| [Objective]To investigate the symptoms’ onset time points of the symptom clusters in gastric cancer patients receiving chemotherapy after operation(one week from the day of chemotherapy),and to explore the existence of sentinel symptoms;to analyze the continuous change track of the incidence and intensity of symptoms during chemotherapy(one week from the day of chemotherapy).To analyze the differences of symptom groups in tumor stage,operation mode,chemotherapy cycle,chemotherapy protocol,basic diseases and TCM types.[Methods]The study was a prospective longitudinal study.A convenient sample of 166 patients in the postoperative chemotherapy period of gastric cancer hospitalized in one hospital in Jiangsu from January 2019 to November 2019.Patients were investigated with questionnaires at the time of admission and within 7 days(d1-d7)from the day of chemotherapy.The general information,quality of life and functional status of patients who underwent postoperative chemotherapy of gastric cancer were investigated at the time of admission with KPS and QLICP-ST.The onset time points and the daily severity of symptoms were recorded by patients or their caregivers with MDASI-GI.Whether carried symptom interventions were recorded by researchers due to the electronic medical record system.SPSS Statistic 22.0 and SPSS modeler 18.0 were used to analyze the data.Descriptive statistical method was used to analyze the general situation,the frequency and severity of symptoms;Correlation analysis and Apriori algorithm model was used to explore the coexistence relationship among symptoms in symptom clusters in order to identify the sentinel symptoms;Kruskal-Wallis Test were used to examine patients’ symptoms differences on Tumor stage,chemotherapy cycle,chemotherapy protocol,combined diseases and symptom interventions.[Results]1 The number of symptoms before chemotherapy was 5.46±1.76,and the higher incidence of symptom were sadness,feeling fullness and distress.The first three severity symptoms were distress(1.30±1.76),sadness(1.23±1.36)and pain(1.22±1.51).The incidence of 7 symptoms was lower than 20%before chemotherapy,which were nausea,forgetfulness,drowsiness,vomiting,numbness and dysphagia.The symptoms experienced by patients in the postoperative chemotherapy period of gastric cancer(one week from the day of chemotherapy)changed dynamically,the number of symptoms fluctuated from 8.57±3.78 to 5.48±3.79 every day,and the number of symptoms peaked on the third day.The five highest incidence of symptoms in chemotherapy period were fatigue,decreased appetite,distress,nausea and sadness.There were some differences among the frequency and severity of different symptoms at each time point.On the day of chemotherapy(D1),the three highest incidence symptoms were distress,sadness and fatigue,and the symptoms with higher severity are distress(1.95±1.70),fatigue(1.90±1.80)and sadness(1.70±1.60).On the second day(D2),the three highest incidence symptoms were fatigue,loss of appetite and nausea,The symptoms with higher severity were fatigue(3.17±1.48),loss of appetite(2.5±1.58),nausea(2.13±1.82);On day 3(D3)the three highest incidence symptoms were fatigue,loss of appetite,and distress;the symptoms with higher severity were fatigue(3.52±1.27),loss of appetite(2.53±1.53),nausea(2.08±1.76),and distress(2.08±1.63);On day 4(D4)the three highest incidence symptoms were fatigue,loss of appetite and nausea.The symptoms with higher severity were fatigue(3.55±1.12),loss of appetite(2.31±1.54)and distress(1.95± 1.57).On day 5(D5)the three highest incidence symptoms were fatigue,loss of appetite and distress.The symptoms with higher severity were fatigue(3.40±1.12),loss of appetite(2.17±1.53)and distress(1.84±1.56).On day 6(D6)the three highest incidence symptoms were fatigue,loss of appetite and distress.The symptoms with higher severity were fatigue(2.95±1.16),loss of appetite(1.75±1.45)and distress(1.53±1.36).On day 7(D7)the three highest incidence symptoms were fatigue,loss of appetite and distress.The symptoms with higher severity were fatigue(2.58±1.22),loss of appetite(1.62± 1.46)and distress(1.47±1.39)。4 of the 18 symptoms investigated which were less than 20%were shortness of breath,forgetfulness,constipation and dysphagia,were eliminated in the study.2 The earliest onset time points of the symptom clusters in gastric cancer patients receiving chemotherapy after operation were sadness(11.88±8.95),dysphagia(12.71±6.93),distress(13.72±15.10),pain(18.64±23.83),forgetfulness(21.02±17.28),and feeling fullness(22.58± 14.74).In the previous study,exploratory factor analysis was used to cluster the symptoms of postoperative patients with gastric cancer during chemotherapy,and five symptom clusters were identified,namely,the symptomatic symptom cluster,emotional symptom cluster,gastrointestinal symptom cluster,gastric cancer specific symptom cluster and nervous system related symptom cluster.Among the symptomatic symptom cluster,the stable symptoms were pain,fatigue and sleep restlessness,among which pain appeared the earliest.Two effective association rules were generated by analysis:pain fatigue(the former support degree was 53.0%,the rule confidence degree was 98.9%),pain sleep restlessness(the former support degree was 53.0%,the rule confidence degree was 60.2%).That is to say,in the symptomatic symptom cluster,pain tended to occur first,then was apt to co-ocurrent with fatigue and sleep disturbance;Stable symptoms in digestive symptom cluster include nausea,vomiting,thirst and loss of appetite,among which thirst appears the earliest,and five effective association rules are generated by analysis:vomiting→nausea(the former support degree is 52.9%,the rule confidence degree is 