| Objective To investigate the incidence and severity of the symptom clusters in patients with gastrointestinal cancer undergoing chemotherapy,and to identify the common symptom clusters of the patients.Then,a cognitive-behavioral intervention was designed for the common symptom clusters of gastrointestinal cancer patients undergoing chemotherapy,so as to evaluate the intervention effects on the common symptom clusters of patients.Methods This study consists of two stages.For the first stage,a cross-sectional survey was conducted by convenient sampling.Six hundred patients with gastrointestinal cancer undergoing chemotherapy in two affiliated hospitals of Anhui medical university and Anhui province cancer hospital were investigated.The questionnaires included demographic and disease related questionnaire,Brief Illness Perception Questionnaire(B-IPQ)and M.D.Anderson Symptom Inventory(MDASI).For the second stage,a cognitive-behavioral intervention for the common symptom clusters of gastrointestinal cancer patients undergoing chemotherapy was applied.The patients recruited for the first six months were assigned to the control group,and the patients recruited for the later six months were assigned to the intervention group after one month interval between.The patients were assigned to two groups with matched pairs,according to age(with a deviation less than five years),gender,diagnosis and chemotherapy regimens.Patients in control group received usual care,while the intervention group received a 5-week cognitive-behavioral intervention.The intervention contained four sections including cognitive reframing,cancer diet education,relaxation,and exercise techniques.The main outcome measures were illness perception,gastrointestinal symptom cluster,psychological symptom cluster and energy deficiency symptom cluster at baseline and post intervention.Patients' satisfaction of the intervention was also evaluated after the intervention.Epi Data3.1 software was used for the data entry and SPSS 24.0(IBM,Beijing,China)was used to analyze the data.Descriptive statistics were used to describe the characteristics of demographic and disease related variables,the illness perception,the symptoms,the symptom disturbance,symptom clusters and the patients' satisfaction of the intervention.The exploratory factor analysis was used for the extraction of symptom clusters.Paired t-test was used for the comparison of quantitative data of normal distribution when comparing the difference within and between two groups.Wilcoxon Signed Ranks Test was used for non normal distribution and ranked data.Chi square test was used for the non ranked qualitative data.Results Phase 1: The total score of illness perception in 600 patients with gastrointestinal cancer undergoing chemotherapy was(42.65 ± 9.46).The most common and severe symptoms were fatigue,distress and lack of appetite,and their incidence were higher than 80%.Symptoms have the greatest interference on work,then mood and enjoyment of life,and their incidence were all above 80%.Five factors were extracted by the exploratory factor analysis,with the cumulative variance contribution rate was 68.381%.According to the symptom characteristics of the 5 factors and literature review,the 5 factors were named as gastrointestinal symptom cluster(nausea-vomiting-lack of appetite),psychological symptom cluster(distress-sadnesssleep disturbance),pain related symptom cluster(pain-shortness of breath-dry mouth),energy deficiency symptom cluster(fatigue-drowsiness),and neurotoxicity symptom cluster(difficulty remembering-numbness).Phase two:(1)A total of 151 patients were included and completed the baseline assessment.Eleven patients were lost during the intervention process.Finally,140 patients completed the intervention with 70 patients in each group.(2)Two groups did not differ significantly at baseline in terms of demographic and disease variables,illness perception and symptom clusters(all P>0.05),indicating that the data of the two groups were balanced and comparable.(3)The comparison between the post intervention score and the baseline score suggested that the illness perception and three symptom clusters were improved after the intervention in the intervention group(all P<0.05).While there were no statistically significant differences in outcome measures between two timelines in the control group(all P>0.05).(4)Compared with the control group,patients in intervention group reported a significant decrease in the scores of illness perception and three symptom clusters after the intervention(all P<0.05).(5)By comparing the mean difference between two groups,significant differences were found in all outcomes(all P<0.05).(6)The results of the satisfaction of the intervention showed that 71.5% of the patients indicated that the intervention were medium and above helpful to them,82.8% of the patients expressed willingness to adhere to the intervention,52.9% of the patients often followed the contents of the intervention when they were home,and 80.0% of the patients were satisfied with the intervention.Conclusion(1)Patients with gastrointestinal cancer undergoing chemotherapy had some negative cognition and experienced multiple symptoms and disturbance.The multiple related symptoms often constituted symptom clusters,which had a negative impact on patients' physical and psychological health.Therefore,it is necessary to pay attention to the improvement of negative cognition and effective strategies for the symptom management.(2)The cognitive-behavioral intervention was developed based on the cognitive-behavioral theory and the characteristics of the target population.The results suggested that the intervention was effective for the symptom clusters and illness perception,and most patients were satisfied with the intervention.This intervention will be beneficial to the clinical management of the symptom clusters in patients with chronic disease,and can be used for further clinical application in the future. |
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