care and education and in promoting quality of life in these patients.
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Humans , Education , Heart Valves , Heart , Linear Models , Occupations , Postoperative Period , Quality of Life , Tertiary Care CentersABSTRACT
Objective To explore the possible types of patients with gastric cancer undergoing chemotherapy based on their experience with the symptom cluster of pain, fatigue, sleep disturbance. Methods Totally 161 gastric cancer patients were investigated by the demographic and clinical characteristics questionnaire, the Numeric Rating Scale (NRS), the Brief Fatigue Inventory (BFI), the Pittsburgh Sleep Quality Index (PSQI), Quality of Life Questionnaires (QLICP-ST). Cluster analysis using SPSS 22.0 version was performed to categorize patients. Results Four different types of patients were got through cluster analysis. Type Ⅰpatients showed all low symptoms (23 cases accounted for 14.3%), TypeⅡpatients showed low pain and moderate fatigue (43 cases accounted for 26.7%), TypeⅢpatients showed low pain and high fatigue (62 cases accounted for 38.5%), TypeⅣpatients performed moderate-to-high on all symptoms (33 cases accounted for 20.5% ). Their education status, chemotherapy cycle sand KPS score were the main factor influencing the classification of pain-fatigue-sleep disorder symptoms in patients with gastric cancer undergoing chemotherapy after operation (χ2=13.873, 26.442, F=3.193, P<0.05 or 0.01). Type Ⅳ tended to have higher education level, lower KPS score and later stage of chemotherapy. Furthermore, patients in moderate-to-high class had significantly lower quality of life score than all low class (F=10.552, P <0.01). Conclusion In this research, patients with gastric cancer undergoing chemotherapy were divided into 4 types based on their experience with the symptom cluster of pain, fatigue and sleep disturbance. It could provide basis for effectively screening and implementing measures for symptoms management.
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Objective@#To explore the possible types of patients with gastric cancer undergoing chemotherapy based on their experience with the symptom cluster of pain, fatigue, sleep disturbance.@*Methods@#Totally 161 gastric cancer patients were investigated by the demographic and clinical characteristics questionnaire, the Numeric Rating Scale (NRS), the Brief Fatigue Inventory (BFI), the Pittsburgh Sleep Quality Index (PSQI), Quality of Life Questionnaires (QLICP-ST). Cluster analysis using SPSS 22.0 version was performed to categorize patients.@*Results@#Four different types of patients were got through cluster analysis. Type Ⅰ patients showed all low symptoms (23 cases accounted for 14.3%), Type Ⅱ patients showed low pain and moderate fatigue (43 cases accounted for 26.7%), Type Ⅲ patients showed low pain and high fatigue (62 cases accounted for 38.5%), Type Ⅳ patients performed moderate-to-high on all symptoms (33 cases accounted for 20.5%). Their education status, chemotherapy cycle sand KPS score were the main factor influencing the classification of pain-fatigue-sleep disorder symptoms in patients with gastric cancer undergoing chemotherapy after operation (χ2=13.873, 26.442, F=3.193, P<0.05 or 0.01). Type Ⅳ tended to have higher education level, lower KPS score and later stage of chemotherapy. Furthermore, patients in moderate-to-high class had significantly lower quality of life score than all low class (F=10.552, P <0.01).@*Conclusion@#In this research, patients with gastric cancer undergoing chemotherapy were divided into 4 types based on their experience with the symptom cluster of pain, fatigue and sleep disturbance. It could provide basis for effectively screening and implementing measures for symptoms management.
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PURPOSE: The purpose of this study was to investigate the level of self-efficacy, grit (consistency of interest-CI, perseverance of effort-PE), symptom clusters and self-care agency in brain neoplasm patients and to identify factors influencing their self-care agency. METHODS: A descriptive correlational design was used, and the participants were a convenience sample of 152 brain neoplasm patients from C national university hospital in Hwasun. Data were collected using a structured questionnaire from October 1, 2017 to February 15, 2018. The collected data were analyzed using descriptive statistics, t-test, ANOVA, factor analysis, Pearson correlations and multiple regression analysis with the SPSS 22 program. RESULTS: The most frequently reported symptoms included sadness (57.9%), numbness (50.7%), lack of energy (49.3%), nervousness (45.4%), worry (40.8%). There were significant positive correlations between self-care agency and self-efficacy (r=.54, p < .001), CI (r=.58, p < .001), and PE (r=.50, p < .001). There were significant negative correlations between self-care agency and cluster I (r=−.56, p < .001), cluster II (r=−.31, p < .001), cluster III (r=−.49, p < .001) cluster IV (r=−.30, p < .001). The significant factors influencing self-care agency were self-efficacy, grit, cluster I and cluster IV. These variables explained 55.4% of the variance in self-care agency. CONCLUSION: The results suggest that intervention programs to increase the level of self-efficacy and grit, to reduce the level of symptoms among patients would improve the self-care agency of brain neoplasms patients.
