Longitudinal Study Of Association Between Perioperative Symptom Clusters And Quality Of Life In Patients With Primary Liver Cancer Based On Patient-Reported Outcomes

Objective:The composition and dynamic trend of perioperative symptom clusters in patients with primary liver cancer were systematically and comprehensively evaluated,and the correlation between symptom clusters and quality of life in perioperative patients with liver cancer was analyzed.Methods:Convenience sampling method was used to select 90 PLC patients who met the inclusion criteria in a third-class a hospital in Sichuan Province.Before surgery(T1～T2)and after surgery(T3～T12),a total of 12 time points,Anderson Symptom Assessment Scale and M.D.Anderson Symptom Inventory-Perioperative-Hepatoma were used to conduct longitudinal assessment of perioperative symptoms related to liver cancer patients.Before surgery(T2)and after surgery(T9 ～ T12),a total of 5 time points,Quality of Life-Liver cancer V2.0 was used to evaluate the quality of life of perioperative patients with liver cancer and the correlation between symptom clusters and quality of life.Results:1.The number of symptoms fluctuated from 2.39±2.38～9.91±2.33 at various time points during the perioperative period in patients with hepatocellular carcinoma,and the incidence of symptoms ranged from 1.1 to 100 percent.2.The top 3 symptoms with high incidence and severity in T1 and T2(preoperation)were sleep disturbance,dry mouth and distress,while the incidence and severity of symptoms in liver cancer patients increased rapidly from T3(1d postoperatively)onwards;The top 5 symptoms with high incidence and severity are pain,abdominal cramps,drowsiness,dry mouth and fatigue for T3 to T6;The top 5 symptoms of high incidence and severity are pain,abdominal cramps,lethargy,loss of appetite and sleep disturbance for T7 to T8;the top 5 symptoms of high incidence and severity are pain,abdominal cramps,loss of appetite,sleep disturbance and incisional tightness for T9 to T10;the top 5 symptoms with a high incidence and severity of T11 to T12 are pain,abdominal cramps,dry mouth,loss of appetite and incisional tightness.3.Sickness symptom clusters,pain-related symptom clusters and emotional-psychiatric symptom clusters are common to patients with liver cancer and persist over 12 time periods.4.The number of perioperative symptoms(r=-0.34～-0.69,P < 0.01)and severity(r=-0.37 ～-0.76,P < 0.01)of patients with liver cancer at each time point were negatively correlated with quality of life.That mean when the number and severity of perioperative symptoms in patients with liver cancer were higher,the quality of life was worse.5.The scores of pathogenetic symptom clusters,pain symptom clusters and emotional and mental symptom clusters were significantly negatively correlated with the total score of quality of life in patients with liver cancer(r=-0.13～-0.66,r=-0.20～-0.61,r=-0.36～-0.64,P<0.05).That mean when the higher the score of each symptom group,the worse the quality of life.Conclusion:1.Patients with hepatocellular carcinoma have a high perioperative symptom burden,with rapid,numerous,high incidence and severe symptom changes starting from T3(1d postoperatively).Clinical observation needs to be focused and patients’ symptom changes need to be assessed at any time.2.Multiple perioperative symptoms in patients with liver cancer can be grouped into symptom clusters,and pathogenic symptom clusters,pain symptom clusters and emotional-psychiatric symptom clusters are common symptom clusters in patients with liver cancer during perioperative period.3.The perioperative symptoms and symptom clusters of patients with liver cancer at different time points were significantly negatively correlated with the total score of quality of life,suggesting that clinical work should strengthen the management of symptoms and symptom groups of patients undergoing surgery to improve the quality of life of patients.