| Objectives1.Introduce and sinicized Anderson symptom scale perioperative period module of gynecological cancer,explore and evaluate the feasibility,reliability,validity and responsiveness of the Chinese version of the scale applied to the evaluation of perioperative symptoms of gynecological cancer,and form a perioperative symptom evaluation scale of gynecological malignant tumor suitable for Chinese cultural environment.2.This paper conducted a longitudinal study on the changes of symptoms of gynecological cancer in the perioperative period in China,and explored the symptom experience,change trajectory,influencing factors and correlation with quality of life of patients with gynecological cancer in the perioperative period.Methods1.Sinicization of the scale:obtaining authorization,using Brislin double translation-back translation model for translation and back translation;cross-cultural adjustment of the translation scale through expert consultation and pre-survey;convenience sampling method was used to conduct a questionnaire survey on 324 perioperative patients with gynecological cancer in two hospitals in Sichuan Province to evaluate the reliability,validity,acceptance and responsiveness of the scale.SPSS20.0 was used for statistical analysis,frequency and percentage were used for counting data,mean ±standard deviation was used for measurement data,internal consistency reliability Cornbach’s α coefficient was used for the reliability of the scale,Spearman correlation coefficient test was used for test-retest coefficient and criterion validity,exploratory factor analysis was used for construct validity,and independent sample t-test or paired t-test was used for response analysis.2.Applied study:this study was a longitudinal study.322 patients with gynecological cancer in two hospitals in Sichuan Province were investigated by questionnaire.Thesymptoms of patients with gynecological cancer were assessed by MDASI-Peri Op-GYN before operation and 1,2,3,5,7,14 and 21 days after operation.The Chinese version of EORTC QLQ-C30 was used to evaluate the quality of life of the patients before operation,7 days and 21 days after operation.SPSS20.0was used for statistical analysis,frequency and percentage were used for counting data,mean ± standard deviation was used for statistical description,generalized estimation equation was used to analyze the influencing factors of symptoms,and Spearman correlation analysis was used to analyze the relationship between quality of life and symptoms.Results1.Evaluation of MDASI-Peri Op-GYN Chinese version(1)The MDASI-Peri Op-GYN Chinese scale included 22 symptom items and 6symptom disturbance items.The recovery rate of the scale was 97%,the completion rate was 98%,and the average completion time was 12 minutes.(2)The Cronbach’s coefficient of the scale was 0.826,the split half reliability was 0.841,and the retest reliability was 0.922,indicating a good reliability of the scale.(3)The content validity of the scale was 0.902,and the content validity of each item was >0.71.The Chinese EORTC QLQ-OV58 was used as the calibration tool,and the correlation coefficient was 0.873.The calibration validity was good.(4)The scale can effectively distinguish the symptom severity of patients with different time(1 and 2 days after the operation),different surgical methods,and different physical scores(P<0.001),with a better response.2.Changes of perioperative symptoms in patients with gynecologic cancer(1)The incidence and severity of perioperative symptoms and symptom disturbance in patients with gynecological cancer gradually alleviated and recovered over time.The total score of symptoms and the score of symptom disturbance were lower,which were 20.97 ± 13.15 and 1.24 ± 2.44,respectively.The somaticsymptoms were the most serious from 1 to 3 days after the operation.5 days after the operation,the symptom score decreased significantly.On the 7th day after the operation,the symptom distress score decreased significantly.On the 14 th and 21 st day after the operation,the patient was basically restored to the preoperative level.(2)Before surgery,the severity of symptoms of the patients was generally low.Psychological symptoms were prominent(distress,sadness),and the incidence was over 40%.The severity of sleep disturbance(3.78 ± 2.03)and the incidence rate(91.9%)were the highest.(3)1-3 days after the operation,the incidence and severity of symptoms were the highest.Patients with an incidence of more than 50% have 11 symptoms,including fatigue(fatigue),pain,grogginess/drowsiness,drowsiness(drowsiness),dry mouth,decreased appetite,hot flashes,abdominal distension/tightness,dizziness,restless sleep,and numbness of the limbs.Symptoms with a severity score above 4 were fatigue(fatigue)8.26 ± 1.34,drowsiness(drowsiness)7.51 ± 1.76,grogginess/drowsiness 7.43±1.60,loss of appetite 6.90±2.91,dry mouth 5.79±1.86,sleep disturbance 5.39±3.14,hot flashes 4.33±2.00,pain 4.11±1.46.(4)On the 5th and 7th days after the operation,the incidence and severity of symptoms significantly decreased.Symptoms with an incidence of more than 50%include 5 symptoms,including pain,fatigue(fatigue),abdominal distension/tightness,appetite,and sleep disturbance.Only fatigue(fatigue)with a symptom severity score of more than 4 was 4.26±1.08.(5)On the 14 th and 21 st days after the operation,the incidence and severity of symptoms were basically restored to the preoperative level.The incidence of fatigue(fatigue)is still above 75%.Fatigue(fatigue)is a severe symptom with a high incidence and a long duration throughout the perioperative period.3.Analysis of generalized estimation equation for influencing factors of perioperative symptoms in patients with gynecological cancer(1)Influencing factors of pain:surgical methods(laparoscopic =-0.171,P=0.007),surgical methods(hysterectomy and bilateral adnalectomy β =-0.366,P=0.004),indwamination time(β=0.288,P=0.007),and time factors(β=0.49～3.66,P<0.001),the differences were statistically significant.