| Background:Colon cancer is one of the most common malignant tumors. The incidence rate is increasing every year worldwide. Postoperative adjuvant chemotherapy as a comprehensive treatment of colon cancer has been widely used in clinical. However, while adjuvant chemotherapy improving the survival rates of colon cancer of patients, it also brings patients a variety of physical and psychological symptoms. This longitudinal study is to assess the characteristics of symptoms and physical and psychological distress caused by adjuvant chemotherapy for colon cancer patients, while discussing the influencing factors of the symptom distress and correlation between symptom distress and the completion of chemotherapy. The study is significant in providing theoretical basis of effective nursing intervention to enhance symptom management, and reducing the negative impact of chemotherapy on patients, helping patients to complete 6 months of adjuvant chemotherapy to improve patients'quality of life.Objective:①to describe the characteristics of symptom occurrence, symptom frequency, symptom severity and symptom distress for postoperative colon cancer patients with adjuvant chemotherapy.②to analyze the change of symptoms characteristics during 6-month postoperative adjuvant chemotherapy for colon cancer patients and its influential factors.③to describe the completion of chemotherapy and influential factors, and discuss the correlation between symptom distress and the completion of chemotherapy in patients with postoperative adjuvant chemotherapy in colon cancer.Methods:A prospective longitudinal design was used in this study.108 patients with postoperative colon cancer were recruited in the outpatient using alternative adjuvant chemotherapy regimen of FOLFOX or XELOX in two hospitals. Memorial Symptom Assessment Scale (MSAS), Trait Anxiety Inventory (T-AI), social support Rating Scale (SSRS) and other questionnaires were used to measure their symptoms of adjuvant chemotherapy, psychological and social characteristics and their longitudinal changes in the whole cycles of chemotherapy for 6 months. Analyze the completion of chemotherapy and its related factors through the history of each patient data access during follow-up periods. Data was collected for 3 times at 1 month,4 months,7 months postoperation (afterl,6,12 cycles of FOLFOX/afterl,4,8 cycles of XELOX) respectively.Results:1. There are obvious differences of symptom characteristics caused by adjuvant chemotherapy for colon cancer in patients during the different periods of chemotherapy. The four dimensions scores of symptoms showed a gradual increase in the symptom occurrence, frequency, severity and distress.2. The 6 symptoms which have the generally higher scores in four dimensions of symptom with adjuvant chemotherapy in colon cancer patients were fatigue, nausea, loss of appetite, taste changes, numbness of the limbs and appearance changes.3. The sorts of the frequency, the severity and the distress of the 6 kinds of symptoms were different in the early, mid and late stages of chemotherapy. Numbness of the limbs and the appearance changes in the incidence of symptoms were gradually aggravated with the progress of chemotherapy; the frequency score of numbness, fatigue, loss of appetite was significantly higher with the progression of chemotherapy; the severity score of appearance changes, numbness, fatigue, taste changes were significantly increased during chemotherapy. The most distressed symptom were nausea and loss of appetite in the early period of chemotherapy, and limb numbness and changes in appearance were the first two distressed symptom in the late period.4. There are significantly differences of symptom occurrence, symptom frequency and symptom severity between male and female patients, with women had higher scores than men.5. There was highly positive correlation between symptom distress and symptom occurrence (r= 0.84), symptom frequency (r= 0.87) and symptom severity (r= 0.93). 6. Symptom occurrence (r= 0.20), symptom frequency (r= 0.35), symptom severity (r= 0.30) and symptom distress (r= 0.38) were significantly correlated with anxiety during chemotherapy. Multiple linear regression results suggest that anxiety is the main influential factors of the symptom frequency, symptom severity and symptom distress.7. Symptom occurrence, symptom frequency, symptom severity showed a significant negative correlation with sleep quality in patients during chemotherapy, coefficients were r=-0.23,-0.28,-0.21 repectively.8.31.6% of patients completed the planned 12 cycles of chemotherapy,68.4% of the patients did not completed as planned, the mainly cause were increased symptom scores, allergic reaction of oxaliplatin, bone marrow suppression and regimen changes because of disease progression.9. The symptom distress scores were significant different between whether the patient completed chemotherapy as planned, the symptom distress score was significantly higher of patients who were failure to complete chemotherapy program than those completed as planned.Conclusions:1. The 6 symptoms which have the generally higher scores in four dimensions of symptom with adjuvant chemotherapy in colon cancer patients were fatigue, nausea, loss of appetite, taste changes, numbness of the limbs and appearance changes. The sorts of the frequency, the severity and the distress of the 6 kinds of symptoms were different in the early, mid and late stages of chemotherapy. It is recommended that symptoms assessment should be multi-dimensional, and should strengthen targeted, longitudinal symptom evaluation and care.2. There are significantly differences of symptom occurrence, symptom frequency and symptom severity between the sexes; women are higher than men, suggesting that the women should be paid particular attention during chemotherapy.3. Anxiety is the main influential factors of the symptom frequency, symptom severity and symptom distress, suggesting that nurses should apply these patients psychological support during chemotherapy, encourage patients to utilize positive coping strategies.4. Symptom occurrence, symptom frequency, symptom severity showed a significant negative correlation with sleep quality in patients during chemotherapy. It is showed that symptom distress was correlated directly with the sleep quality of patients, suggesting that nurses should strengthen the symptom management during chemotherapy, and apply activated intervention to improve the patients'quality of sleep.5. Symptom distress was the influential factors of whether the patients completed chemotherapy as planned, and symptom distress was highly positive correlated with symptom occurrence, symptom frequency and symptom severity. It is suggested that symptom management should be strengthened while patients were treated with chemotherapy to relieve the reaction of symptoms, reduce symptom distress, help patients completed standard chemotherapy programs to improve patient quality of life. |
PDF Full Text Request