| Objectives A cross-sectional study was used to evaluate the symptom clusters in lung cancer patients receiving chemotherapy,and analyzed the correlation between the symptom clusters and quality of life,specific inflammatory cytokines,and determined the inflammatory markers associated with the symptom clusters in lung cancer patients receiving chemotherapy,in order to provide evidence-based basis for the management of symptom clusters of lung cancer patients receiving chemotherapy and improving patients’ clinical outcomes.MethodsFrom June 2020 to January 2021,using a convenient sampling method,151 lung cancer patients who receiving chemotherapy were recruited at a tertiary Level A hospital in He Fei city,An Hui province.Patients were investigated by the demographic and clinical characteristics questionnaire,the Chinese Version of M.D.Anderson Symptom Inventory(MDASI-C),the Lung Cancer Module of M.D.Anderson Symptom Inventory(MDASI-LC),and the Chinese Version of Functional Assessment of Cancer Therapy-Lung(FACT-L).The serum levels of IL-2,IL-6,IL-10 and TNF-α were detected by Enzyme-Linked Immuno Sorbent Assay(ELISA).Data were analyzed using SPSS 23.0;Descriptive statistics and frequency distributions were calculated for the demographic and clinical characteristics,exploratory factor analysis to extract symptom clusters,t-test,Chi-square test,Wilcoxon rank sum test and Logistic regression to analyze the differences in the occurrence of symptom clusters in patients with different demographic and clinical characteristics,as well as the correlation between the occurrence of symptom clusters and the quality of life,specific inflammatory cytokines.Results1.Symptoms and symptom clusters in lung cancer patients receiving chemotherapy:151 lung cancer patients were included.The top five of the severity and occurrence of symptoms were fatigue[4.0(0.0,5.0),70.2%]、distress[3.0(2.0,5.0),82.1%],loss of appetite[3.0(0.0,5.0),55.6%],dry mouth[3.0(0.0,4.0),54.3%]and cough[3.0(0.0,3.0),57.6%].The severity and occurrence of symptom distress at work(including housework)was the highest and at the relationship with others was the lowest.Five symptom clusters were extracted through exploratory factor analysis,namely,sickness behavior symptom cluster,gastrointestinal symptom cluster,respiratory symptom cluster,lung cancer specific symptom cluster and neurological symptom cluster.The most serious and highest occurrence was the sickness behavior symptom cluster[10.0(5.0,16.0),78.1%],the other four symptom clusters were all mild in severity and ranked according to their incidence,which were lung cancer specific symptom cluster(41.7%),gastrointestinal symptom cluster(32.5%),respiratory symptom cluster(25.8%)and neurological symptom cluster(25.2%).2.Association between symptom clusters and quality of life in lung cancer patients receiving chemotherapy: The total score of quality of life was(94.15±8.48),the score of physiological condition dimension was(22.37±3.63),the score of social and family status dimension was(15.89±1.44),the score of emotional condition dimension was(16.60±2.22),the score of functional status dimension was(13.91±2.63)and the score of additional attention dimension was(25.38±2.44).According to the definition of symptom cluster,each was devided into the occurrence group and the non-occurrence group.The results showed that in all five symptom clusters,the total scores of quality of life of the occurrence groups were lower than the non-occurrence groups,the differences were significant(P<0.05);in addition,in the sickness behavior symptom cluster,the scores of physiological condition dimension,emotional condition dimension,and functional condition dimension of the occurrence group were lower than the non-occurrence group,the differences were significant(P<0.05);in the gastrointestinal symptom cluster,the scores of physiological condition dimension,social and family condition dimension,emotional condition dimension,and additional attention dimension of the occurrence group were lower than the non-occurrence group,the differences were significant(P<0.05);in the respiratory symptom clusters,the scores of functional status dimension and additional attention dimension of the occurrence group were lower than the non-occurrence group,the differences were significant(P<0.05);in the lung cancer specific symptom clusters,the scores of emotional status