A Longitudinal Study Of Symptom Clusters And Sentinel Symptoms Of Patients With Lung Cancer During Chemotherapy

ObjectivesThis study aimed to identify the symptom clusters,and longitudinally track the dynamic trajectory of the occurrence and development of symptom clusters in patients with lung cancer during chemotherapy.At the same time,sentinel symptoms were explored within the symptom clusters,which provided a basis for targeted assessment and scientific management of symptom cluster.MethodsUsing the convenience sampling method,a total of 122 patients with lung cancer who received chemotherapy were selected in the respiratory departments and Oncology departments at two tertiary Level A hospitals in Hefei,Anhui Province from March2022 to December 2022.Chinese version of the Andersen symptom assessment scale(MDASI-C)and the revised MDASI Lung Cancer Specific Module,and symptom first appearance scale were investigated at the first 3 chemotherapy cycles(7 consecutive days in the first week of each chemotherapy cycle).Generalized estimation equation was used to explore the differences in longitudinal changes in symptoms and symptom clusters of patients with lung cancer during the chemotherapy.Latent class growth analysis was performed to extract symptom clusters of each chemotherapy cycle and examine symptom cluster trajectories.The Apriori algorithm combined with the first appearance time of symptoms after chemotherapy was used to determine the sentinel symptoms of each symptom cluster.Results1.Sample collection: 193 questionnaires were distributed in the first chemotherapy;42patients were lost to follow-up,and 151 questionnaires were collected in the 2nd chemotherapy.A total of 122 questionnaires were collected from 29 patients lost to follow-up in the 3rd chemotherapy,and the return rate was 63.21%.The final data were analyzed with the final 122 samples.2.The occurrence of symptoms in patients with lung cancer during chemotherapy:(1)incidence: The survey results of symptoms in the first week of chemotherapy cycle 1(7consecutive days)showed that the symptoms with a high incidence always were distress,sadness,and cough;the survey results of symptoms in the first week of the chemotherapy cycle 2 showed that distress and sadness were always high incidence,cough was high in the first 3 days and fatigue was high in the 4-7 days;symptom survey results during the first week of the 3rd chemotherapy cycle showed distress and sadness had consistently high incidence,and drowsiness had high incidence during the1-4 days and fatigue had high incidence during the 5-7 days.(2)Severity: the distress and sadness in the first week of the first 3 chemotherapy cycles(7 consecutive days)always had a high degree of severity;on the days 3-7,fatigue also had a high degree of severity;the severity of loss of appetite was higher on days 4-5 of the third chemotherapy cycle.(3)The difference of symptoms severity in chemotherapy cycles:The results of generalized estimation equation analysis showed that the severity scores of pain and cough symptoms of patients with lung cancer in the first chemotherapy cycle and the second chemotherapy cycle were higher than those in the third chemotherapy cycle,among which the severity scores of pain and cough symptoms in the first chemotherapy cycle were the highest(P<0.01).The severity scores of nausea,numbness,and weight loss in patients with lung cancer in the first chemotherapy cycle were lower than those in the third chemotherapy cycle(P<0.05).The severity of chest tightness was higher in the first chemotherapy cycle than in the third chemotherapy cycle(P<0.01).3.Symptom clusters and its trajectory of patients with lung cancer in the chemotherapy stage:(1)Symptom clusters were grouped by latent class growth analysis.The results showed that six symptom clusters were extracted,which were nervous system symptom cluster,respiratory symptom cluster,emotion-related symptom cluster,pain-related symptom cluster,pain-emotion symptom cluster and fatigue-related symptom cluster in the study.There were five symptom clusters in the first and third chemotherapy cycles,which were nervous system symptom cluster,respiratory symptom cluster,emotionrelated symptom cluster,pain-related symptom cluster and fatigue-related symptom cluster.In the second chemotherapy cycle,there were 4 symptom clusters,which were nervous system symptom cluster,respiratory symptom cluster,pain-emotion symptom cluster and fatigue-related symptom cluster.(2)In the first three chemotherapy cycles,the trajectory of fatigue-related symptom cluster on patients with lung cancer always increased first and then decreased;respiratory symptom cluster showed a slow decreasing trend.The trajectory of other symptom clusters showed a stable trend.(3)The severity scores of nervous system symptom cluster and respiratory symptom cluster in the first chemotherapy cycle and the second chemotherapy cycle were higher than those in the third chemotherapy cycle(P≤0.01).Among the neurological symptom cluster,the severity of the second chemotherapy cycle was the highest.The respiratory symptom cluster had the highest score with the severity of the first chemotherapy cycle.The severity scores of fatigue-related symptom cluster in the first chemotherapy cycle were higher than those in the third chemotherapy cycle(P<0.01).4.Sentinel symptoms of symptom clusters in patients with lung cancer during chemotherapy: cough is the sentinel symptom of respiratory symptom cluster(coughexpectoration-chest tightness-shortness of breath)during the first and third chemotherapy cycles,pain and fatigue are the sentinel symptoms of pain-related symptom cluster(pain-constipation)and fatigue-related symptom cluster(fatigue-loss of appetite)during the first chemotherapy cycle,respectively.ConclusionThe symptom cluster categories of patients with lung cancer in the first 3 chemotherapy cycles have certain stability,while the severity,trajectory and symptom composition within each symptom cluster have dynamic changes in different chemotherapy cycles.In addition,the exploration of sentinel symptoms has reference values for efficient symptom clusters management and improving the quality of nursing.In clinical practice,health care professionals can use the sentinel symptoms as intervention targets to reduce the incidence or severity of other symptoms within symptom clusters,in terms of improving the whole symptom clusters.