The Analysis Of Symptom Clusters, Adverse Effects And Its Influencing Factors In Patients With Lung Cancer During Radiotherapy

ObjectiveTo analyze the adverse effects of patients with lung cancer during radiotherapy and identify the influencing factors of adverse effects and establish symptom clusters for lung cancer patients during radiotherapy and chemotherapy, so as to provide the basis to propose adverse effects risk screening and intervention program.MethodsWe included patients diagnosed with lung cancer who received radiotherapy between February2011and January2013at Tianjin medical university cancer hospital. At the baseline before radiotherapy, a general questionnaire designed by the investigators was administrated to evaluate the patients’demographic characteristics and clinical data. From the beginning of radiotherapy to the end, we assessed the12adverse effects of patients with lung cancer during radiotherapy, including radiodermatitis, radiation esophagitis, radiation pneumonitis, myelosuppression, fatigue, fever, insomnia, astriction, diarrhea, anorexia, nausea and vomiting. The variables were examined for their association with adverse effects by x2test. A multivariate logistic regression analysis was performed to identify the potential factors leading to adverse effects. We included patients diagnosed with lung cancer who received radiotherapy and chemotherapy between May2013and February2014at Tianjin medical university cancer hospital. MDASI-C was used to assess the frequency and intensity of clinical symptoms in the past24h so as to analyze the influencing factors of symptom clusters. Descriptive analysis is used to describe MDASI-C scale score and Spearman correlation analysis for MDASI-C symptoms. Principal component analysis is used to extract the symptom clusters. The reliability analysis is used to test the internal reliability of the symptoms.ResultsA total of182patients with lung cancer were enrolled.85(46.7%) patients were in anxiety,87(47.8%) patients in depression,41,8%patients in fatigue,68(37.4%) patients in astriction,14(7.7%) patients in diarrhea,133(73.1%) patients in anorexia,57(31.3%) patients in radiation esophagitis,87(47.8%) patients in radiodermatitis, 40(22.0%) patients in radiation pneumonitis,62(34.1%) patients in lower hemoglobin,94(51.6%) patients in reduction of leukocyte,33(18.1%) patients in platelet inhibition,and57(31.3%) patients in neutrophile granulocyte inhibition. Univariate analysis showed that there were significant differences of fatigue, astriction, fever, and vomiting between two groups. By logistic regression analysis, surgical history, high blood pressurenutritional support, depression and pain were retained as significant risk factors that contributed independently to adverse effects of patients with lung cancer during radiotherapy. A total of128patients with lung cancer who received radiotherapy and chemotherapy were enrolled. The most significant four symptoms included fatigue, pain, anorexia and distress. The analysis of three principal component of MDASI-C showed that there were three symptom clusters. The three symptom clusters had high internal reliability. The coefficient of Cronbach’s a is0.82,0.83and0.82respectively.ConclusionThe incidence of malnutrtion was high in patients with lung cancer during radiotherapy. So clinical medical staff should pay more attention to them. Surgical history, high blood pressure, nutritional support, depression and pain are retained as significant risk factors that contribute independently to adverse effects of patients with lung cancer during radiotherapy. Based on the symptom clusters established in our study, health care providers can propose adverse effects risk screening and intervention program for lung cancer patients during radiotherapy and chemotherapy.