| Research BackgroundThe incidence of lung cancer ranks second in the world and the mortality rate ranks first.In China,its incidence and mortality rank first.Although some progress has been made in the prevention,diagnosis and treatment of lung cancer in recent years,the 5-year survival rate for lung cancer is still very low in most parts of the world.At present,the main treatment methods for lung cancer include surgery,radiotherapy,chemotherapy,targeted therapy and immunotherapy.These treatments can cause different levels of adverse reactions while obtaining curative effects,and lung cancer itself can cause various symptoms.The advantage of traditional Chinese medicine(TCM)lies in the control of adverse reactions and the management of symptoms under dialectical treatment.Numerous studies have shown that study and intervention in symptom clusters can not only manage symptoms,guide treatment to improve the quality of life of patients,but also provide clinical medical staff with efficacy evaluation criteria for symptom management.The research combined of symptom clusters and TCM syndromes can provide a reference basis for TCM syndrome differentiation and the useage of clinical drug,which is conducive to the standardization and quantification of TCM syndrome,and helps to take measures of integrated TCM to intervene in symptoms to improve the treatment effect and improve the quality of life of patients.Research objectiveThis study is divided into two parts.In this study,the questionnaire "Expert Consensus on Standardization of Symptom Evaluation of Traditional Chinese Medicine in Lung Cancer" was used to investigate the incidence and severity of symptoms of lung cancer patients in the postoperative stage and chemotherapy stage.Further analyze the correlation between symptom clusters and TCM syndrome,in order to provide medical staff the basis of symptom management and fully reflect the advantages of TCM symptom management.Research MethodsStudy 1:Study on symptom clusters and TCM syndromes in postoperative stage of lung cancerLung cancer patients who met the exclusion criteria within one month after surgery in the Cancer Hospital Chinese Academy of Medical Sciences were selected as the research subjects,and the basic information form,the questionnaire of TCM syndrome elements and the questionnaire of "Expert Consensus on Standardization of TCM Symptom Evaluation of Lung Cancer" were filled in.SPSS25.0 software is used for data analysis,and the collected data was entered and verified by two people.The mean,standard deviation,composition ratio were used to statistically describe the basic data,clinical data,syndrome incidence,symptom incidence and severity.The exploratory factor analysis was used to identify the symptom clusters and Spearman correlation analysis was used to verified the results of symptom clusters.Spearman correlation analysis method was used for the correlation analysis between symptom clusters and TCM syndrome types.The hypothesis tests were all conducted on both sides,with a P<0.05 statistically significant.Study 2:Study on symptom clusters and TCM syndromes in chemotherapy stage of lung cancerThe study subjects were hospitalized during platinum-based doublet-chemotherapy for lung cancer in Guang’anmen Hospital,Chinese Academy of Chinese Medical Sciences.The symptom cluster analyzed without distinguishing between mild,medium and severe symptoms is defined as the overall symptom clusters.The symptoms with a score of ≥2 are moderate-to-severe symptoms for symptom clusters analysis,and the resulting symptom clusters are named moderate-to-severe symptom clusters.Spearman correlation analysis was used for the correlation analysis between symptom clusters and blood routine index.The composition ratio was used for the statistics of the frequency and ratio of TCMs,and the cluster analysis was used for the study of TCMs clusters.The hypothesis tests were all conducted on both sides,with a P<0.05 statistically significant.The remaining research methods were the same as Study 1.Research resultsStudy 1:Study on symptom clusters and TCM syndromes in postoperative stage of lung cancer1.Incidence and severity of symptoms:43 symptoms with an incidence rate between 0～78.50%,of which 20 symptoms with a symptom incidence more than 20.00%,and the incidence of 5 symptoms more than 50.00%,the top three symptoms incidence rate were shortness of breath(78.50%),cough(76.64%),and fatigue(60.75%).Among them,5 symptoms were not occurred in all patients,and the severity of the remaining 38 symptoms was between 0.01±0.009～0.95±0.069.The top three severe symptoms were