| Objectives This study aim to study the status of symptom clusters in patients with multiple myeloma undergoing chemotherapy and to analyze the influencing factors of the symptom clusters.so as to arouse the attention of medical personnel to the symptom clusters of patients with multiple myeloma and to provide theoretical reference for symptom management.Methods From November 2018 to November 2019,144 patients with multiple myeloma in hematology department of 3 Grade A hospitals(Tangshan People’s Hospital,Tangshan Workers’ Hospital,and Affiliated Hospital of North China University of Science and Technology)in Tangshan City,Hebei Province were conveniently selected as the research objects.The Chinese version of the Memory Symptom Assessment Scale(MSAS-ch)was used to investigate the symptom experience of multiple myeloma patients.The selfdesigned general data questionnaire,EOCG physical evaluation scale and Social Support Rating Scale(SSRS)were used to evaluate the general demographic data,disease-related characteristics,physical status and social support of multiple myeloma patients.Descriptive statistical methods were used to describe the occurrence of symptoms,principal component factor analysis was used to extract the symptom clusters.T-test,analysis of variance and multiple linear regression were used to analyze the influencing factors of symptom clusters.Results 1 Symptom clusters of multiple myeloma patients undergoing chemotherapy:(1)The incidence of 32 symptoms ranged from 2.1 to 72.9%.The top five most symptoms of occurrence rate were dry mouth(72.9%),lack of energy(68.1%),pain(67.4%),tension(66.7%),worry(65.3%).The top five most symptoms of frequency occurrence(frequent +almost continuous)were numbness or tingling in hands and feet(52.1%),pain(44.5%),difficulty sleeping(36.1%),dry mouth(35.4%),lack of energy(32.6%).The top five symptoms of severity(mean±standard deviation)were worry(1.65±1.38),numbness or tingling in hands and feet(1.62±1.46),insufficiency of energy(1.60±1.34),pain(1.59±1.28),dry mouth(1.54±1.18).The top five most symptoms of trouble(larger+very large)were difficulty in sleeping(31.3%),dry mouth(30.6%),numbness or tingling in hands and feet(27.8%),pain(21.6%),and lack of energy(18.8%).(2)A total of 6symptom clusters were extracted by principal component factor analysis.Bone pain psychological symptom cluster(pain-sadness-concerns-constipation-tension),digestive tract symptom cluster(abdominal distension-dry mouth-sick-loss of appetite),fatigue symptom cluster(low energy-difficult to fall asleep),drug related symptom cluster(diarrhea-hands and feet swelling),bone marrow suppression of symptom cluster(hard to concentrate-shortness of breath),nervous system symptom cluster(paralysis of limbs or sting-sweat).The variance contribution rates were 18.021%,13.024%,10.395%,8.443%,7.564%,7.572%,and the total contribution rate was 65.109%.2 Analysis of the factors influencing the severity of symptom clusters showed:(1)Gender,residence,understanding of the disease,clinical stage,pathological classification,chemotherapy regimen,chemotherapy cycle,combined chronic disease,recurrence or not,ECOG physical status,social support had statistical significance on symptom clusters severity score(P<0.05);age,marriage,education level,occupation and family monthly income groups had no statistical significance on symptom clusters severity score(P>0.05).(2)The degree of disease understanding was the influencing factor of the severity of bone pain psychological symptom cluster,digestive tract symptom cluster,fatigue symptom cluster and total symptom clusters.The cycle of chemotherapy was the influencing factor of the severity of bone pain psychological symptom cluster and nervous system symptom cluster.The complicating chronic disease was the influencing factor of the severity of the nervous system symptom cluster and total symptom clusters.Relapse was a factor influencing the severity of bone marrow suppression of symptom cluster,fatigue symptom cluster and total symptom clusters.Physical state was a factor influencing the severity of nervous system symptom cluster and total symptom clusters.Social support was a factor influencing the severity of bone pain psychological symptom cluster,drug-related symptom cluster and total symptom clusters(P<0.05).Conclusions 1 Patients undergoing chemotherapy for multiple myeloma were burdened with multiple symptoms.The incidence of 32 symptoms ranged from 2.1 to 72.9%.The top five most symptoms of occurrence rate were dry mouth,lack of energy,pain,tension worry.The top five most symptoms of frequency occurrence were numbness or tingling in hands and feet,pain,difficulty sleeping,dry mouth,lack of energy.The top five symptoms of severity were worry,numbness or tingling in hands and feet,insufficiency of energy,pain,dry mouth.The top five most symptoms of trouble were difficulty in sleeping,dry mouth,numbness or tingling in hands and feet,pain,and lack of energy.2 There were 6symptom clusters: bone pain psychological symptom cluster,digestive tract symptom cluster,fatigue symptom cluster,drug-related symptom cluster,bone marrow suppression of symptom cluster and nervous system symptom cluster,and the contribution rate of bone pain psychological symptom cluster was the highest,the second was digestive tract symptom cluster.3 The higher the understanding of the disease,the longer the chemotherapy cycle and the higher the degree of social support,the lower the severity of the bone pain psychological symptom cluster.The higher the understanding of the disease,the lower the severity of the digestive tract symptom cluster.The lower the understanding of the disease and recurrence,the higher the severity of the fatigue symptom cluster.The higher the level of social support,the lower the severity of drug-related symptom cluster.The relapsed patients had severe bone marrow suppression of symptom cluster.Chemotherapy cycle increased,combined with chronic diseases,the weaker the physical state,the more severe the nervous system symptom cluster.The severity of the total symptom clusters was affected by the degree of understanding of the disease,complicating chronic disease,recurrence,physical status and social support.Figure1;Table16;Reference154... |
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