98.8%),vomiting→loss of appetite(the former support degree is 52.9%,the rule confidence degree is 98.8%),nausea→loss of appetite(the former support degree is 52.9%,the rule confidence degree is 98.8%);nausea→loss of appetite(74.5%of the former support,96.6%of the regular confidence),thirst→loss of appetite(53.5%of the former support,89.3%of the regular confidence),thirst→nausea(53.5%of the former support,67.9%of the regular confidence).Among them,74.5%of the patients who had nausea co-occurred with loss of appetite,and thirst first occurred and then tended to have nausea and loss of appetite,which could not trigger the occurrence of vomiting symptoms.Among the specific symptoms of gastric cancer,diarrhea,feeling fullness and changes of appetite were the stable symptoms,among which feeling fullness first appeared.Two effective rules were generated by analysis,feeling fullness→changes of appetite(the former support degree was 51.1%,the rule confidence was 66.7%),diarrhea→changes of appetite(the former support degree was 51.9%,the rule confidence was 66.7%)The confidence rate was 62.9%);sadness was the earliest in the emotional symptom group,and an effective association rule was generated by analysis,sadness to distress(the former support degree was 86.5%,and the rule confidence rate was 99.1%).That is to say,the patients in the emotional symptom group tended to appear sadness first,then distress;the stable symptoms in the nervous system related symptom cluster were drowsiness and numbness,and the onset time were very close,and no effective association rules are produced.3 There are differences in clinical characteristics of symptom clusters in tumor patients.There were significant differences in patients’ tumor stage and chemotherapy cycle among the symptomatic symptom group(P<0.05).There were significant differences in patients’ tumor stage,chemotherapy protocol and chemotherapy cycle among the emotional symptom group(P<0.05).There were significant differences in patients’ tumor stage and chemotherapy protocol among the nervous system related symptom group(P<0.05).There were significant differences in patients’ tumor stage,chemotherapy protocol and chemotherapy cycle among the digestive symptom group(P<0.05),and there were significant differences in patients’ whether carried therapy intervention on nausea and vomiting(P<0.05).There were significant differences in patients’ tumor stage and chemotherapy protocol among the specific gastric cancer symptom group(P<0.05).There were significant differences in age,tumor stage,chemotherapy protocol,chemotherapy cycle and TCM syndrome type in pain(P<0.05);there were significant differences in education level,tumor stage,operation type,chemotherapy protocol,chemotherapy cycle and TCM syndrome type in sentinel symptom pain(P<0.05).4 There was a correlation between the symptom group and the quality of life,KPS score.Five symptom groups were negatively correlated with quality of life(P<0.05),that is,the higher the severity of symptom groups,the lower the quality of life of patients.There was a negative correlation between KPS score and the symptomatic group,and the correlation was statistically significant(P<0.05).[Conclusion]1 Patients in the postoperative chemotherapy period of gastric cancer experienced many symptoms,with high incidence and severity,which caused heavy burden of symptoms,suggesting that medical staff should pay attention to the evaluation and management of patients’symptoms.2 The symptoms of the gastric cancer patients receiving chemotherapy at different time during chemotherapy can gather in groups,including symptomatic group,gastrointestinal symptoms group,gastric cancer specific symptoms group,emotional symptoms group and nervous system related symptoms group.Among the symptomatic group,pain is the sentinel symptom,pain appeared first.Patients with pain symptoms are more likely to co-occurrent with fatigue and sleep disturbance.Among the emotional symptom groups,sadness was the sentinel symptom,and the first symptom was sadness.The patients who had sadness were prone to suffer distress.In the digestive symptom group,thirst was the earliest.Patients with thirst were more likely to have nausea and appetite decline;patients with nausea were more likely to have appetite decline;patients with vomiting were more likely to have nausea and appetite decline.In the digestive specific symptom group,feeling fullness appeared first.The patients with feeling fullness are prone to have changes in appetite.The patients with diarrhea are also prone to have changes in appetite.This indicated that the symptoms of digestive symptom group and gastric cancer specific symptom group appeared alternately,and no obvious sentinel symptoms were found.No sentinel symptoms were found in the nervous system symptom group.The sentinel symptoms in symptom cluster provide the possibility to carry out targeted symptom intervention and improve the efficiency of symptom management in the future.3 There were differences in the clinical characteristics of different symptoms in the symptom clusters of patients.It can identify the high-risk groups according to the clinical characteristics,provide a foundation for symptom evaluation and develop more targeted symptom management measures.4 The five symptom groups of the gastric cancer patients receiving chemotherapy at different time during chemotherapy were negatively correlated with their quality of life,among which the symptom groups of disease,digestive tract and gastric cancer specific symptom groups were negatively correlated with KPS scores,which was also conducive to early symptom evaluation and symptom intervention. |
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