| ObjectivesThis study aimed to identify symptom clusters in perioperation patients with lung cancer at different measurement points,and examine the association between these symptom clusters and patients’ quality of life,thus providing a basis for the dynamic management of clinical symptom clusters and improving patients’ quality of life.MethodsFrom January 2019 to September 2019,using a convenient sampling method,217 lung cancer patients were selected for surgery by thoracic surgery at a tertiary Level A hospital in He Fei city,An Hui province.At the first day of admission(T1),2 to 4 days post-operation(T2)and one month post-operation(T3),the socio-demographic data and disease information of perioperation patients with lung cancer were evaluated using a general data questionnaire(only T1 collected),and symptom clusters of perioperation patients with lung cancer were evaluated using the Chinese Andersen version of the symptom assessment scale(MDASI-C)and the revised MDASI Lung Cancer Specific Module,and patients’ quality of life were evaluated using the Chinese version of theQuality of Life Assessment Scale for Lung Cancer Patients(FACT-L).The statistical description and analysis were carried out by SPSS 23.0 statistical software;The extraction method of symptom clusters were selected to be verified by two methods of complex system entropy division method based on prior knowledge and social network analysis method,and social network analysis were visualized with Gephi software.The longitudinal change and rate of change in perioperation lung cancer patients’ the total and each dimension scores of quality of life with in repeated measurements were discussed by using single-factor repeated measurement univariate analysis.Using generalized estimation equation(GEE),the differences in the longitudinal change and rate of change in the symptom clusters of perioperation patients with lung cancer were explored,and the longitudinal correlation between severity scores of symptom clusters in perioperation patients with lung cancer and total scores of quality of life and scores in various dimensions.Results1.Sample collection: 226 questionnaires were distributed at the first day of admission(T1);8 cases of seriously ill patients were excluded,and 218 cases were recovered at 2to 4 days post-operation(T2),the return rate was 96.5%;at one month post-operation(T3)excluded 1 case of patients who died of illness,217 questionnaires were recovered,and the return rate was 96.0%.The final date analysis were analyzed with the final 217 samples.2.Symptoms of perioperation patients with lung cancer and the composition of symptom clusters: Perioperation patients with lung cancer had 19 symptoms at 3measurement points.At the first day of admission(T1),the incidence of pain,nausea,vomiting,weight loss,constipation,drowsiness,hemoptysis and numbness were lessthan 20%,with the remaining symptoms were the top three with the incidence of distress(93.55%),fatigue(82.03%),and sadness(54.84%).At 2 to 4 days post-operation(T2),the elimination of two symptoms(constipation,numbness),the remaining symptoms were the top three with the incidence of pain(99.08%),distress(99.08%)and expectoration(97.24%).At one month post-operation(T3),the elimination of two symptoms(nausea,vomiting),the incidence of distress(100.0%),fatigue(100.0%),chest tightness(88.0%)were the top three.At the first day of admission(T1),,four symptom clusters(respiratory symptom clusters,pain-fatigue-sleep disturbance symptom clusters,psycho-emotional symptom clusters,and neurological symptom clusters)were found in all the respondents,at 2 to 4 days post-operation(T2),and one month post-operation(T3),patients had increased gastrointestinal symptom cluster,and there were five symptom clusters.Perioperation patients with lung cancer had multiple stable symptom clusters,there were dynamic changes in the composition of symptoms within their clusters at each assessment.3.Perioperation lung cancer patients’ quality of life: At each assessment,the included perioperation patients with lung cancer through the process of high to low and then recovery on the total and each dimension scores of quality of life,and the time effect differences of perioperation lung cancer patients’ the total and each dimension scores of quality of life(except social and family status dimension)were statistically significant(P<0.01)4.Correlation between symptom clusters and the scores of quality of life in perioperation patients with lung cancer: The total scores of quality of life were negatively correlated with the severity scores of respiratory symptom clusters(B =-1.006,OR = 0.366,95%CI(0.281,0.477))and symptoms disturbance(B =-0.512,OR= 0.599,95%CI(0.460,0.781)),the higher the severity scores of respiratory symptomsclusters and symptoms disturbance in lung cancer patients,the lower the total scores of quality of life(P<0.01).The scores of physiological condition dimension was negatively correlated with the severity scores of respiratory symptom clusters(B =-0.077,OR =0.926,95%CI(0.864,0.993)),pain-fatigue-sleep disturbance symptom clusters(B =-0.115,OR = 0.891,95%CI(0.829,0.957))and symptoms disturbance(B =-0.164,OR= 0.848,95%CI(0.798,0.902)),the higher the severity scores of respiratory symptom clusters,pain-fatigue-sleep disturbance symptom clusters,and symptoms disturbance in lung cancer patients,the lower the scores of physiological condition dimension(P<0.05).The scores of social and family condition dimension was negatively correlated with the severity scores of respiratory symptom clusters(B =-0.135,OR = 0.873,95%CI(0.794,0.961)),neurological symptom clusters(B =-0.269,OR = 0.764,95%CI(0.616,0.947))and symptoms disturbance(B =-0.192,OR = 0.825,95%CI(0.742,0.918)),the higher the severity scores of respiratory symptom clusters,neurological symptom clusters and symptoms disturbance in lung cancer patients,the lower the scores of social and family condition dimension(P<0.05).The scores of emotional condition dimension was negatively correlated with the severity scores of respiratory symptom clusters(B =-0.089,OR = 0.915,95%CI(0.863,0.969))and psycho-emotional symptom clusters(B =-0.226,OR = 0.798,95%CI(0.676,0.942)),the higher the severity scores of respiratory symptom clusters and psycho-emotional symptom clusters in lung cancer patients,the lower the scores of emotional condition dimension(P<0.05).The scores of functional condition dimension was negatively correlated with the severity scores of respiratory symptom clusters(B =-0.223,OR = 0.800,95%CI(0.712,0.900))and pain-fatigue-sleep disturbance symptom clusters(B =-0.300,OR = 0.741,95%CI(0.583,0.941)),the higher the severity scores of respiratory symptom clusters and pain-fatigue-sleep disturbance symptom clusters in lung cancer patients,the lower the scores of functional condition dimension(P<0.05).The scores of additional attention dimension was negatively correlated with the severity scores of respiratory symptom clusters(B =-0.482,OR = 0.618,95%CI(0.571,0.668))and symptom disturbance(B =-0.095,OR =0.894,95%CI(0.787,1.016)),the higher the severity scores of respiratory symptom clusters and symptom disturbance in lung cancer patients,the lower the scores of additional attention dimension(P<0.05).ConclusionPerioperation patients with lung cancer have multiple stable symptom clusters,there are dynamic changes in the composition of symptoms within their clusters at each assessment.There are differences in lung cancer patients’ the total and each dimension scores of quality of life at each assessment,and the scores go through a process from high to low and then recovered.The total and each dimension scores of quality of life are negatively correlated with the severity scores of symptom clusters,and the dynamic management intervention of medical staff on the symptom clusters is expected to improve the quality of life of perioperation patients with lung cancer. |
PDF Full Text Request