| Objective:1.To develop a symptom evaluation module specific to domestic ovarian cancer patients, provide an assessment tool for symptom management in ovarian cancer patients.2.To investigate the symptoms occurrence and explore the symptom clusters in ovarian cancer patients at different times during clinical course.3.To analyze the relationships between symptom clusters and quality of life (QOL) in ovarian cancer patients during different treatment phases, provide guidance for improving QOL from the perspective of symptom management.Methods:1.Build ovarian cancer symptom item pool on basis of cancer symptom assessment tools, literature review, clinical observation and interview. After 2 rounds of expert enquiry for screening items, form the predict questionnaire of specific module. Evaluate the reliability and validity of the specific module by using questionnaire survey.2.A prospective longitudinal study was conducted on 116 ovarian cancer patients. The Chinese version of the M.D. Anderson Symptom Inventory(MDASI-C), a self-designed Symptom Module specific for Ovarian Cancer (TSM-OC) and the Functional Assessment of Cancer Therapy-ovarian(FACT-O) were completed by these patients before surgery(T1), after surgery (T2),after first chemotherapy(T3), after third chemotherapy (T4), after sixth chemotherapy (T5).Demographic and clinical data, symptoms occurrence and QOL were analyzed by descriptive statistics. Exploratory factor analysis was used to determine the symptom clusters. Longitudinal changes in QOL were analyzed using one-way analysis of variance. Spearman correlation analysis was performed for the relationship between symptom clusters and QOLResults:l.The Cronbach's a coefficient of TSM-OC was 0.746,the scale-level CVI was 0.936.Two factors were obtained by exploratory factor analys is, the cumulative variance contribution rate was 65.043%. All criterion validity had statistical significance(P<0.05).2.The number of symptoms at different stages fluctuated in the range of 9.30±2.41? 15.64±2.71. The prevalence and severity of fatigue, loss of appetite, hot flashes and night sweat always ranked in a higher level. The highest levels of symptom distress items were work (1.81±1.88?9.61±0.81), followed by enjoyment of life (2.56±1.38?5.23±1.23) and mood (1.40±1.86?5.87±1.50).3. Symptom clusters can be identified at different stages. Emotional and sickness-behavior symptom clusters existed at all time points, the former had stable symptom composition and the latter displayed fatigue as core symptom. Pain-related cluster emerged from Tl to T3, then disappeared with recovery after treatment. Menopausal and sexual characteristics clusters firstly appeared at T2, and then continued with stable symptom composition. They were clusters specific to ovarian cancer patients, and were directly related to surgery and chemotherapy. Gastrointestinal symptom cluster emerged from T3 to T5, which has relatively stable composition, was closely associated with chemotherapy. Treatment-related symptom cluster existed at T4 and T5 with stable component symptoms, it was the adverse reaction of later chemotherapy.4. The scores of QOL at different stages ranged from 92.32±10.92 to 106.92±11.13, the highest level existed before surgery while the lowest level after first chemotherapy. There were statistically significant differences in the scores of QOL at different stages(P<0.01).5.There was a negative correlation between emotional symptom cluster and QOL (r=-0.38?-0.75,P <0.01); Sickness-behavior symptom cluster had significantly negative correlation with QOL(r=-0.42?-0.58, P<0.01);Gastrointestinal symptom cluster showed a big and significantly negative correlation with QOL(r=-0.55?-0.72,P<0.01);It indicated that the higher scores of these clusters, the worse quality of life in patients.Conclusion:1.TSM-OC includes 9 symptoms as followed:abdominal distension, hair loss, anxiety, hot flashes, night sweat, weight loss, sexual life disorders, irritability, feelings of weakened female characteristics, which has good reliability and validity, it can serve for symptom assessment in ovarian cancer patients.2. The various distressed symptoms experienced by ovarian cancer parents can be gathered into clusters, we get 7 kinds of clusters in the clinical course by exploratory factor analysis:emotional, sickness-behavior, pain-related, menopausal, sexual characteristics, gastrointestinal and treatment-related symptom cluster.3. The symptom clusters in ovarian cancer patients show dynamics and stability. The dynamics refers to appearances of new clusters or changes of symptom composition in cluster with the progress of disease and treatment, while the stability refers to certain clusters persist or symptom composition keep consistent at different stages. Mastering the feature can help medical staff predict changes in clusters and take early measures according to the longitudinal evolution of symptom clusters.4. The scores of QOL and its dimensions present dynamics at different clinical stages. Symptom clusters are inversely related to QOL and its dimensions, which indicates that symptom clusters impair QOL in ovarian cancer patients and the influence degree is varying. The medical staff should grasp the characteristics of the changes to improve patients'quality of life from the perspective of relieving symptom clusters. |
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