| Objectives:The study was conducted to investigate the fear of disease progression and symptoms in gastric or colorectal cancer patients receiving chemotherapy.The differences in the demographic and clinical data of the fear of disease progression in the overall population in the study were analyzed.The correlation between the fear of disease progression and the symptom severity was discussed.The influencing factors of the fear of disease progression in gastric or colorectal cancer patients undergoing chemotherapy were explored.The subgroups of fear of disease progression were identified,and then the differences in symptom occurrence and symptom clusters among different subgroups were explored.According to the heterogeneity of different subgroups of patients with the fear of disease progression,a stepwise intervention scheme for patients with gastric or colorectal cancer with the fear of disease progression receiving chemotherapy was preliminarily constructed to provide a theoretical reference for clinical nursing practice.Methods:This cross-sectional study recruited 347 patients with gastric or colorectal cancer receiving chemotherapy using a convenient sampling method.Survey instruments included demographic and clinical questionnaires,the Chinese version of the fear of disease progression,and the Chinese version of the Memory Assessment Scale.Data analysis was performed with SPSS27.0 statistical software,R software,and Mplus 8.3 software.Methods included descriptive analysis,Chi-square test,Mann-Whitney U test,Kruskal-Wallis test,correlation analysis,multiple linear regression analysis,and latent profile analysis.In the third part,a stepwise intervention plan for the fear of disease progression in patients during chemotherapy with gastric or colorectal cancer was preliminarily constructed based on a meta-analysis and the stepped care model.Results:Part 1:(1)In this study,the total score of the fear of disease progression in 347 gastric or colorectal cancer patients receiving chemotherapy was(22.37±8.95),the total score of physiological health dimension was(11.95±4.98),and the average score of social family dimension was(10.42±4.60).The top three items were item 10 “I am worried that the drug will damage my body”,item 9 “I am worried that there will be some major treatment during the disease”,and item 3 “I am afraid of the pain caused by this disease”.Patients with psychological disorders(≥34 points)accounted for 15.0 %(n=52).(2)There were 27 symptoms with a prevalence of 20 % or more.The top three symptoms were lack of energy(67.1 %),weight loss(52.2 %),and difficulty sleeping(48.1 %).The top three symptoms with severity scores were difficulty sleeping(2.24±0.90),problems with sexual interest/activity(2.18±1.88),and dysuria(1.93±0.10).The top three symptoms with distress scores were difficulty sleeping(2.97±0.86),vomiting(2.76±0.97),and problems with urination(2.74±1.10).Among the 24 symptoms,the top three symptoms with frequency scores were problems with sexual interest/activity(3.11±1.04),difficulty sleeping(2.82±0.92),and numbness or tingling in the hands / feet(2.42±0.88).(3)There were differences in gender,age,and occupation of fear of disease progression in347 patients with gastric or colorectal cancer during chemotherapy(P < 0.05).The sum score of fear of disease progression was positively correlated with the severity scores of 19 physical symptoms such as pain,difficulty sleeping,and lack of energy,and 4 psychological symptoms(worrying,feeling nervous,feeling sad,feeling irritable)(P < 0.05).(4)Multiple linear regression results showed that retirement,anxiety,nervousness,pain,dizziness,difficulty concentrating,sadness,and fatigue explained the 48.3 % variation in the fear of disease progression in gastric or colorectal cancer patients receiving chemotherapy.Part2:(1)The results of the latent profile analysis showed that the fear of disease progression in gastric or colorectal cancer patients receiving chemotherapy was divided into two potential categories: Class1,low fear of disease progression class(65.7 %,n=228),and Class2,high fear of disease progression class(34.3 %,n=119).(2)The chi-square test results showed that the differences in sex,age,residence,occupation,and underlying diseases between the two subgroups of fear of disease progression had statistically significant.The incidence of 32 symptoms was lower in the fear of disease progression in Class 1 than that in Class 2.There were statistically significant differences in the incidence of 25 symptoms,including difficulty concentrating,pain(such as abdominal pain,low back pain),and lack of energy.(3)There were 19 symptoms with a prevalence of 20% or more in Class 1 and 30 symptoms in Class 2.The results of the exploratory factor analysis showed that there were six symptom clusters in Class 1: symptom cluster,gastrointestinal symptom cluster,nervous system symptom cluster,self-image disorder symptom cluster,self-image impaired symptom cluster,and psycho-psychological symptom cluster.There were seven symptom clusters in Class 2: neurological symptom cluster,digestive tract symptom cluster,psychological symptom cluster,self-image disorder symptom cluster,food-related symptom cluster,constipationitching symptom cluster,cough-pain symptom cluster.(4)the results of Spearman correlation analysis showed that the severity of the symptom clusters,self-image disorder symptom group,and psycho-psychological symptom group in Class 1 was positively correlated with fear of disease progression.In Class 2,the severity of the gastrointestinal symptom cluster,psychological symptom cluster,and constipation-skin itching symptom cluster was positively correlated with fear of disease progression.Part 3:(1)Based on the meta-analysis of 16 literatures,a stepwise intervention scheme for gastric or colorectal cancer patients during chemotherapy was preliminarily constructed,including intervention object,intervention form,intervention assessment,intervention duration,intervention content,effect evaluation,etc.Conclusions:(1)Gastric or colorectal cancer patients receiving chemotherapy had different statuses of fear of disease progression,15.0 % of which showed psychological dysfunction.Retirement,psychological symptoms,worrying,feeling nervous,feeling sad and physical symptoms,pain,dizziness,difficulty concentrating,and lack of energy were the factors that affected the fear of disease progression of gastric or colorectal cancer patients receiving chemotherapy.The symptom factors which can be modified provided the direction for the effective management of fear of disease progression in the clinic.(2)There were two heterogeneous subgroups of patients with gastric or colorectal cancer with fear of disease progression during chemotherapy: Class 1(65.7 %,n=228)and Class2(34.3 %,n=119).There were differences in the symptom cluster between the different classes,which suggested that the heterogeneity of the fear of disease progression in patients should be focused on,providing ideas for formulating intervention strategies for the fear of disease progression in gastric or colorectal cancer patients during chemotherapy in clinical practice.(3)The preliminary intervention scheme of the stepped cognitive behavioral therapy was constructed,which was helpful to accurately intervene against the heterogeneity of the fear of disease progression in cancer patients.However,its feasibility and effectiveness needed to be further discussed in the empirical studies. |
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