Investigation Of The Symptom Clusters Of Patients With Primary Brain Tumor And Analysis Of Influencing Factors

Objectives:1.To Test the reliability and validity of the Chinese version of M.D.Anderson Symptom Inventory Brain Tumor Module(MDASI-BT),so as to provide a reliable and specific tool for the symptom evaluation of brain tumor patients in China.2.To explore the type and composition of the symptom clusters of patients with primary brain tumor,and analyze the related influencing factors to provide bases for the symptom management of patients with brain tumor.Methods:From December 2019 to October 2020,208 patients with primary brain tumor were investigated by the Chinese version of MDASI-BT,the Chinese version of European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire(QLQ-C30)(V3.0),and the Karnofsky Performance Status Scale(KPS)by convenience sampling method from a tertiary hospital in Yunnan Province.Using item analysis,internal consistency,exploratory factor analysis and criterion-related validity and sensitivity to test the reliability and validity of the Chinese version of MDASI-BT.Exploratory factor analysis was used to explore the type and composition of symptom clusters,univariate analysis and multiple linear regression were used to analyze the influencing factors of the severity of symptom clusters of patients with priamary brain tumor.Results:1.The Chinese version of MDASI-BT contained 28 items,which including 22 symptom assessment items and 6 symptom interference assessment items.2.The results of item analysis showed that there were significant differences between high-score group and low-score group(all P<0.001)except item 19 "Your vision at its worst?";The correlation coefficients between item score and total score were between 0.235 and 0.753 except item 19,and all reaching the significant level(all P<0.001).The Cronbach’s a coefficient of the instrument was 0.920,and the split-half reliability was 0.894.Through exploratory factor analysis,6 common factors extracted from 22 symptom assessment items could account for 63.137%of the cumulative variance.One common factor extracted from 6 symptom interference assessment items could explain a cumulative variance of 63.368%.The absolute value of the correlation coefficient of MDASI-BT and each area of QLQ-C30(V3.0)was 0.215～0.825(all P<0.001).The scores of the Chinese version of MDASI-BT with different KPS status had significant difference(P<0.001).3.The top five symptoms of primary brain tumor were:distress,fatigue,sadness,pain,and forgetfulness;the top three symptom interference were:mood,work,and enjoyment of life.The more serious symptoms were pain,disturbed sleep,seizures,change in vision,and fatigue;the more serious symptom interference were mood,work,and walking.Five symptom clusters were extracted from 22 symptom assessment items,named neurocognitive symptom cluster,negative emotion and decreased vitality symptom cluster,gastrointestinal symptom cluster,general symptom cluster,and elimination-appearance symptom cluster.Multivariate linear regression analysis showed that the influencing factors of neurocognitive symptom cluster were pathological grade,tumor location and KPS score;the influencing factors of negative emotion and decreased vitality symptom cluster were pathological grade,tumor growth location and KPS score;the influencing factors of gastrointestinal symptom cluster were pathological grade and KPS score;the influencing factors of general symptom cluster were tumor location,age and KPS score;the influencing factors of elimination-appearance symptom cluster were the number of comorbidity and tumor location.Conclusions:1.The Chinese version of MDASI-BT has good reliability and validity,which can be used to evaluate the severity of symptoms and interference to life in patients with brain tumor.2.Patients with primary brain tumor experience multiple symptoms at the same time,and the symptoms are related,which appearing in the form of symptom clusters,mainly include neurocognitive symptom cluster(difficulty understanding-difficulty speaking-difficulty concentrating-forgetfulness-shortness of breath),negative emotion and decreased vitality symptom cluster(distress-sadness-disturbed sleep-fatigue),gastrointestinal symptom cluster(nausea-vomiting-lack of appetite),general symptom cluster(change in bowel pattern-pain-dry mouth-drowsiness-irritability),elimination-appearance symptom cluster(change in vision-change in appearance).The symptom clusters are mainly affected by pathological grade,tumor location,KPS score,age,and numbers of comorbidity,and the influencing factors of different symptom clusters are more or less different.The establishment of symptom clusters and the analysis of influencing factors can provide a basis for the management of symptom clusters of patients with brain tumor.