Symptom Clusters And Quality Of Life In China Patients With Lung Cancer Undergoing Chemotherapy

ObjectivesThis study was to characterize the prevalence and severity of symptoms in patientswith lung cancer undergoing chemotherapy, in order to identify symptom clusters in lungcancer patients. The Revised Model for Symptom Management was used to build a modelof symptom clusters, situational variables and QOL in lung cancer patients, and finally totest a hypothesis that symptom clusters mediates between situational variables and qualityof life (QOL).MethodsIn the descriptive phase, a convenient sample of200LC subjects undergoingchemotherapy was recruited from three public hospitals in Xi’an. A self-reported surveyconsisted of a demographic questionnaire, the Functional Assessment of CancerTherapy-Lung Cancer and the M. D. Anderson Symptom Inventory, Hospital Anxiety andDepression Scale, Social Support Rating Scale. EFA was used to propose the model of symptom clusters in participants, then test and revised by CFA. The influencing factors ofsituational variables and symptom clusters were identified by MSRM, and the proposedhypothesis was confirmed by SEM. In the exploratory phase, a purposive of10participants were invited for a semi-structured interview to examine their experienceduring chemotherapy.Results(1) The prevalence and severity of most symptoms were always in a higher level.Fatigue was the most severe (96.5%) and prevalence (6.18±1.71). The highest levels ofsymptom interference items were work (7.12±1.88), followed by mood (5.48±1.68) andenjoyment of life (5.18±1.81).(2) Three symptom clusters can be identified as gastrointestinal, emotional andfatigue–related symptom clusters.(3) The mean item score of FACT-L was2.20, suggesting a moderate lever of QOL.Social and family well-being was2.76, LC module was2.53, emotional well-being was2.20, physical well-being was2.04, and functional well-being was1.38.(4) The factors of pain, together with covariates of social support and emotionalexplained36.0%of the variance associated with insomnia. Marital status predictedinsomnia and fatigue through an indirect pathway by its association with social support.Also,53.0%of the variance associated with fatigue was explained by pain and insomnia,together with social support and emotional. No factor that influenced pain was identifiedin the model. The factors of pain, fatigue, insomnia, together with the covariates of socialsupport and emotional, explained86.0%of the variance associated with QOL.(5) The findings of the exploratory stud are organized in three categories. The resultsrevealed the participants’ experience of fatigue, pain and insomnia during the course ofchemotherapy. The interrelationships were identified from participants’ descriptions ofthose symptoms, though they were not aware that the three symptoms were associatedwith one another. Results of the exploratory study revealed that the participants made useof various coping strategies to help them through the cancer treatment. Most participantsagreed that their family provided primary support resources to help them get through their cancer treatment. Cultural beliefs have an effect of on participants’ perceptions of health,responses to cancer treatment and daily activities.Conclusion(1) The symptom burden of LC patients was high. Severity, prevalence and distressof symptoms were always in high level. More attention should be pay on evaluating andmanaging their symptoms. Fatigue was the most prevalent and severe symptoms, followedby insomnia, lack of appetite, shortness, dry mouth, pain, distressed, nausea and vomiting.These symptoms were the keynotes of symptom management in LC patients.(2) The multiple symptoms LC patients experienced concomitant can be grouped asgastrointestinal, emotional and fatigue–related symptom clusters.(3) The findings reflected the symptom cluster and situational variables haddetrimental effects on the QOL of participants.(4) The findings of the qualitative studies was consistent with quantitative. Thecultural beliefs attaching to the participants’ perception of health and illness wereidentified which might also affect participant’ responses to the cancer treatment and theirdaily activities.