cough(0.95±0.069),shortness of breath(0.88±0.054),and fatigue(0.74±0.066).2.Symptom clusters analysis:A total of 3 symptom clusters were extracted,namely:emotion related symptom cluster,including sadness,irritability,distress,and insomnia.Fatigue pain related symptom cluster,including fatigue,pain,dry mouth,bitter mouth,and day sweating.Lung cancer specific symptom cluster,including wheezing,shortness of breath,drowsiness,and cough.3.Distribution of TCM syndromes:Qi deficiency syndrome was the highest in the stage of postoperative,with a composition ratio of 69.16%.Followed by Yin deficiency syndrome,with a composition ratio of 46.73%.The composition ratio of phlegm dampness syndrome was 36.45%.The composition ratio of blood stasis syndrome was 28.97%.Tthe composition ratio of heat toxin syndrome was 12.15%.4.Correlation analysis between symptom clusters and TCM syndromes:The group of emotion related symptom cluter was positively correlated with yin deficiency and phlegm dampness syndrome.The group of fatigue pain related symptom cluster was positively correlated with Qi deficiency,Yin deficiency,and blood stasis syndrome.The lung cancer specific symptom cluster wsa positively correlated with Qi deficiency,phlegm dampness,Yin deficiency,and blood stasis syndrome.Study 2:Study on symptom clusters and TCM syndromes in chemotherapy stage of lung cancer1.Incidence and severity of symptoms:The incidence of 43 symptoms was between 1.18%～89.35%,of which 30 symptoms with a symptom incidence more than 20.00%,and the incidence of 12 symptoms more than 50.00%.The top three incidences were loss of appetite(89.35%),cough(82.25%),and nausea-vomiting(78.70%).The severity of 43 symptoms ranged from 0.01 10.008～1.75±0.077,among which the top three severe symptoms were:loss of appetite(1.75±0.077),fatigue(1.43±0.085),dry stool(1.34±0.078).2.Symptom clusters analysis:A total of 6 overall symptom clusters were extracted,namely:chemotherapy related symptom cluster,including bitter mouth,dry mouth,nausea-vomiting,fatigue,loss of appetite,pain,and chilly.The emotion related symptom cluster include sadness,distress,irritability,and chest tightness.The lung cancer specific symptom clusters include white sputum,cough,shortness of breath,and yellow sputum.The illness symptom cluster include itchy sore throat,iciness of hands and feet,dry stools,and wheezing.The neuroendocrine related symptom cluster include drowsiness,nocturia,yellow urine,and day sweating.The gastrointestinal symptom cluster include gaseous distention,abdominal distension,and night sweating.A total of 3 symptom clusters were extracted for moderate-to-severe symptoms,namely chemotherapy related symptom cluster,including nausea-vomiting,loss of appetite,dry mouth,and fatigue.The lung cancer specific symptom cluster include white sputum,cough,and shortness of breath.The illness symptom cluster include dry stools,nocturia,and wheezing.3.Distribution of TCM syndromes:The highest incidence was Qi deficiency syndrome,with a composition ratio of 93.49%.The composition ratio of phlegm dampness syndrome was 88.17%.The ratio of Yin deficiency syndrome was 74.56%.The composition ratio of heat toxicity certificate was 57.40%,and the composition ratio of heat toxin syndrome was 50.30%.4.Correlation analysis between symptom clusters and TCM syndromes:the correlation analysis results between the overall symptom clusters and TCM syndromes showed that:the chemotherapy related symptom cluster was positively correlated with the Qi deficiency syndrome.The emotion related symptom cluster was not associated with any of the five TCM syndromes.The lung cancer specific symptom cluster was positively correlated with Qi deficiency and phlegm dampness syndrome.The illness symptom cluster was positively correlated with heat toxin,Yin deficiency,and Qi deficiency syndrome.The neuroendocrine related symptom cluster was positively correlated with Yin deficiency and heat toxin syndrome,and negatively correlated with blood stasis syndrome.The gastrointestinal related symptom cluster was positively correlated with Qi deficiency and Yin deficiency syndrome.The correlation analysis results between moderate-to-severe symptom clusters and TCM syndromes showed that:The chemotherapy related symptom cluster was positively correlated with Qi deficiency syndrome.The lung cancer specific symptom cluster was positively correlated with Qi deficiency and Yin deficiency syndrome.The illness symptom cluster was positively correlated with heat toxin and Yin deficiency syndrome.5.Correlation analysis between symptom cluster and blood routine index:the correlation analysis