Characteristics Of Menopausal Symptoms And Its Related Factors In Young And Middle-aged Breast Cancer Patients Undergoing Chemotherapy

Objectives:The aims of the study were to understand the incidence,the severity and the internal network structure characteristics of menopausal symptoms in young and middle-aged breast cancer patients undergoing chemotherapy,and explore the demographic and lifestyle factors,clinical factors,and psychosocial factors related to menopausal symptoms,for providing ideas for the precise managements and interventions of menopausal symptoms in this population.Methods:A convenient sampling method was used,and 522 young and middle-aged breast cancer patients receiving chemotherapy in a tertiary A cancer hospital in Shandong province from December 2019 to November 2020 were enrolled.The measurements included General Information Questionnaire,Type D Personality Scale,Brief Illness Perception Questionnaire,the Positive Psychological Capital-Resilience Subscale,the Perceived Social Support Scale and Menopausal Rating Scale(MRS)Statistical analysis was performed using SPSS25.0 and R4.0.2 software.The main methods included descriptive analysis,Mann-Whitney U tests,Kruskal-Wallis H tests,Spearman correlation tests,linear regression models,network analysis and so on.Results:1.Scores of menopausal symptoms in young and middle-aged breast cancer patients undergoing chemotherapyThe median score of menopausal symptoms in young and middle-aged breast cancer patients was 6.0,and the upper and lower quartiles were(2.8,12.0).According to the classification of the total score of the scale,112(21.5%)patients had mild symptoms,134(25.7%)had moderate symptoms,and 67(12.8%)had severe symptoms.The scores of the three dimensions of menopausal symptoms were as follows:somatic symptoms(3.0[1.0,5.0]),psychological symptoms(2.0[0.0,5.0])and urogenital tract symptoms(0.0[0.0,3.0]).With regard to the scores of each item,the three most frequently symptoms from the MRS were physical and mental fatigue(63.2%),sleep problems(62.5%),and hot flushes and sweating(62.3%).The top three most severe symptoms were joint and muscle discomfort(1.0[0.0,2.0]),sleep problems(1.0[0.0,2.0]),and hot flushes and sweating(1.0[0.0,2.0]).2.Network structure of menopausal symptoms in young and middle-aged breast cancer patients undergoing chemotherapyNetwork analysis were used to construct the internal networks of the incidence or severity of menopausal symptoms in young and middle-aged breast cancer patients.For the Ising model based on the prevalence of menopausal symptoms,the results showed that irritability,anxiety and bladder problems were the three most core symptoms in the network,with the scores of strengths of 6.091,5.931 and 5.621,respectively.Depression,anxiety and bladder problems were the bridge nodes connecting the symptoms in different dimensions,with the scores of bridge strength was 3.783,3.511 and 3.767,respectively.The network stability tests showed that the stability coefficients of network centrality were edge=0.517,node=0.439,indicating that the network structure was relatively stable;For the Gaussian model based on symptom severity,physical and mental fatigue,irritability,and anxiety were the three most core symptoms in the network,with the scores of strengths of 1.061,1.058 and 0.954,respectively.Depression,anxiety,physical and mental fatigue were the bridge nodes that connected the symptoms of different dimensions,and the scores of bridge strength was 0.697,0.582 and 0.817,separately.Moreover,the network stability tests showed that the stability coefficients of network centrality were edge=0.594,node=0.594,indicating that the network structure was relatively stable3.Linear regression analysis of factors related to menopausal symptoms in young and middle-aged breast cancer patients undergoing chemotherapyLinear regressions were fitted after including the total score of menopausal symptoms,the scores of three dimensions as the dependent variables,respectively,and corresponding independent variables that had statistical significance in univariate analyses.The results represented as follows.With regard to demographic and lifestyle factors,the duration of night sleep was related to the total score of menopausal symptoms,somatic symptoms and psychological symptoms;sleep satisfaction was related to the total score of menopausal symptoms,somatic symptoms,psychological symptoms,and urogenital tract symptoms(Ps<0.05).With regard to clinical-related factors,chemotherapy-induced amenorrhea(CIA)was associated with somatic symptoms and psychological symptoms;family history of cancer was correlated to the total score of menopausal symptoms,somatic symptoms,and urogenital tract symptoms;chemotherapy regimen was associated with urogenital tract symptoms;and course of treatment was related to total score and somatic symptoms(Ps<0.05);Besides,with regard to psychosocial factors,illness perception was related to the total score of menopausal symptoms,somatic symptoms,psychological symptoms,and urogenital tract symptoms;resilience was related to the total score of menopausal symptoms,somatic symptoms,and psychological symptoms;while social support was with the total score of menopausal symptoms and psychological symptoms(Ps<0.05).4.Network analysis of factors related to menopausal symptoms in young and middle-aged breast cancer patients undergoing chemotherapyMixed graphical models of network analysis were used.The incidence or severity of symptoms in each dimension,and the corresponding relevant factors that linear regressions had shown statistical significance were included to build network analysis models.The results represented as follows.With regard to somatic symptoms,CIA(cs=0.239,0.148)were directly associated with hot flashes and night sweats;the duration of night sleep(cs=0.121,0.146),sleep satisfaction(dissatisfied vs.neutral,cs=0.247,0.268;satisfied vs.neutral,cs=0.176,0.123)were directly correlated to sleep problems;illness perception(cs=0.134,0.123)was mainly associated with articular and muscular discomfort,directly.Regarding to psychological symptoms,resilience(cs=0.222,0.104),and social support(cs=0.161,0.096)directly correlated to irritability and irritability;sleep satisfaction(dissatisfied vs.neutral,cs=0.035,0.036),social support(cs=0.182,0.077)was primarily associated with anxiety,directly;and sleep satisfaction(satisfied vs.neutral,cs=0.176,0.123),CIA(cs=0.160,0.134),social support(cs=0.089,0.051)was mainly,directly related to physical and mental fatigue.With regard to urogenital tract symptoms,chemotherapy regimen(cs=0.223,0.226),illness perception(cs=0.1 16.0.091)were related with sexual problems,directly;sleep satisfaction(cs=0.095,0.061)was directly related to bladder problems;and the family history of cancer(cs=0.243,0.175)was correlated with vaginal dryness,directly.Conclusions:1.The prevalence of menopausal symptoms in young and middle-aged breast cancer patients undergoing chemotherapy was high,and 38.5%of the patients had moderate-to-severe symptoms;2.In the three dimensions of menopausal symptoms,somatic symptoms(including sleep problems,hot flashes and sweating)were most prominent,and psychological symptoms(such as irritability,anxiety)were the core symptoms in the network;3.The menopausal symptoms of young and middle-aged breast cancer patients undergoing chemotherapy were correlated with demographic and lifestyle factors,clinical-related factors and psychosocial factors,and the factors were varied from different dimensions of menopausal symptoms,which provided a theoretical basis for accurate and effective clinical interventions.