| Objectives:To investigate and analyze the changes of symptoms and quality of life in Primary livercancer(PLC) patients undergoing transcatheter arterial chemoembolization (TACE) atdifferent times during six months, identify the symptom clusters, describe thecharacteristics of symptom clusters, and find out the relationships among the symptoms,symptom clusters and quality of life at different times.Materials and methods:A prospective longitudinal design was used in this study.202patients with primary livercancer firstly receiving TACE were recruited in a Three Level Hospital between December2010and December2011. We investigated the symptoms, quality of life and functionstates of these patients by questionnaires and telephones at five time points in the sixmonths. The five time points were: the day before TACE (T1), three days after TACE (T2),one month after TACE (T3), three months after TACE (T4), six months after TACE (T5).The questionnaires included M. D. Anderson Symptom Inventory (MDASI-C), TheSymptom Module specific for Primary Liver Cancer (TSM-PLC), Function Assessment ofCancer Therapy (FACT-G) and KPS scale. At each time point, descriptive statistics wereused to generate information on the patients’ demographic and clinical characteristics, aswell as on symptom occurrence and severity. An exploratory factor analysis was used toidentify the symptom clusters. Spearman correlation analysis was done to figure out therelationship among symptoms, symptom clusters and quality of life.Results:(1)112patients finally completed the whole procedure,41patients died and49of themlost during the follow up.(2) The number of symptoms at different time points waved in the range of7.41±3.00～12.46±3.14. The prevalence and severity of fatigue, distress, sadness, and pain, and sleepdisturbance, lack of appetite, dry mouth, abdominal distension and weight loss werealways in a higher level. Fatigue was the most severe (3.52±2.20～5.60±2.32) andcommon symptom (90.10%～98.21%) at every time point. The highest levels of symptominterference items were enjoyment of life, followed by mood and work. (3)At each time point, symptom cluster of TACE patients can be identified. Sicknesssymptom cluster and Psychological symptom cluster were the common symptom clustersfor cancer patients; they existed at all time points and remained relatively stable. Liverfunction impairment symptom cluster was the specific cluster for TACE patients. It firstlyemerged at T2, and at T4and T5it emerged again. The symptoms in this cluster alwaysstay the same. The Upper gastrointestinal symptom cluster only appeared at T2, it directlycorrelated with the therapy of TACE.(4) Numbers of symptoms were inversely related to patients quality of life （r=－0.19～－0.69, p<0.01）as well as the symptom severity (r=－0.27～－0.75, p<0.01)at each timepoint. It indicated if patients experienced more symptoms and higher symptom severity,the patients would have lower quality of life. Correlation between the scores of Sicknesssymptom cluster and quality of life were high (（r=－0.20～－0.77, p<0.05or p<0.01) aswell as the correlation between the scores of Psychological symptom cluster and patientsemotional states(r=－0.18～－0.78, p<0.05or p<0.01). That mean when patients gothigher scores of Sickness symptom cluster or Psychological symptom cluster, they wouldhave worse quality of life or emotional state.Conclusion:(1) The symptom burden of TACE patients was high. TACE patients often experiencedmultiple symptoms. Prevalence, severity and distress of symptoms were always in a highlevel. We should pay more attention on evaluating and managing their symptoms.Fatigue, distress and sadness were the most prevalent and severe symptoms, followed bysleep disturbance, lack of appetite, pain, abdominal distention, dry mouth, and weight loss.These symptoms were the keynotes of symptom management in these patients.(2) The multiple symptoms TACE patients experienced at the same time can be groupedinto a cluster; the Sickness symptom cluster and the Psychological symptom cluster werethe common symptom clusters for cancer patients. The two symptom clusters keptrelatively stable and emerged at each time point. Liver function impairment symptomcluster was the specific cluster for TACE patients, and appeared intermittently. Uppergastrointestinal symptom cluster was directly related to the treatment of TACE. Theexistence and dynamic change rule of symptom clusters provided us theoretical bases toexplore the ways of symptom management from the perspective of symptom clusters. (3) High correlations were found between symptom numbers and quality of life as well assymptom severity and quality of life at each time point. It reminds us if we prevent andcontrol the symptoms, we can alleviate symptom burden and improve patients’ quality oflife to some degree. The Sickness symptom cluster and Psychological symptom clustercontinued stability at each time point, and they were inversely related to patients’ qualityof life. We should reinforce the research about the mechanism and central symptoms ofsymptom clusters, we hope we can find a new perspective to manage the symptoms andfinally improve the effectiveness on symptom management. |
PDF Full Text Request