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Humans , Anxiety , Brain Neoplasms , Brain , Hypesthesia , Self Care , Self EfficacyABSTRACT
Objective To investigate the symptom clusters and their effect on daily life among the adolescents with osteosarcomaduring chemotherapy. Methods A total of 127 adolescents with osteosarcoma undergoing chemotherapy were enrolled and investigated by using the Chinese version of the M.D.Anderson Symptom Inventory (MDASI-C).Then exploratory factor analysis and regression analysis were used to identify symptom clusters and the associations of symptom clusters and daily life respectively. Results For adolescents with osteosarcoma during chemotherapy, the high incidence of symptoms are loss of appetite[96.06％(122/127)], nausea[94.49％(120/127)] and fatigue[91.33％(116/127)], the severe sympyoms are loss of appetite[4.00(3.00,5.00) points], fatigue [4.00(3.00,5.00) points] and nausea[3.5(3.00,5.00) points]. Four symptom clusters were identified: gastrointestinal symptom cluster, pain-related symptom cluster, respiratory symptom cluster and neuro symptom cluster. Symptom clusters except neuro symptom cluster were predictors of distress in daily life. Conclusions The incidence of symptoms in adolescents with osteosarcoma during chemotherapyis high. Several symptom clusters significantly affect their daily life . Medical staff should pay attention to the symptom clusters and provide effective symptom management to improve patients'quality of life.
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Objective To explore the effects of guideline-based symptom cluster management program on the severity of fatigue, pain, sleep disturbance and the quality of life in lung cancer patients. Methods A total of 88 lung cancer patients admitted from July 2017 to November 2017 were divided into the intervention group and the control group with 44 cases in each group by the wards. The control group received routine nursing. The intervention group received health education and related skills guidance about symptom management of fatigue,pain and sleep disturbance on the basis of routine. The severity of fatigue, pain, sleep disturbance and quality of life were compared between the 2 groups after 3 weeks intervention. Results After 3 weeks intervention, the scores of fatigue,pain and sleep disturbance in the intervention group were 3.65 ± 0.97, 2.44 ± 0.79, 9.30 ± 2.41 respectively,the scores in the control group were 3.89 ± 1.05, 2.77 ± 0.88, 10.09 ± 1.97 respectively. There was no statistically significant differences in fatigue score (F=1.60,P>0.05),but there were statistically significant differences in pain and sleep disturbance scores between two groups (F=7.83, 5.13, all P<0.05). The scores of quality of life, physical, psychological, social, environmental domains in the intervention group were 52.42 ± 4.71,14.02 ± 2.05, 12.39±2.36, 14.39±2.45, 11.61±1.84 respectively,the control group were 50.77±4.11, 13.31±2.21, 11.89 ± 2.04, 13.65 ± 2.69, 11.92 ± 1.86 respectively. There was no statistically significant differences in scores of psychological and environmental domains (F=0.52, all P>0.05), but there were statistically significant differences in total score, scores of physical and social domains between two groups(F=5.03-6.86, all P<0.05). Conclusion The guideline-based management program could effectively control the deterioration of the severity of fatigue,pain,sleep disturbance and improve patient's quality of life.
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PURPOSE: The purpose of this study was to investigate symptoms experienced by patients who reported fever at the emergency room (ER) and to identify any existing cluster of symptom related to fever. METHODS: The study used a retrospective and descriptive design with secondary data analysis. Data were abstracted from 665medical records of patients with fever who visited ER from September 1, 2015 to August 31, 2016 at a tertiary hospital. RESULTS: The most frequently reported symptoms included cold (43.9%), myalgia (24.1%), headache (16.2%), general weakness (15.3%), respiratory symptoms (12.3%), gastrointestinal (GI) symptoms (12.0%), mental change (4.5%), sweating(1.8%), and warmth (0.9%). Analysis of the symptoms related to fever revealed seven symptom clusters; Cluster 1 (n=190) included cold (100%) and myalgia (28.9%); Cluster 2 (n=37), headache (100%) and myalgia (32.4%); Cluster 3 (n=33), GI symptoms (100%), general weakness, headache, and cold; Cluster 4 (n=34), cold (100%), myalgia, headache, and respiratory symptoms; Cluster 5 (n=241), respiratory symptoms (10.8%); Cluster 6 (n=76): myalgia (75.0%) and general weakness, and Cluster 7 (n=54), cold (87.0%), general weakness, and respiratory symptoms. CONCLUSION: The results of this comprehensive symptom assessment are hoped to be helpful in developing better symptom management for ER patients with fever than before. Further research is warranted to verify the symptom clusters of this study in different clinical settings.
