Study On Symptom Clusters And Its Relationship With Quality Of Life And Illness Perception In Patients With Head And Neck Cancer

ObjectivesThe purpose of this study is to investigate and analyze the pattern of symptom clusters and their influencing factors in patients with head and neck cancer,to investigate the relationship between symptom clusters and quality of life,illness perception and whether illness perception has a mediating effect,to promote early identification of symptom clusters and their influencing factors by medical and nursing staff,to explore relevant ways to reduce the symptom burden of patients with head and neck cancer and improve their quality of life,and to provide reference for the formulation of specific intervention plans.Methods（1）A convenience sampling method was used to apply.The General Information Questionnaire（including sociodemographic characteristics and disease characteristics）,the Hospital Anxiety and Depression Scale（HADS）,the M.D.Anderson Symptom Inventory-Head and neck（MDASI-H&N）,Brief Illness Perception Questionnaire（BIPQ）,and Functional Assessment of Cancer Therapy（FACT-H&N）were used to administered to 300 inpatients with head and neck cancer from October 2021 to December 2022 in two tertiary care hospitals.（2）After the participants gave informed consent,they scanned the QR code and filled in the electronic questionnaire through the"Questionnaire Star"system,used Excel 2019 to store the data,and applied SPSS 26.0 to process and analyze the data.The statistical data were expressed as frequency（n）and composition ratio（%）;the measurement data were described as mean±standard deviation（x±S）,median and quartile[M(P₂₅～P₇₅)];the exploratory factor analysis was used to explore symptom clusters,and the validation factor analysis was used to verify the"morphological model of symptom clusters of patients with head and neck cancer";the influence of demographic characteristics,disease characteristics and psychological characteristics on symptom clusters was investigated by using two independent samples Mann-Whitney U,Kruskal-Wallis ANOVA（K samples）and multivariate linear regression;Spearman correlation analysis was used to analyze the correlation among symptoms and between symptom clusters,illness perception and quality of life in patients with head and neck cancer;path analysis in structural equation modeling was used to explore the mediating effect of illness perception between symptom clusters and quality of life in patients with head and neck cancer,and AMOS 24.0 was applied to the structural equation model to fit,and the model was tested for mediating effects（test levelα=0.05）.Results（1）A total of 318 questionnaires were collected in this study,of which 18 were unqualified,and the questionnaire qualification rate was 94.34%.（2）The prevalence of symptoms in patients with head and neck cancer ranged from69.33%to 94.33%,and most of the symptoms were significantly correlated with each other（P<0.05）.The top five symptoms were“sadness”（94.33%）,“distress”（91.00%）,“vomiting”（89.33%）,“pain”（89.33%）,“sore mouth/throat”（88.67%）,and“nausea”（88.67%）;the mean symptom severity scores ranged from 2.08 to 4.26,with the top five symptoms being“sadness”（4.26 scores）,“pain”（3.78 scores）,“vomiting”（3.76scores）,“sleepiness”（3.57 scores）,and“distress”（3.55 scores）;the mean distress severity scores ranged from 2.25 to 4.70,with the top three ranked in order of enjoyment of life（4.70 scores）,mood（4.16 scores）,and work（including housework）（3.78 scores）.（3）Using exploratory factor analysis,four symptom clusters were finally extracted based on the fragmentation diagram and eigenvalues>1:（1）pain-digestive symptom cluster（“nausea”,“vomiting”,“pain”,“abnormal taste”,“shortness of breath”and“vocal and speech difficulties”）;（2）treatment side effect symptom cluster（“oral and throat mucus”,“skin pain/burning/rash”,“numbness and pins and needles”,“sore mouth/throat”,“constipation”and“dry mouth”）;（3）neuropsychological symptom cluster（“forgetfulness”,“sadness”,“sleepiness”,“distress”,“poor appetite”,“sleep disturbance”and“fatigue”）;（4）sickness-sensing behavioral symptom cluster（“choking on food or drinks”,“tooth or gum problems”and“difficulty swallowing and chewing”）.Among them,the mean scores of overall symptom cluster severity for patients with head and neck cancer were 2.97;the mean scores of neuropsychological symptom cluster severity were 3.38;the mean scores of pain-digestive symptom cluster severity were 3.17;the mean scores of treatment side effect symptom cluster severity were 2.69;the mean scores of sickness-sensing behavioral symptom cluster severity were 2.63.