The Relationship Between Symptom Clusters And Quality Of Life In Esophageal Cancer Patients After Surgery

ObjectiveTo investigate symptom clusters,resilience and quality of life(QoL)experienced by patients with esophageal cancer three months after surgery,to identify the types and influencing factors of symptom clusters.Furthermore,to examine whether resilience moderates the relationship between symptom clusters and QoL.Exploring the mechanics of symptom clusters may facilitate the development of strategies to reduce the impact of symptoms and improve QoL.MethodsA convenience sample of 262 esophageal cancer patients enrolled from two tertiary hospitals in Jinan was investigated at three months after surgery.Participants completed the demographic and clinical characteristics questionnaire,the M.D.Anderson Symptom Inventory for Gastrointestinal Cancer(MDASI-GI),the Functional Assessment of Cancer Therapy-General(FACT-G)and the Connor-Davidson Resilience Scale(CD-RISC).SPSS 22.0 was used to analyze data.Exploratory factor analysis was performed to identify symptom clusters.Multiple linear regression was used to analyze which variables might be factors of the symptom clusters.Pearson correlation analysis was used to analyze the correlation between symptom clusters and QoL.and hierarchical regression analysis was used to analyze the moderating effect of resilience between symptom clusters and QoL.Results1.The top six prevalent symptoms among participants were fatigue(76.0%),lack of appetite(71.8%)disturbed sleep(69.8%),distress(66.6%),sadness(59.2%)and reflux(55.7%).The top four severe symptoms experienced by the participants were fatigue(4.86±3.21),lack of appetite(4.17±2.68),disturbed sleep(4.03± 2.76),and reflux(3.65±3.09).The higher severities of the symptom-related interference were work and mood.2.Four symptom clusters were identified,accounting for 62.15%of the total variance,including the dysphagia-psychological symptom cluster(difficulty swallowing,pain,distress and sadness),the digestive tract reconstruction symptom cluster(reflux,feeling bloated,diarrhea and shortness of breath),the chemoradiotherapy side-effect symptom cluster(nausea,vomiting,lack of appetite,and dry mouth)and the fatigue-sleep symptom cluster(fatigue,disturbed sleep and drowsiness).3.Four separate multiple linear regressions were performed.The results indicated that gender,marital status,education,comorbidities and stage of disease were influencing factors of the dysphagia-psychological symptom cluster.Gender,education,stage of disease and anastomotic position were influencing factors of the digestive tract reconstruction symptom cluster.Gender,marital status,treatment,education and stage of disease were the influencing factors of the chemoradiotherapy side-effect symptom cluster.Gender,age,treatment,comorbidities and stage of disease were the influencing factors of the fatigue-sleep symptom cluster.The influencing factors explained the total variance of each symptom cluster by 16.4%、10.8%、15.8%and 27.3%,respectively.4.The mean score of total symptom cluster was 45.12±23.94,the mean score of resilience was 26.02± 6.55,and the mean score of QoL was 67.95±13.31.Each symptom cluster was negatively correlated with physical well-being,emotional well-being,functional well-being,and overall QoL,but not significantly correlated with social/family well-being.Different symptom clusters have different impacts on different dimensions of QoL.Dysphagia-psychological symptom cluster had the strongest impact on emotional well-being(-0.424,P<0.01),chemoradiotherapy side-effect symptom cluster had the maximum impact on physical well-being(r=-00.331,P<0.01),fatigue-sleep symptom cluster had the strongest impact on functional well-being(r=-0.307,P<0.01)5.Hierarchical regression analysis showed that the association between symptom cluster and QoL was moderated by resilience(β=0.170,P<0.01).When the level of resilience was higher,the impact of symptom cluster on QoL was weaker.Conclusions1.Patients with esophageal cancer experienced multiple symptoms simultaneously three months after surgery.Among them,the most severe and common symptoms were fatigue,lack of appetite,disturbed sleep,and reflux,which could not be neglected and should be prioritized in symptom management.2.Nurses should pay more attention to the symptom management of patients with esophageal cancer three months after surgery by focusing on four symptom clusters:chemoradiotherapy side-effect,the dysphagia-psychological,the digestive tract reconstruction and the fatigue-sleep symptom cluster.As the symptoms within the cluster are closely related,medical staff can intervene the main symptoms within the cluster,so as to alleviate other symptoms accordingly,thus simplifying symptom management and improving nursing efficiency.3.It is necessary to implement individualized care depending on the influencing factors including gender,education,marital status,comorbidities.stage of disease.treatment,anastomotic position and so on.4.The association between symptom cluster and QoL was moderated by resilience,that is,resilience can break the link between symptom cluster and QoL.Patients with esophageal cancer may potentially benefit from interventions supporting resilience.These findings will help with the development of targeted interventions to facilitate further symptom management for the transitional nursing from the peri-operative phase to long-term rehabilitation.