dimension and additional attention dimension of the occurrence group were lower than the non-occurrence group,the differences were significant(P<0.05);in the neurological symptoms clusters,the score of physiological condition dimension of the occurrence group was lower than the non-occurrence group,the difference was significant(P<0.05).3.Association between symptom clusters and inflammatory cytokines in lung cancer patients receiving chemotherapy: the single factor analysis showed that in all five symptom clusters,the KPS scores of the occurrence group were lower than the non-occurrence group,the differences were significant(P<0.05);in addition,there were significant differences in per capita monthly income,TNM stage and the level of IL-10 between the two groups in the sickness behavior symptom cluster(P<0.05).There were significant differences in chemotherapy times and the level of IL-10 between the two groups in the gastrointestinal symptom cluster(P<0.05),there was significant difference in age between the two groups in lung cancer specific symptom cluster(P<0.05),and there was significant difference in gender between the two groups in neurological symptom cluster(P<0.05).The Logistic regression results showed that the IL-10 level,KPS score,per capita monthly income and TNM stage were the influencing factors of the sickness behavior symptom cluster.The IL-10 level and KPS score were significantly negatively associated with the sickness behavior symptom cluster(OR=0.992,95%CI= 0.986～0.999,P=0.018;OR= 0.873,95%CI= 0.803～0.948,P=0.001);with the per capita monthly income < 1000 as the control group,patients with per capita monthly income ≥ 1000 had a low risk of developing sickness behavior symptom cluster(P<0.05);with TNM stage Ⅳ as the control group,patients in stage Ⅲ had a low risk of developing sickness behavior symptom cluster(OR= 0.226,95%CI=0.077～0.664,P=0.007).In the gastrointestinal symptom cluster,IL-10 level,KPS score and chemotherapy times were the influencing factors.The IL-10 level and KPS score were significantly negatively associated with the gastrointestinal symptom cluster(OR=0.991,95%CI= 0.984～0.997,P=0.006;OR= 0.940,95%CI= 0.895～0.987,P=0.013);with the 1-2th chemotherapy as the control group,patients with the 3-4th chemotherapy had a high risk of developing gastrointestinal symptom cluster(OR= 2.811,95%CI=1.275～6.199,P=0.010).ConclusionDue to the influence of disease and chemotherapy drugs,patients with lung cancer receiving chemotherapy were often accompanied by a series of severe symptoms,which negatively affect the outcomes of patients.Among them,the severity and occurrence of distress,fatigue,cough and loss of appetite were among the top ones.Through exploratory factor analysis,five symptom clusters were extracted: sickness behavior symptom cluster,gastrointestinal symptom cluster,respiratory symptom cluster,lung cancer specific symptom cluster and neurological symptom cluster.Based on the definition of symptom clusters,each was devided into the occurrence group and the non-occurrence group.In all five symptom clusters,the total scores of quality of life of the occurrence groups were lower than the non-occurrence groups,suggesting that clinical symptom cluster managements should be strengthened to improve the quality of life of patients.In addition,there were differences in the two groups of sickness behavior symptom cluster in per capita monthly income,TNM stage,KPS score and IL-10 level,and the two groups of the gastrointestinal symptom cluster in chemotherapy times,KPS score and IL-10 level.The two groups of lung cancer specific symptom cluster differed in age and KPS score,and the two groups of neurological symptom clusters differed in gender and KPS score.It suggested that the clinical medical staff should identify the high-risk groups and give targeted intervention strategies.The Logistic regression results showed that the level of IL-10 was significantly negatively associated with the risk of sickness behavior symptom cluster and gastrointestinal symptom cluster.It suggested that IL-10 might be an inflammatory marker for sickness behavior symptom cluster and gastrointestinal symptom cluster of lung cancer patients receiving chemotherapy.In the future,we can further explore the mechanism of symptom clusters in terms of inflammation,and to provide new ideas for effective relief of symptom clusters. |