(2)Influence factors of fatigue(weakness): Types of diseases(cervical cancerβ =-0.861,P=0.004,endometrial cancer β =-0.583,P=0.001),surgical methods(laparoscopic β =-0.419,P=0.001),basic diseases(no β =-0.421,P=0.034),Postoperative ICU transfer(none β=-0.278,P=0.041),preoperative other anti-tumor treatments(none β =-0.488,P=0.000,cervical conical resection =-0.883,P=0.000),time factors(β=0.569～6.157,P<0.001),The difference was statistically significant.(3)The influence factors of sleep uneasy: disease diseases(cervical cancer β=0.845,P=0.005,endometrial cancer β =0.583,P=0.001),the operation way(laparoscopic β=0.415,P=0.001),postoperative is transferred to the ICU(noβ = 0.267,P =0.047),medical treatment charge of payment(β = 285,P= 0.009),the time factor(except for 14 days after the rest of the time point β= 0.909 ～ 4.598,P<0.001),the difference was statistically significant.(4)Influencing factors of distress: disease type(cervical cancer β =-0.606,P=0.014,endometrial cancer β=-0.504,P=0.000),tumor metastasis(none β=-0.55,P=0.040),exhaust time(β=0.239,P=0.001),and time factors(except 14 days after surgery,other time points β=0.236～1.183,P=0.001),the differences were statistically significant.(5)The influence factors of appetite: disease diseases(cervical cancer β= 1.936,P = 0.000,endometrial cancer β=-1205,P = 0.001),the operation way(laparoscopicβ=0.529,P=0.001),ECOG score(0 β=0.830,P=0.007),preoperative other anti-tumor treatment(none β = 0.829,P = 0.000,cervical cone resection=1.407,P=0.000),the time factorβ =0.258 ～ 5.473,P≦0.001,the difference was statistically significant.(6)Influencing factors of abdominal distension/tightness: disease type(cervical cancer β=-0.903,P=0.000,endometrial cancer β=-0.693,P=0.001),surgical method(laparoscopicβ =-0.32,P=0.001),exhaust time(β=0.19,P=0.000),and time factor(β=0.846～3.385,P<0.001),the differences were statistically significant.(7)Influencing factors of the total symptom score :(cervical cancer β=-9.184,P=0.000,endometrial cancer β =-6.671,P=0.000),surgical methods(laparoscopicβ=-1.827,P=0.042),ECOG score(0 β=-4.723,P=0.001),indwending time(β=0.255,P=0.045),and time factors(β =3.128-53.841,P<0.001),the differences were statistically significant.4.Generalized estimation equation analysis of the influence of perioperative symptoms on quality of life in patients with gynecological cancer(1)Influencing factors of the overall quality of life: fatigue(tiredness)(β=-1.606,P<0.001),decreased appetite(β=-0.407,P=0.049),distress(β=-1.724,P<0.001),total symptom score(β =-1.229,P<0.001),time factor(7 days after surgery β =-16.696,P<0.001),the differences were statistically significant.(2)Influencing factors of body function: fatigue(tiredness)(β=-1.024,P<0.001),sleep disturbance(β =-0.669,P<0.001),pain(β =-0.555,P=0.009),abdominal distention/abdominal tightness(β=-0.405,P=0.005),time factor(7 days after surgeryβ=-41.508,P<0.001),the differences were statistically significant.(3)Influencing factors of role function: appetite loss(β=-0.443,P=0.011),distress(β =-2.177,P<0.001),time factor(7 days after surgery β =-36.478,P<0.001),the differences were statistically significant.(4)Influencing factors of emotional function: sleep disturbance(β=-0.659,P<0.001),decreased appetite(β =-0.713,P<0.001),distress(β =-2.606,P<0.001),time factor(before surgery β=-10.065,P<0.001),the differences were statistically significant.(5)Influencing factors of social function : fatigue(tiredness)(β =-0.443,P=0.046),sleep disturbance(β =-0.631,P=0.002),decreased appetite(β =-0.894,P<0.001),distress(β=-1.492,P<0.001),and time(7 days after surgery β=-16.565,P<0.001),with statistically significant differences.Conclusions1.The Sinicization of MDASI-Peri Op-GYN is applicable to the evaluation of perioperative symptoms of gynecological cancer patients in Chinese socioculturalenvironment.The reliability,validity,reactivity and feasibility of the scale have good clinical adaptability.The scale is characterized by the shortest assessment interval(24h),which provides a high-quality assessment tool for postoperative symptom management and is conducive to early perioperative rehabilitation management.2.The postoperative symptoms of patients with gynecological malignant tumor gradually recovered over time,with the highest incidence and severity of symptoms within 3 days,requiring close care.The symptoms were significantly relieved on 5th and 7th,and basically returned to the preoperative status on 14 th and 21 st.Preoperative psychological symptoms were prominent;The early somatic symptoms were serious,and fatigue(fatigue)had a long-term effect on the recovery and treatment of patients.On the one hand,the track characteristics of perioperative symptoms with time can make patients understand the recovery process and enhance their confidence in recovery.On the other hand,it can provide patients with predictive care and focus on the control of the main symptoms at different stages.3.Patients with ovarian cancer,open abdominal surgery,preoperative chemotherapy and radiotherapy,self-payment,and other chronic diseases should have a high burden of symptoms,so clinical attention should be paid to these patients and individualized nursing should be implemented.4.The higher the severity of perioperative symptoms in patients with gynecological cancer,the lower the quality of life of the patients.The patients’ emotional function was the worst before the operation,and the patients’ physical function,role function and social function were the worst 7 days after the operation.Improving the quality of perioperative symptom management will effectively improve the quality of life of patients. |
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