Subject(s)
Humans , Emergencies , Emergency Service, Hospital , Fever , Headache , Hope , Myalgia , Retrospective Studies , Statistics as Topic , Symptom Assessment , Tertiary Care CentersABSTRACT
Objective:To understand the symptom cluster and its connection with sense of coherence in patients with digestive tract cancer during chemotherapy.Methods:A total of 212 patients with digestive tract cancer during chemotherapy were surveyed with the M.D.Anderson Symptom Inventory (MDASI) and the Sense of Coherence (SOC) scale in 2 hospitals in Anhui Province.Exploratory factor analysis were used to extract the symptom clusters.Spearman correlation analysis were used to determine the relationships between the symptom clusters and SOC.Two subgroups were classified based on the scores of symptom clusters by using cluster analysis,and two independent samples t-tests were used to compare the differences between the two groups.Results:According to the factor analysis,four symptom clusters were identified,including psychological symptom cluster,gastrointestinal symptom cluster,fatigue-pain symptom cluster and neurotoxic symptom cluster.The cumulative variance contribution rate was 64.16％.The fatigue-pain symptom cluster was divided into fatigue symptom cluster and pain symptom cluster according to the correlation.Those 5 symptom clusters were negatively correlated with the SOC (r =-0.14-0.57,Ps ＜ 0.05).Two subgroups were classified based on the cluster analysis,patients in the high-score group (n =81) had significantly lower SOC scores (P ＜ 0.001) than those in low-score group (n =131).Conclusion:It suggests that digestive tract cancer patients during chemotherapy could experience several physiology and psychology symptom clusters,which are significantly negatively correlate with the sense of coherence.
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Objective To explore the dynamic changes of symptom clusters in young and middle-aged lymphoma patients receiving chemotherapy. Methods A longitudinal study was conducted among 101 patients with primary lymphoma receiving chemotherapy. The Chinese version of Memorial Symptom Assessment Scale(MSAS-Ch) and the self-designed general questionnaire were applied before chemotherapy (T1),as well as 1 cycle (T2),3 cycles(T3), and 6 cycles (T4) after chemotherapy. Results The incidence and severity of symptoms were different in different chemotherapy circles among lymphoma patients. Symptom clusters structure was relatively unstable. There were 3 symptom clusters (psychology-related,lymphoma B symptoms,disease-related) before receiving chemotherapy. After 1 cycle,there were 3 symptom clusters (psychology-related,chemotherapy side-effect,fatigue-related),After 3 and 6 cycles, there were 4 symptom clusters(psychology-related,gastrointestinal reactions,damaged self-image and other chemothera-py-related). Conclusion Based on the trend of change of different symptom clusters,we can provide focused nurs-ing interventions to prevent and alleviate symptoms,and to improve quality of life.
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Objective To explore symptom clusters and changes with time goes among inpatients of lung cancer to provide the basis for clinical nursing staff on symptom management. Methods Using the Chinese version of the M.D. Anderson Symptom Inventory (MDASI-C) and the revised lung cancer module on 217 cases of inpatients with lung cancer, and the follow-up after 1 month, 3 months by telephone. Results The result of principal component analysis of three times:there are same symptom clusters on three times evaluation, fatigue-related symptom cluster, lung cancer specific symptom cluster, chemotherapy-related symptom cluster and psychological symptom cluster. The first and third time assessment also contains respiratory symptom cluster. Over time some kinds of symptom clusters company with the disease trajectories. Fatigue-related symptom cluster is the major cluster and correlate to psychological and other symptom clusters. Conclusions Clinical workers should perfect the symptom management of patients all the time according to severity and changes of symptom clusters to benefit patients with lung cancer.
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Objective To investigate the influence of symptom incidence,severity,symptom clusters and related interference on the daily activities of colorectal cancer patients during the chemotherapy.Methods A sample of 112 colorectal cancer patients during the chemotherapy has been presented by M.D.Anderson Symptom Inventory (MDASI-GI) of Chinese Version.Exploratory factor and regression analysis are utilized to discuss influence of symptoms on the daily activities of patients.Results For patients with colorectal cancer after chemotherapy,the high incidence of symptoms are successively fatigue [99.1％ (111/112)],sadness [98.2％ (110/112)] and changes in taste [97.3％ (109/112)].Meanwhile,the severe symptoms are successively fatigue [92.8％ (104/112)],disturbed sleep [92.0％ (103/112)] and dry mouth.Furthermore,four symptom clusters are identified as upper-gastrointestinal symptom cluster,emotional symptom cluster,fatigue-related symptom cluster and excretion-related symptom cluster which possess statistical significance to the daily activities of patients (R2=0.782,F=96.071,P＜0.01).They were effective predictors factors of symptom distress.Conclusions Due to high relapse rate and severe condition,colorectal cancer patients during chemotherapy suffer from multiple symptoms which affect seriously daily activities of patients.Consequently,Medical staff should give prompt and accurate assessment,and then take specific intervening measures to alleviate the patients' symptom so as to improve patients' living conditions.
