Studying On Symptom Clusters In Patients With Nasopharyngeal Carcinoma Undergoing Concurrent Chemoradiation Therapy

Objectives: To explore the prevalence and severity of the mostcommon symptoms in patients with NPC undergoing adjuvantchemotherapy, and to investigate whether the symptoms occurred in“symptom cluster” during the disease development process. To evaluate thepredictors on the intensity of symptom clusters through multiple regressionanalysis. To investigate the relationship among the symptom cluster、antecedents and consequences relating NPC by structural equationmodeling，and provide scientific basis for symptom cluster study andmanagement work.Methods: we used cross-sectional study design. M.D AndersonSymptom Inventory-Head&Neck Module (MDASI-HN),Revised Life Orientation Test(LOT-R) and Positive And Negative AffectScale(PANAS) were completed. A total of250individuals were involved inour study.Statistical analysis: We use SPSS17.0statistical software to processthe data. Descriptive analysis was used to describe the general demographicdata and symptoms related MDASI-HN. Pearson Correlation wasperformed for the inter-correlations among the symptoms related NPC. Exploratory factor analysis were used to identify the symptom cluster.Thehierarchical multiple regression analysis was used to determined significantinfluential factors of symptom cluster.The model of Structural EquationModeling was built by IBM SPSS Amos20.0to test the relationship amongthe symptom cluster、antecedents and consequences.Results: A total of235patients completed the survey during six monthsfrom June to November2013.1The prevalence, severity of MDASI-HN symptoms.Obviously，dysgeusia、swallowing/chewing difficulties、dry mouth andmouth/throat mucus were the most common symptoms in the NPCpatients,its prevalence were98.7%、98.3%、98.2%and97.5%respectively.From the Tab2.2,we found that dysgeusia and dry mouth were the mostsevere symptoms whose scores ranged from5.74±2.67(dysgeusia) to5.51±2.40(dry mouth). The score of mouth/throat mucus was4.87±2.66,while Swallowing/chewing difficulties score (4.58±2.61) was relativelylower than that of dysgeusia, dry mouth and mouth/throat mucus,however,they still severer than that of other symptoms in our survey.2The relationship among the symptoms of NPC patientsA strong relationship was found among the inter-symptoms of theMDASI-HN. It proved that there is a positive inter-correlations betweenmouth/throat mucus and swallowing/chewing difficulties, nausea andvomiting, distress and sadness, dry mouth and mouth/throat mucus,drymouth and swallowing/chewing difficulties, the scores of correction were0.72、0.69、0.60、0.56、0.56, p<0.01.3The symptom cluster related NPCExploratory factor analysis identified4symptom clusters: Oral mucosa-associated(dry mouth-swallowing/chewing difficulties-dysgeusia-mouth/throat mucus、Gastrointestinal(nausea-vomiting-distress-sadness)、sickness-behavior(numbness/tingling-memory difficulties-Short of breath)and general symptom cluster, which had Cronbach’α coefficients of0.833、0.801、0.833、0.606and0.589respectively.4Factors on the NPC patientsPredictors on the intensity of oral mucosa-associated symptomclusters were health insurance、cancer staging、distant metastasis andchemotherapy. Sex、 occupation、 religion and health insurance weresignificant factors of gastrointestinal cluster. Sickness-behavior cluster’sfactors were sex、age and medicare. Type of disease was the factor of thegeneral symptom cluster.5The model of Structural Equation ModelingThe study fitted the data of symptom cluster(oral mucosa-associated)、antecedents(general demographic data disease and individualcharacteristics、optimism) and consequences(positive and negative mood)on NPC. The Adjusted Goodness of Fit Index(AGFI)=0.81, the Root MeanSquare Residual(RMSR)=0.091.The fitting effect of the model wasgood.The symptom cluster closely correlated with the antecedents andconsequences.Discussion1In conclusion, this study suggested that dysgeusia、Swallowing/chewingdifficulties、dry mouth and mouth/throat mucus were the most common andsevere symptoms of NPC patients.We should pay attention to evaluate and manage the symptoms.2The multiple symptoms patients experienced can be grouped into acluster, including oral mucosa-associated symptom clusters、gastrointestinalcluster、sickness-behavior cluster and general symptom cluster.3Predictors on the intensity of symptom clusters were sex、occupation、religion、age、cancer staging、distant metastasis、chemotherapy and healthinsurance. Health insurance was the common factor among the first threeclusters. Cancer patients who had no medicare faced economic pressuremay be experience more symptoms. Furthermore, female patients maybehad more severe GI cluster.Limitations:1The study did not evaluate the KPS of patients with NCP duringconcurrent radiotherapy and chemotherapy, which need further researchto make the concept scientific.2This study identified4symptom clusters theoretical, due to there is nottoo much research on the symptom cluster related NPC, but lack of controlstudies. Research on symptom cluster should commit its clinicalinterventions and management in order to improve patients’outcome.