| Objective:1.To construct a specific symptom assessment and management tool suitable for postoperative chemotherapy of gastric cancer patients in China.2.Follow up and investigate the symptoms and quality of life of postoperative patients with gastric cancer during chemotherapy.3.To explore the composition and evolution of symptom clusters at different time points.4.To analyze the dynamic correlation between symptom clusters and quality of life.Methods:1.Firstly,on the basis of the existing cancer symptom assessment tools,the common symptom entry pool of postoperative chemotherapy patients with gastric cancer was developed by combining literature review and patient interview.Using the Delphi method,20 experts were invited to conduct two rounds of evaluation on the questionnaire items,and the first draft of the questionnaire was formed.Convenience sampling selected the patients receiving postoperative chemotherapy for gastric cancer in the department of gastroenterology of a grade a hospital in Shanxi Province as the test subjects,and the reliability and validity of the first draft of the questionnaire were tested.Items were selected by project analysis method,Cronbach's alpha coefficient and retest reliability were used to evaluate the reliability of the questionnaire,and content validity,structure validity and criterion correlation validity were used to evaluate the validity of the questionnaire.2.Prospective longitudinal survey method is used,the early stage of the application of the postoperative chemotherapy for gastric carcinoma patients with symptoms of common evaluation system of quality function module evaluation questionnaire cancer a first-class ternary hospitals in Shanxi Province line of postoperative patients with gastric cancer chemotherapy,the questionnaire survey to investigate the time for the first time after chemotherapy(T1)after chemotherapy for the third time(T2)the sixth time after chemotherapy(T3)uses the standard deviation of mean percentage of general symptom occurrence symptom severity and quality of life score was described.Exploratory factor analysis was used to extract symptom groups.One-way anova was used to analyze the longitudinal changes of patients' quality of life.Spearman correlation analysis was conducted to analyze the correlation between symptom group and quality of life,with alpha =0.05 as the test level,and P<0.05 as the difference with statistical significance.Results:1.The "symptom assessment questionnaire for postoperative chemotherapy patients with gastric cancer" was preliminarily constructed,including 26 items,with Cronbach's alpha coefficient of 0.929,retest reliability of 0.824 and average content validity of 0.91.Five factors were extracted by factor analysis,and the cumulative variance contribution rate was 59.802%.The correlation coefficient between the score of the questionnaire and the total score of the criterion scale and its four dimensions was between-0.643 and-0.384,which was statistically significant.2.Postoperative patients with gastric cancer experience multiple symptoms during chemotherapy,and the incidence and severity of symptoms gradually increase with the continuation of chemotherapy.The incidence and severity of symptoms were consistent.Fatigue,appetite loss,nausea,distress and anxiety were the top five symptoms in terms of overall incidence during chemotherapy,while fatigue,appetite loss,distress,anxiety and nausea were the top five symptoms in terms of severity.Other symptoms such as alopecia,numbness of hands and feet,constipation,change in eating taste,oral mucositis,and pain at intravenous administration had a low incidence of side effects after the first chemotherapy(less than 20%),and the incidence and severity of these symptoms significantly increased after the third chemotherapy.The incidence and severity of psychological symptoms such as distress and anxiety declined over time.3.There were six symptom clusters in postoperative chemotherapy for gastric cancer patients at three time points,but the number of symptom clusters obtained at each time point was different.After the first chemotherapy,four symptom clusters were obtained,namely gastrointestinal symptom cluster,sickness-behavior symptom cluster,psychological symptom cluster and gastric cancer-specific symptom cluster.Six symptom clusters were identified after the third and sixth chemotherapies,i.e.,neurologic and epithelial-related symptom clusters were added to the original symptom clusters.The composition of symptoms within each symptom cluster also remained dynamic and stable to a certain extent.Except that the composition of symptoms within the epithelial-related symptom cluster remained unchanged,the composition of symptoms within the other five symptom clusters all changed slightly over time.4.The total qol score of patients undergoing postoperative chemotherapy for gastric cancer fluctuated between 59.42±9.57 and 61.67±9.54 points during chemotherapy,and declined with the progress of chemotherapy.The scores of social and family status dimensions and functional status dimensions gradually decreased at three time points.The scores of emotional state dimension increased gradually at three time points.Physiology dimension scores the highest after the first chemotherapy,the third time after chemotherapy significantly reduced to the lowest,the sixth time after chemotherapy and recovered the single factor analysis of variance comparing the quality of life of postoperative gastric cancer patients during chemotherapy,it is concluded that the quality of life scores during chemotherapy,no statistical difference(P = 0.100),the quality of life of the four dimension scores during chemotherapy were significant difference(P < 0.05).5.Correlation analysis of the symptom clusters and quality of life of patients undergoing postoperative chemotherapy for gastric cancer showed that the six symptom clusters during chemotherapy were negatively correlated with the quality of life of patients to varying degrees(r=-0.168~-0.538,P < 0.05).Among them,the gastrointestinal symptom cluster,sickness-behavior symptom cluster,psychological symptom cluster and gastric cancer-specific symptom cluster were negatively correlated with the total quality of life score in the three time periods before,during and after chemotherapy(r=-0.273~-0.485,P < 0.05).Conclusion:1.The "symptom assessment questionnaire for postoperative chemotherapy patients with gastric cancer" was preliminarily constructed,and the reliability and validity of the questionnaire were good,which can provide a practical assessment tool for the symptom assessment and management of postoperative chemotherapy patients with gastric cancer in the future.2.The symptoms of postoperative gastric cancer patients during chemotherapy affect each other,gathered in one clangorous flock to scoop of chemotherapy before,during and after the three period of investigation,6 kinds of symptoms,respectively is: gastrointestinal symptom cluster,sickness-behavior symptom cluster,psychological symptom cluster,gastric cancer-specific symptom cluster,neurologic and epithelial-related symptom clusters.This conclusion provides guidance for medical staff to manage patients' symptoms from the perspective of symptom group.3.Through dynamic research,it was found that the symptom clusters of postoperative patients with gastric cancer were dynamic and stable during chemotherapy.The awareness of the changing characteristics of the symptom clusters is conducive to the medical staff to accurately predict the change of the symptom clusters according to the evolution trajectory of the symptom clusters,and take proactive intervention measures as early as possible.4.The total score of quality of life and the scores of each dimension of postoperative chemotherapy of patients with gastric cancer presented dynamic changes before,during and after chemotherapy;Each symptom cluster has a negative impact on patients' quality of life.Medical staff can improve the quality of life of patients from the perspective of intervening symptom clusters according to the correlation between symptom clusters and patients' quality of life. |
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