The Symptom Clusters And Its Influence Factors Among Inpatients With Gastrointestinal Cancer

Objective To explore symptoms and symptom clusters in patients with gastrointestinal cancer during chemotherapy, analyzing the general demographic and disease related information influence on symptom clusters, for the symptom extraction and to provide reference for the intervention program in patients with gastrointestinal cancer.Method Selecting patients treating in medical oncology in Anhui Province Tumor Hospital from October 2014 to November 2015. On the second day of chemotherapy in hospital, using unified questionnaire to explore general demographic and disease related information. Measuring symptoms with Anderson Symptom Assessment Inventory Chinese version (MDASIC-C) designed by Anderson cancer center in American, to assesses the incidence and severity of 13 symptoms at their worst in the last 24 hours (pain, fatigue, disturbed sleep, distress, shortness of breath, drowsiness, dry mouth, sadness, difficulty remembering, and numbness, lack of appetite,nausea and vomiting), Symptom interference with daily activities is measured by six functional scales regarding general activity, mood, walking, work, relations with others, and enjoyment of life. In sorting the incidence and severity of the 13 symptoms, using exploratory factor analysis method to extract symptom clusters, the reliability analysis used for testing the consistency of symptoms in the same clusters; Severity of the symptoms on the results of single factor analysis, multiple stepwise regression method is used to analysis the influence factors of each symptom clusters.Results 1.A total of 180 patients receiving chemotherapy in gastrointestinal cancer,174 patients (96.7%) occurred fatigue, severity of 4.00 (2.00-6.00),158 (87.8%) patients appeared lack of appetite, severity of 4.00 (2.00-5.00),156 (86.7%) patients experienced distress, severity of 3.00 (2.00-5.00),148 patients (82.25%) appeared sadness, severity of 3.00 (1.00-5.00),118 (65.6%) patients appeared difficulty remembering, severity of 1.00 (0.00-3.00),116 (64.4%) patients appeared disturbed sleep, severity of 2.00 (0.00-3.00),108 (60%) patients appeared nausea, severity of 1.50 (0.00-3.00),106 (58.9%) patients exist numbness, severity of 1.00 (0.00-4.00),105 cases (58.3%) patients appeared pain, severity of 1.00 (0.00-2.00),94 (52.2%) patients had vomiting and severity of 1.00 (0.00-3.00),84 patients (46.7%) existed dry mouth symptoms, severity of 0.00 (0.00-2.00),80 patients (44.4%) appeared drowsiness, severity of 0.00 (0.00-1.00),52(28.8%) patients existed shortness of breath, severity of 0.00 (0.00-1.00), the top of the incidence and severity of symptoms were fatigue, lack of appetite, distress and sadness.2.Exploratory factor analysis showed that the four main symptom clusters:the physical and mental symptoms clusters (pain-disturbed sleep-distress-sadness), energy deficiency symptom clusters (fatigue-lack of appetite-dry mouth), the gastrointestinal symptom clusters(nausea-vomiting), neurotoxic symptoms clusters (numbness-difficulty remembering). Single factor analysis results show that different cancer chemotherapies,the severity of the energy deficiency symptom clusters were different(P< 0.05), age was negatively correlated with the severity of physical and mental symptom clusters (r= 0.28, P< 0.05), with different cultural level, the severity of upper gastrointestinal clusters were different (P< 0.05), with different chemotherapies, the severity of neurotoxicity clusters were different (P< 0.05), the frequency of chemotherapy were positively correlated with th severity of neurotoxic symptoms clusters (r= 0.225, P< 0.05).3.Single factor analysis shows that the difference in chemotherapy project lead to the difference in the severity of lack of energy symptom clusters(p<0.05), the difference in cancer type^ chemotherapy project and times of chemotherapy lead to the difference in the severity of neurotoxicity symptom clusters(p<0.05).Correlation analysis find that age is related to neurotoxicity symptom clusters and,physical-mental symptom clusters (p<0.05).4.Multiple linear regression analysis showed that the factors of energy deficiency symptom clusters were chemotherapy project (p< 0.05), the influence factors of mental and physical symptom clusters were age, the influence factors of neurotoxic symptom clusters were chemotherapy project、 times of chemotherapy and cancer stage (p< 0.05).Conclusions There are many symptoms in chemotherapy gastrointestinal cancer patients, high incidence and severity of those symptoms, especially the symptoms such as fatigue, lack of appetite, distress, sadness. This should cause the attention of clinical medical personnels, strengthen the discussion of the relationship between these symptoms. Through the questionnaire investigation and exploratory factor analysis, finally it is concluded that the four symptom clusters, can provide reference for the future description of the symptom clusters in chemotherapy gastrointestinal cancer patients, for the early prevention and intervention of symptoms, to relieve symptom burden, and helps to improve the quality of life. Multivariate regression analysis results show that the influence factors of energy deficiency symptom clusters were chemotherapy project and cancer types, the influence factors of mental and physical symptom clusters were age and drinking, the influence factors of neurotoxic symptoms clusters were chemotherapy project and times of chemotherapy, these results are good for establishing early prediction of symptoms and providing scientific evidence for the intervention of symptom clusters.