Symptom Clusters Changes And Influence Factors In Patients With Lung Cancer During Treatment

BACKGROUNDThe world’s highest mortality of cancer is lung cancer. According to "Global Cancer Report 2014", the latest data show that there are 1.8 million patients suffering from lung cancer in 2012. With the rise in the level of medical care, the treatment methods diversified, such as surgery, chemotherapy, radiotherapy, minimally invasive treatment. As the increasing rate of the five-year survival of lung cancer, it’s paid attention to alleviate the symptom burden by working on the effective symptoms assessment and management of patients with lung cancer in recent years.Symptoms occur simultaneously because of illness, treatment, social psychological and other reasons, so multiple symptom assessment study compared single symptom assessment to better reflect the integrity of the symptoms of cancer patients. Lin, S. research showed pain, fatigue, sleep disturbances and anguish affect the quality of life of patients with lung cancer after surgery and those symptom are the most common and most serious symptoms. Dodd, M.J proposed the concept of symptom clusters at the first, that is three or more symptoms associated with the composition of clusters. In his research, pain, fatigue, sleep anxiety consist in symptom clusters a multiple regression analysis showed explain 48.8% of KPS score of the variation. The current symptom management program is mainly managed for single symptom (Jensen, W.eg improve the symptoms of patients with breathless of lung cancer through management) or more symptoms improved by one activity (Improved anxiety, depression and other symptoms of lung cancer through aerobic exercise).Multi-symptom comprehensive behavior management intervention program is the future direction of symptom management research.According to current research status, this research investigate the changes and factors of lung cancer including treatment, disease, psychosocial orientation of symptom cluster to provide the basis for clinical workers to predict changes of symptoms of lung cancer patients, based on pre-established causes of change programs, systematic symptom management program.OBJECTIVE1. Explore formation and changes of symptom clusters during treatment, the internal structure and changes over time by M. D. Anderson Symptom Inventory-Chinese (MDASI-C) and the module revision symptoms of lung cancer.2. Explore factors of symptoms change to provide evidence for clinical workers about symptom management.SUBJECTS AND METHODS1. Object217 cases of lung cancer patients of Guangdong Province three top hospitals are investigated by convenience sampling method in March to November of 2015.2. QuestionnaireM. D. Anderson Symptom Inventory-Chinese (MDASI-C) and the module revision symptoms of lung cancer and ECOG conducted a questionnaire survey. Patients with general information including gender, age, marital status, education, religion, work status, occupation, family income, treatment expenses, medical expenses sources and disease-related information. Investigators complete tables including cell type, tumor location, differentiation, long time of diagnosis, tumor stage, tumor metastasis number, have done and the doing treatment.3. Survey MethodsA prospective longitudinal study design, conducted a three-month investigation during treatment. Investigation is on the first time(T1), a month later(T2), three months later(T3). During the first survey of patients hospitalized questionnaire, one month, three months later by telephone follow-up on the contents of 25 items MDASI-C and revisions symptoms of lung cancer module up for 15 to 20 minutes.4. Statistical MethodsDescriptive statistical methods described on the basic information, incidence and symptom severity of symptoms, Spearman correlation to analyze symptom correlation, principal component to extract symptom clusters, the maximum variance method (Varimax) for factor rotation and multiple regression for investigating factors affecting symptom clusters changes.RESULT1. Patient InformationThe first assessment of the patient is 217 cases,164 cases of the second time and 142 cases of the third assessment. In the second investigation, sample loss is 53 cases, including 15 cases refused to investigate, lost contact in 31 cases, patients died seven cases. The third investigation, the amount of sample lost is 22 cases, including six cases refused to investigate, lost contact 8 cases,8 patients died cases.2. The incidence and severity of symptomsThe incidence of the top three symptoms in the first assessment descending order of fatigue, disturbed sleep, cough, the lowest incidence of the three symptoms from low to high as vomiting, lethargy, coughing up blood; the severity of the symptoms of sleep most anxiety, pain, fatigue, the severity of symptoms of hemoptysis lowest, lethargy and vomiting. The second highest incidence assess symptoms of fatigue, weight loss, sleep disturbances, the lowest incidence of symptoms of vomiting, hemoptysis, nausea; the severity of the symptoms of the highest fatigue, disturbed sleep, distress, the severity of symptoms of hemoptysis lowest, forgetfulness, weight loss. Third Assessment highest incidence of symptoms of fatigue, weight loss, loss of appetite, the lowest incidence of hemoptysis, vomiting, amnesia; the highest severity of fatigue, distress, pain severity was lowest forgetfulness, weight loss, shortness of breath.3. Life Project plagued the incidence and severityThird Assessment troubled highest incidence are emotional, the lowest incidence of troubled relations with others are.1st assess the severity of the most troubled of the work, the lowest for relationships with others; the second highest severity assessment bothered to work, the lowest for relationships