results of the overall symptom clusters and blood routine index showed that:the chemotherapy related symptom cluster was negatively correlated with RBC.The emotion related symptom cluster was negatively correlated with RBC,HGB and BOAO#.The lung cancer specific symptom cluster was negatively correlated with EO#and BOAO#.The illness symptom cluster was negatively correlated with RBC and HGB,and positively correlated with CRP.The neuroendocrine related symptom cluster was negatively correlated with LYMPH#and positively correlated with CRP.The gastrointestinal symptom cluster was positively correlated with PLT and NEUT#.The correlation analysis of moderate-to-severe symptom clusters and blood routine index showed that:there was no correlation between chemotherapy related symptom cluster and blood routine index.The lung cancer specific symptom cluster was negatively correlated with EO#.The illness symptom cluster was negatively correlated with RBC and LYMPH#,and positively correlated with CRP.6.Analysis of traditional Chinese medicine intervention:A total of 90 TCM prescriptions were included during hospitalization,with a total of 216 TCM prescriptions,and the total frequency was 1673 in which 23 TCMs are used more than 20%.Among them,the most used drug was Astragalus,with a frequency of 56 and a ratio of 62.2%.The top 15 TCMs used in order are:Astragalus,Rhodiola,Tangerine peel,Platycodon grandiflorus,Poria,Licorice,Chicken’s gizzard-membrane,fried Atractylodes macrocephala with bran,fried Semen armeniacae amarum,ginger Pinellia ternate,Scutellaria baicalensis,Bulbus fritillariae thunbergii,Angelica sinensis,Paeonia lactiflora pall,and Codonopsis pilosula.Systematic clustering analysis of TCMs with more than 20%use frequency showed that 23 TCMs could produce 8 clusters which were as follows:cluster 1:ginger Pinellia ternate,Codonopsis pilosula,Bupleurum chinense,fried malt;cluster 2:Chicken’s gizzard-membrane,Rhizoma alismatis;cluster 3:Angelica sinensis,Paeonia lactiflora pall,Atractylodes macrocephala,Ligusticum chuanxiong Hort;cluster 4:Astragalus,Poria,fried Atractylodes macrocephala with bran,Rhizoma pinellinae praeparata;cluster 5:fried Semen armeniacae amarum,Bulbus fritillariae thunbergii,Platycodon grandiflorus;cluster 6:Bamboo Shavings;cluster 7:Tangerine peel,Chicken’s gizzard-membrane,Licorice,Scutellaria baicalensis;cluster 8:Rhodiola.Research conclusions1.The results show that the incidence and severity of symptoms in patients in the postoperation stage and chemotherapy stage of lung cancer are different.In general,the incidence and severity of symptoms during chemotherapy were more severe than those during postoperation stage.2.A total of three symptom clusters were extracted from patients during the postoperation stage,namely emotion related symptom cluster,fatigue pain symptom cluster,and lung cancer specific symptom cluster.A total of 6 symptom clusters were extracted during chemotherapy stage,namely chemotherapy related symptom cluster,emotion related symptom cluster,lung cancer specific symptom cluster,illness related symptom cluster,neuroendocrine related symptom cluster,and gastrointestinal related symptom cluster.A total of 3 moderate-to-severe symptom clusters were extracted,namely chemotherapy related symptom cluster,lung cancer specific symptom cluster,and illness symptom cluster.Among them,lung cancer specific symptom cluster and emotion related symptom cluster appeared in both stages,and this study can provide a basis for symptom management in patients at different treatment stages.3.Most of the correlations between symptom clusters and TCM syndromes,and between symptom clusters and blood routine indexes,can lay a foundation for further exploration of symptom clusters and the biological mechanism of TCM syndromes,and can guide clinical treatment.4.By comparing the overall symptom clusters and the moderate-to-severe symptom clusters,it is found that the moderate-to-severe symptom clusters are more accurately consistent with the clinical situation.This symptom cluster analysis method provides ideas for subsequent similar studies.5.This study elaborates the correlation between syndromes,symptom clusters,blood routine indexes and traditional Chinese medicine,which provides a reference for Chinese medicine to improve the symptom clusters of patients under the guidance of dialectical treatment,which is helpful to give full play to the advantages of traditional Chinese medicine in the aspect of symptom management and improve the quality of life of lung cancer patients on the basis of prolonging the survival time. |
PDF Full Text Request