（4）Results of univariate analysis:all symptom clusters had significant differences in scores at different levels of patient age,educational status,monthly per capita household income,disease stage,ECOG score,and whether they were in anxiety state and depression state,and the differences were statistically significant（P<0.05）;results of multivariate analysis:monthly per capita household income,ECOG score,and being in anxiety state or depression state were common factors for the four symptom clusters;disease stage was a common influencing factor for pain-digestive symptom cluster and sickness-sensitive behavior symptom cluster;occupational status was a common influencing factor for pain-digestive symptom cluster and treatment side effect symptom cluster;ability to pay for medical care was a unique influencing factor for pain-digestive symptom cluster;education status and payment method were unique influencing factors for sickness-sensitive behavior symptom cluster.（5）Spearman correlation analysis showed that symptom clusters of patients with head and neck cancer were correlated with illness perception and quality of life（P<0.05）.Symptom clusters were positively correlated with illness perception（r=0.352,P<0.01）,symptom clusters were negatively correlated with quality of life（r=-0.369,P<0.01）,and illness perception was negatively correlated with quality of life（r=-0.463,P<0.01）.（6）A structural equation model was constructed with symptom clusters as the independent variable,illness perception as the mediating variable,and quality of life as the dependent variable,and the model fit was good（χ²/df=1.273,RMSEA=0.030,GFI=0.944,AGFI=0.923,RFI=0.931,NFI=0.942,IFI=0.977）.Symptom clusters predicted quality of life directly and negatively with a standardized coefficient of-0.264（P=0.002）;symptom clusters predicted illness perception positively with a standardized coefficient of 0.475（P<0.001）;illness perception predicted quality of life negatively with a standardized coefficient of-0.450（P<0.001）;symptom clusters predicted quality of life indirectly and negatively with a standardized coefficient of-0.213（P<0.001）,with the mediating effect accounting for 44.65%of the total effect;the overall effect of symptom clusters on quality of life was-0.477（P=0.001）.Conclusions（1）Four symptom clusters exist in patients with head and neck cancer:pain-digestive symptom cluster,treatment side effect symptom cluster,neuropsychological symptom cluster,and sickness-sensing behavioral symptom cluster.The symptom clusters are relatively independent and the symptoms within the clusters are closely related,suggesting that health care workers should pay extra attention to the above symptom clusters in the process of caring for patients with head and neck cancer to mitigate their effects on patients.（2）The influencing factors for each symptom cluster varied:monthly per capita household income,ECOG score,and being in anxiety or depression were common factors for the four symptom clusters;disease stage was a common influencing factor for the pain-digestive symptom cluster and the sickness-sensing behavior symptom cluster;occupational status was a common influencing factor for the pain-digestive symptom cluster and the treatment side effect symptom cluster;the ability to pay for medical care was a unique influencing factor for the pain-digestive system symptom cluster;the educational status and payment method were unique influencing factors for the sickness-sensing behavior symptom cluster.Therefore,clinical work should identify relevant symptom clusters early and develop targeted preventive measures based on the commonality and characteristics of the influencing factors of symptom clusters.（3）Illness perception plays a partially mediating role between symptom clusters and quality of life in patients with head and neck cancer,and symptom clusters can affect quality of life both directly and indirectly through patients’illness perception.It is suggested that clinical workers can reduce the negative illness perceptions of patients with head and neck cancer to alleviate patients’discomfort and improve their quality of life.