with others; 3rd assess the severity of the highest for the troubled mood, the lowest for the relationships with others.4. The correlation between symptomsThe most relevant to assess the presence of cough and sputum production; the second is highly relevant to assess the presence of pain and fatigue, loss of appetite and fatigue, cough and sputum; third highly relevant to assess the presence of pain and fatigue, cough and sputum.5. Symptom clusters extraction resultsFactor extraction principles:① load factor rate ≥0.4; ②incidence greater than 15%; the number ③factor greater than one. The first evaluation time point extraction seven factors, variance contribution rate of 63.583%, based on the principles of screening after the remaining five factors, including fatigue, pain symptoms associated group, lung cancer-specific symptom clusters, shortness of breath related symptom clusters, chemotherapy-related symptom clusters, psychological related symptom clusters; the second evaluation time point extracted seven factors, the contribution rate of 67.545% of variance, and the remaining four factors after screening for symptoms of pain and fatigue associated group, the group of lung cancer-specific symptoms, psychological symptoms associated with the group, the group of digestive system-related symptoms; third evaluation time point extracting six factors, the contribution rate of 61.040% of variance, and the remaining five factors after screening for symptoms of pain and fatigue associated group, the group of lung cancer-specific symptoms, psychological symptoms group, the group of respiratory-related symptoms, chemotherapy-related symptom clusters. Third Assessment same constellation of symptoms of fatigue-related symptom clusters, cluster-specific symptoms of lung cancer, chemotherapy-related symptom clusters, psychological symptom clusters, the first and third assessment additionally contain respiratory symptoms group.6. Symptom clusters change factors(1) The first group of factors to assess symptomsFactors related to fatigue symptom clusters for performance status (ECOG) and immune therapy, more than two can explain fatigue-related symptoms group 47.3% of the variation; factors for lung cancer-specific symptom clusters of other anti-inflammatory therapy, monthly family income, medical burden, supportive care, molecular targeted therapy, surgery, explain the severity of symptom clusters 36% of variation; factors associated symptoms of shortness of breath group is supportive care, health insurance type, accompanied by several diseases, immune therapy, tumor transfer number, to explain the severity of the symptoms group 50.3% of the variation; factors associated with chemotherapy symptom cluster is ECOG score, supportive care, medical insurance types, explaining 34.6% of the variation in symptom clusters; psychosocial factors symptom cluster is gender, ECOG score, radiation therapy, education level, family income,35.5% of the group to explain the symptoms of variation.(2) The second group of factors to assess symptomsFactors related to fatigue symptom cluster is ECOG score, education, immune therapy, the number of tumor metastasis, the medical burden, symptom clusters explained 62.6% of the variation; factors lung cancer-specific symptom cluster is family income, medical burden, differentiation degree, surgery, religion, radiotherapy, explaining 40.7% of the variation in symptom clusters; psychosocial factors associated symptom cluster is now the treatment of long-distance monthly family income, the number of tumor metastasis, cell type, explain the symptoms group 25.9%; chemotherapy factors symptom clusters of surgery, gender, ECOG score, could explain 18.5% of the variation in symptom clusters.(3) Third Assessment symptom clusters FactorsFactors related to the number of tumor metastasis fatigue symptom clusters, the types of medical insurance, explaining 36.3% of the variation in symptom clusters; psychosocial factors symptom cluster is immune therapy, explaining 12.3% of the variation in symptom clusters; respiratory symptom clusters:surgery, Marriage health, immune therapy, accompanied by several diseases, cancer metastasis number, supportive care, household income, explain the symptoms group 53.7% of the variation; treatment from long now, surgery, degree of differentiation, supportive treatment, other treatment, ECOG score, monthly family income, cell type,53.4; factors lung cancer-specific symptom clusters of religious, chemotherapy, monthly family income, medical burden, other treatment, immune therapy, chemotherapy, gender, symptom clusters explained 59.9% of the variation.CONCLUSION1. The highest incidence of the highest severity of symptoms in patients with lung cancer to treat fatigue during follow-up and increased incidence.2. No pain as the highest incidence and severity of symptoms, because of the application, to carry out clinical follow-up pain three ladder painkillers like.3. Group fatigue-related symptoms, psychological symptoms group, group-specific symptoms of lung cancer, chemotherapy-related symptoms during follow-up group for the different treatment methods and common among patients with chronic cluster of symptoms associated with the course.4. Fatigue-related symptom cluster is as the core group of lung cancer patients symptom clusters of illness during which the severity of symptoms directly affect other groups.5. Within 3 months of operation factors of lung cancer-specific symptom clusters gradually decreased after 3 months of the influential group of respiratory-related symptoms.6. Radiotherapy will aggravate lung cancer-specific symptom clusters severity.7. Patients with tumor metastasis, the severity of the symptoms of the group is greater than the rate of exacerbations in patients with non-tumor metast...