| Purpose. The purpose of this study was to explore the pattern of symptoms over time in women with gynecological cancers within 6 months after surgery. Study design. Secondary data analysis. Subjects. 66 women with gynecological cancers who received attention control care within 6 months, which included a symptom management toolkit and one home visit and seven phone contacts by a research assistant. Theoretical framework. Theory of Unpleasant Symptoms. Variables and measures. The variables included 10 symptoms, physiological factors (cancer site, new diagnosis/recurrence, stage of disease, treatment and number of comorbidities), psychological factors (emotional distress), situational factors (age and use of symptom management toolkit), and performance (physical function). Symptoms were assessed with a standard symptom checklist. Cancer site, treatment, stage of cancer and new diagnosis/recurrence information were recorded from the medical record audit. Number of comorbid conditions was measured by the Comorbidity Index. Emotional Distress was measured by the Distress Thermometer. Use of the symptom management toolkit was recorded in the report of contact form. Physical function was measured by the SF-12 Health Survey physical function subscale (PCS-12). Statistical methods. General Estimating Equations and Mixed-effect Regression Model. Results. There were two patterns of symptoms. The first pattern (pain, bowel dysfunction, disturbed sleep, depression, nausea, lack of appetite) decreased over time. The second pattern (fatigue, anxiety, hair loss and numbness) remained constant over time. The total number of symptoms decreased over time. Factors influencing each symptom were identified. None of the symptoms independently related to physical function over time. In controlling influencing factors, and baseline physical function, physical functioning remained unassociated with symptoms. Patients who had higher psychological distress, received chemotherapy and who did not use toolkit experienced less physical function. Conclusions. Six symptoms related to recovering from post-gynecological surgery decreased, and four symptoms remained constant. Although physical function improved within 6 months, women reported lower levels of functioning than women with other cancers. Attention control intervention (use of symptom management toolkit) affected the relationship between symptoms and physical function and worked as an effective symptom management strategy. Initial and ongoing assessment, monitoring and management are recommended. |
