Symptom Cluster And Relationships To Quality Of Life, Functional Status Of Lung Cancer Patients

Objectives: To explore the prevalence and severity of fatigue,disturbed sleep, pain and distress, and to examine whether the above foursymptoms occurred in “symptom cluster” during the trajectory of disease,and to evaluate the relationships between symptom cluster and patients’disease outcomes, including functional status and quality of life, and tomake an analysis of the influencing factors of quality of life and functionalstatus.Methods: This cross-sectional study design were assessed by M.DAnderson Symptom Inventory (MDASI), Quality of Life Instruments forCancer Patients—Lung Cancer (QLICP-LU) and Karnofsky PerformanceScale (KPS). Three-hundred and eighty four individuals were involved inthe survey.Statistical analysis: SPSS16.0statistical software was used toanalyze the data. Descriptive statistics were used to summarizedemographic and disease variable. Pearson Correlation was performed forthe inter-correlations among symptoms, and relationships between symptoms and KPS, QLICP-LU scores. The one-way analyses of variancewere used to determine whether QLICP-LU scores and KPS hadsignificant relationships with different number of symptoms. Thehierarchical multiple regression analysis was used to determine significantinfluential factors on patients’ QoL and functional status.Results: Of384lung cancer patients,145cases were surgery, while120and119patients were getting chemotherapy and radiotherapyrespectively.1The prevalence, severity of MDASI symptoms.It was noteworthy that fatigue, disturbed sleep pain, and distress werethe top four prevalence symptoms in lung cancer patients, its prevalencewere89.1%、85.2%、83.9%and80.7%respectively. For the severity, itwas suggested that pain and fatigue were the most severe symptoms andthe scores ranged from4.21±2.75(pain) to4.10±2.58(fatigue). The scoreof disturbed sleep was3.78±2.69, while distress score (3.43±2.59) wasrelatively lower than that of pain, fatigue and disturbed sleep, but stillseverer than that of other symptoms in this study.2The prevalence of co-occurrence of pain, fatigue, disturbed sleep anddistress and its effects on patient’s QLICP-LU subscale/total and KPSscores.Only2.1%(n=8) patients reported co-occurrence of none of pain,fatigue, disturbed sleep, and distress in384patients. It was notable that only4.9%(n=19) patients had only one symptom,9.1%(n=35) and21.1%(n=81) patients reported co-occurrence of two or three symptoms of pain,fatigue, disturbed sleep, and distress. More than half of patients62.8%(n=241) reported co-occurrence of the four symptoms simultaneously. Therelationships between different numbers of symptoms and the KPS,QLICP-LU subscales/total scores suggested that the scores in groups withlarger number of symptoms were significantly lower than that in groupswith a smaller ones.3The relationship between symptom cluster and quality of life, functionalstatus of lung cancer patients.It was revealed that both the total scores(r=-0.545～-0.754) andsubscales scores (PHD: r=-0.628～-0.684, PSD: r=-0.114～-0.588, SOD:r=-0.141～-0.330, SSD: r=-0.433～-0.623, SPD: r=-0.489～-0.617) ofQLICP-LU showed negative inter-correlations with pain, fatigue,disturbed sleep and distress (P＜0.01). It proved that the KPS score(r=-0.518～-0.751, p<0.01) showed negative inter-correlations with pain,fatigue, disturbed sleep and distress as well in this study.4The correlations between characteristics and quality of life, functionalstatus of lung cancer patientsThe correlations between characteristics and QLICP-LU, KPS scoresof lung cancer patients proved that only income and cancer stage showedsignificant positive effects on QLICP-LU score among characteristics of patients（P＜0.05）. For KPS, income and cancer stage showed positivecorrelations with the score as well, while the number of co-morbidities andage showed negative correlations with it.Discussion1In conclusion, this study suggested that pain, fatigue, disturbed sleep,and distress were the most common and severe symptoms of lung cancerpatients.2Pain, fatigue, disturbed sleep, and distress always occurred in cluster,and the number of co-occurrence and severity of symptom clusternegatively correlated with patients’ functional status and QoL.3It was proved that gender, age, marriage status and other factors had nosignificant impact on quality of life. But monthly family income andcancer stage had positive impact on patient’s quality of life, and the higherincome or the earlier stage of caner with the higher quality of life ofpatients. For KPS, income and cancer stage still the positive factors whichcould had independent impact on it, while age and the number ofCo-morbidities are negative correlations with functional status of lungcancer patients, and the older or the more co-morbidities with worsefunctional status.Limitations:1The dimensions of symptoms which will affect quality of life ofpatients including prevalence, severity and distress. More researches need to focus on the impact of symptom’s distress on quality of lifeand functional status in future studies, as this research only focus onprevalence and severity of symptoms.2The study only suggested that the common symptom cluster could besignificant negatively influenced on patients’ outcomes. Research onsymptom clusters should focus on its interventions and management inorder to improve patients’ functional status and QOL in further study.