Analysis The Relationship Between Symptom Clusters And Quality Of Life In Patients With Adult Acute Leukemia During Chemotherapy: A Longitudinal Study

Objective: Explore the frequency,intensity and composition of symptom clusters in adult acute leukemia patients during induction remission period(T1),consolidation treatment period(T2),intensive treatment period(T3)and maintenance of treatment period(T4).And look for the variation of symptom clusters at different points in time.To analysis the relationship between symptom clusters and quality of life at different points in adult acute leukemia patients during chemotherapy,to provide theoretical basis for the formulation of clinical symptom intervention program.Methods: This study is a forward-looking longitudinal survey.116 adult acute leukemia patients who were hospitalized with chemotherapy in hematology at two Grade III A hospitals in Anhui province from October 2018 to August 2019 using a convenient sampling method at 4 different points in time: Induction(T1),consolidation(T2),intensive(T3),maintenance(T4).Survey of patient demographics and disease-related information using general information questionnaire.Assess the frequency and severity of symptoms using The Chinese version Memorial Symptom Assessment Scale(MSAS-Ch).Assess patients' quality of life levels using Functional Assessment of Cancer Therapy generic scale(FACT-G).Analysis using SPSS19.0 software.The general data of patients and the incidence of symptoms were described by frequency and percentage.Severity and quality of life of symptoms in adult acute leukemia patients were described by Average and Standard deviation.The composition of symptom clusters at 4 different time points were obtained by exploratory factor analysis.Correlation between symptom clusters and quality of life was analyzed using Pearson correlation.Results: 1.A total of 120 questionnaires were distributed during the induction period(T1)in this study,116 were recovered,the effective recovery rate was 96.67%,101 questionnaires were issued and recycled during the consolidation period(T2),83 questionnaires were issued and recycled during the intensive period(T3)and 72 questionnaires were issued and recycled during the maintenance period(T4).15,18 and 11 cases were lost to follow-up from T2 to T4,respectively.The reasons for the loss of follow-up were 4 cases of refusal to investigate,4 cases of referral for treatment,3 cases of abandonment of treatment due to critical illness,18 deaths and 15 cases of bone marrow transplantation.2.Symptoms during chemotherapy in adult acute leukemia patients were in dynamic change.The number of symptoms greater than 20% was 23 to 27.The symptom severity score was(1.28 ± 0.61)to(2.84 ± 0.94).The symptoms with high incidence and severity were: lack of energy,worry,loss of appetite,difficulty falling asleep.The incidence and severity of lack of energy were ranked first at 4 different points in time.3.By exploring factor analysis,10 symptom clusters were identified at different points in adult acute leukemia patients during chemotherapy: neuropsychological discomfort symptom clusters,gastrointestinal symptom clusters,self-image impairment symptom clusters,pathological behavioral symptom clusters,adverse reaction symptom clusters,anorexia-sleep-related symptom clusters,pain-related symptom clusters,body symptom clusters,oral-related symptom clusters,genera symptom clusters.There were differences in the numbers and composition of symptom clusters at different points in time.Among them,neuropsychological discomfort symptom clusters,gastrointestinal symptom clusters and self-image impairment symptom clusters were persisted.Neuropsychological discomfort symptom clusters with feel nervous and difficulty concentrating as stable symptoms.Gastrointestinal symptom clusters with ausea and vomit as stable symptoms.Self-image impairment symptom clusters with hair loss and weight loss as stable symptoms.Anorexia-sleep-related symptom clusters with loss of appetite and hard to sleep as stable symptoms.Pathological behavioral symptom clusters included air-boosting,vertigo,sweaty,cough.Adverse reaction symptom clusters included constipation,itching.Pain-related symptom clusters included pain,hand/foot paralysis,abdominal distension.Body symptom clusters included swelling of the hand or feet and skin changes.Oral-related symptom clusters included dry mouth and oral ulcers.But the symptoms at different points in time were more unstable.4.There were differences in severity of symptom clusters at different time points in patients with acute leukemia during chemotherapy.Induction period(T1)pathological behavioral symptom clusters severity score was highest(2.52±0.55).The severity score of the neuropsychological discomfort symptom clusters during consolidation period(T2)and intensive period(T3)score was highest,(2.63±0.57)and(2.54 ± 0.54).The severity score of pain-related symptom clusters for the maintenance period(T4)score was the highest(3.35±1.05).5.The total score of quality of life of adult acute leukemia patients during chemotherapy fluctuated from(51.97±13.68)to(56.10±14.28)at different points in time.Quality of life score in an increasing state,T1 quality of life score was the lowest,T4 quality of life was the highest,T3 slightly decreased.Surveys at different points in time showed that the functional condition score was the lowest among the various dimensions of quality of life,followed by physical condition.The results of ANOVA showed that the difference in physical condition scores at different points during chemotherapy in adult acute leukemia patients were statistically significant(F=5.407,P=0.001).6.The severity of symptom clusters at different time points was negatively correlated with quality of life in the patients with acute leukemia during chemotherapy.And the above statistical significance was relevant.Conclusion:1.Adult acute leukemia patients from induced remission period to maintenance of treatment period experienced more symptoms,the incidence of symptoms was high,severe,the patients' symptoms burden was heavie.Therefore,clinical nursing work needed to strengthen the patients' symptom assessment and symptom management.2.Adult acute leukemia patients formed different symptom clusters from induced remission period to maintenance of treatment period.The results indicate that the symptom clusters had two kinds of manifestations: stability and dynamics at four different time points.Stability referred to the continuous occurrence of some symptom clusters,while dynamics referred to the differences in the types and internal components of symptom clusters.3.Clinical nurses should take different intervention priorities based on the severity of symptom clusters at each point in chemotherapy in adult acute leukemia patients: induction(T1)focused on intervention of pathological behavioral symptom clusters,consolidation(T2)and maintenance(T3)focused on intervention of neuropsychological discomfort symptom clusters,intensive(T4)focused on pain-related symptom clusters.4.Adult acute leukemia patients had the lowest functional condition dimension scores from induced remission period to intensive chemotherapy period,suggested that adult acute leukemia patients had more impaired function throughout chemotherapy.The patients' physical condition dimension showed a gradual improvement from induced remission period to intensive chemotherapy period,suggested that nurses should pay attention to the change of the physical condition of patients induced remission period(T1)and give targeted interventions in time.5.The symptom clusters at 4 different time points in adult acute leukemia patients during chemotherapy were negatively correlated with the dimension of quality of life,indicated that the patients' symptom burden could be reduced through the management of the symptom clusters,which could improved the patients' quality of life.