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Objective The research aimed to identify symptom clusters of head and neck cancer (HNC) patients.Methods The M.D.Anderson Symptom Inventory-Head & Neck (MDASI-H&N) was applied to measure symptoms of 247 HNC inpatients.Factor analysis was applied to identify symptom clusters.The Spearman correlation analysis was used to find the relationship of symptoms within symptom clusters.Results Five clusters were identified and the Cronbach's α coefficients of symptom clusters were 0.904,0.928,0.898,0.815 and 0.662 respectively.Symptoms within clusters were all significantly interrelated to each other (r=0.393-0.856,P＜0.01).Conclusions Symptoms of HNC patients tend to occur not in isolation,but in symptom clusters.Effective management can not only eliminate or alleviate the symptom burden of HNC patients,but also be cost-effective.
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PURPOSE: The purpose of this study to verify the symptom clusters of colorectal cancer patients and also identify the influence of the symptom clusters upon colorectal patient symptom clusters identify acording exper. METHODS: 101 colorectal cancer patients were the subjects of this study. As for a research tool, the global health status/QOL was used including the sub-scales of QLQ-C30. In the functional scales and the symptom scales, the sub-scales of QLQ-C30 and QLQ-CR29 were used. Results: The result of this study shows us there are 7 kinds of symptom clusters. RESULTS: The result of this study shows us there are 7 kinds of symptom clusters, bowel movement problems, abdominal-pelvic problems, feces problems, urination problems, dry mouth-taste problems, side effect problems, and elimination problems. CONCLUSION: Based on the result, the symptom clusters in colorectal cancer patients were confirmed to be influencing the subjects' quality of life and functions. The efficient management of symptom clusters that subjects experience leads to promoting colorectal cancer patients' physical and emotional status, thereby contributing to an improvement in their quality of life.
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Humans , Classification , Colorectal Neoplasms , Feces , Quality of Life , Urination , Weights and MeasuresABSTRACT
Advanced cancer patients tend to present multiple concurrent symptoms which are often moderate or severe in intensity. To date, the majority of studies have focused on either a single symptom, such as pain, fatigue, or depression or associated symptoms. While this approach has advanced understanding of some symptoms, it has offered clinicians not much guidance for treating several multiple concurrent symptoms in cancer patients. So in recent years, a few symptom management studies attempted a new approach of focusing on symptom clusters instead of individual symptoms. A symptom cluster is defined as two or more concurrent symptoms that are related to each other. If we better understand symptom clusters, interrelations of symptoms, and their common mechanisms in advanced cancer patients, clinicians can more effectively control multiple, concurrent symptoms and reduce drug side effects. And clinicians can also predict any other symptoms, functional performance, and the relationship between symptom clusters and survival in advanced cancer patients. At present, there is inconsistency in symptom clusters due to many unexplained mechanisms and various means to assess and analyze symptoms. Still, with further study, the approach to symptom clusters rather than individual symptoms could more effectively control symptoms and improve patients' quality of life.
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Humans , Depression , Fatigue , Quality of LifeABSTRACT
PURPOSE: The purpose of this study was to identify symptom clusters in patients with breast cancer and to investigate the associations among them with functional status and quality of life (QOL). METHODS: A convenient sample of 303 patients was recruited from an oncology-specialized hospital. RESULTS: Two distinct clusters were identified: A gastrointestinal-fatigue cluster and a pain cluster. Each cluster significantly influenced functional status and QOL. Based on these two clusters, we identified subgroups of symptom clusters using K-means cluster analysis. Three relatively distinct patient subgroups were identified in each cluster: mild, moderate, and severe group. Disease-related factors (i.e., stage, metastasis, type of surgery, current chemotherapy, and anti-hormone therapy) were associated with these subgroups of symptom clusters. There were significant differences in functional status and QOL among the three subgroups. The subgroup of patients who reported high levels of symptom clusters reported poorer functional status and QOL. CONCLUSION: Clinicians can anticipate that breast cancer patients with advanced stage, metastasis, and who receive mastectomy, and chemotherapy will have more intense gastrointestinal-fatigue or pain symptoms. In order to enhance functional status and QOL for patients with breast cancer, collective management for symptoms in a cluster may be beneficial.