| ObjectivesTo investigate the subgroups of cancer patients receiving active treatment based on their experience with the symptom cluster of pain,fatigue,sleep disturbance,and depression;To determine whether patients in the subgroups differed on quality of life(QOL),and determine the relationships between inflammatory cytokines and latent class membership.MethodsIn this descriptive,cross-sectional survey,170 Chinese cancer inpatients were recruited consecutively in the department of radiation/chemotherapy oncology of two tertiary hospitals from October 2015 to August 2016 in Ji Nan,Shandong Province.Patients were investigated by the demographic and clinical characteristics questionnaire,the Brief Fatigue Inventory-Chinese version(BFI-C),the worst pain intensity scale,the Pittsburgh sleep quality index(PSQI),The patient Health Questionnaire(PHQ-9),Quality of Life Questionnaires-core30(QLQ-C30).Inflammatory markers including IL-6,IL-1b,TNF-a.Data were analyzed using SPSS 21.0.Descriptive statistics and frequency distributions were generated on the sample characteristics,cluster analysis was used to identify the subgroup of symptom cluster based on their experiences with pain,fatigue,sleep disturbance,and depression.One-way analysis of variance(ANOVA)was used to test for differences among subgroups in quantitative demographic characteristics,symptom scores,QOL and inflammatory markers level.Chi-squared test and Kruskal-Wallis Test were used to examine differences among subgroups in categorical variable demographic characteristics.Logistic regression were conducted to examine which variables were predictive of subgroup membership.Fingdings1.The average score of fatigue scale is(3.52±1.83),86.5%of the sample had the fatigue and mild,moderate and severe fatigue account of 35.3%,47.6%,3.6%respectively;41.2%of the patients had mild and moderate pain,the average pain score is(2.16±1.34);37.2%patients had mild and moderate depression,the average score of PHQ-9 is(5.86±3.99);43.5%patients had sleep disturbance,the average score of subjective sleep quality is(6.14±3.21).The score of global health status is(50.79±17.66);the functioning scales score is(73.78±10.50);the score of symptom and sub-symptom scale is(19.92±13.68)and(20.52±12.54)respectively.2.Cluster analysis were used to identify the subgroups based on the experience with symptom cluster of pain,fatigue,depression and sleep disturbance.Three subgroups were identified:all low symptoms(73.5%),low pain and moderate fatigue(10%),moderate-to-high on all symptoms(16.5%).Significance differences were found in all four of the symptom severity score among the three subgroups.3.The three subgroups had significant differences in ECOG score,gender,residence,current treatment,education,economy,quality of life and the level of IL-6.Patients in the subgroup 3 tend to have higher ECOG score and receive concurrent radiochemotherapy treatment compared to the other two subgroups.Compared to subgroup 1,the patients in subgroup 2 is likely to be female and in the moderate economy.The patients' education level in subgroup 3 was significantly higher than subgroup 2 and is likely to live in countryside compared with subgroup 1.Furthermore,patients in moderate-to-high class had significantly lower global health status and functioning status and higher symptom score than all low class.In addition,patients in the three subgroups only had significantly difference in IL-6 for the three inflammatory cytokines.The moderate-to-high class had prominently higher levels of IL-6 than all low class.4.Logistic regression analysis showed that the ECOG status and IL-6 level were the main risk factors of moderate-to-high class.Increasing in a minor unit(IL-6,ECOG)were associated with over a 1.246 and 31.831-fold increase in the odds of belonging to the all high class(OR:31.831,95%CI:6.017,168.385,P= 000;OR:1.246,95%CI:1.114,1.396,P= 000;).Conclusions1.Cancer patients often simultaneously experience multiple symptoms related to disease diagnose or treatment.In the current study,fatigue has the highest incidence,next is sleep disturbance,pain,depression.The global health status is lower than ECORTC recommended reference values,which suggest the clinicians should assess the symptoms of cancer patients comprehensively and attach great importance of symptom cluster,and take effective measures to relieve the symptom burden and improve the quality of life.2.Cluster analysis was used to identify the subgroups based on the experiencewith symptom cluster of pain,fatigue,depression and sleep disturbance.Three subgroups were identified:all low symptoms(73.5%),low pain and moderate fatigue(10%),all high symptoms(16.5%).Significance differences were found in ECOG score,gender,residence,current treatment,education,economy,quality of life and IL-6.The analytical method used in this study may help to identify the high-riskgroup of patients,and formulate the more targeted symptom management interventions.3.Logistic regression analysis showed that IL-6 plays a role in the process of symptom clustering,which provid new evidence that IL-6 signaling as one mechanism underlying the symptom cluster,and has important guiding significance to offer novel targeted symptom management interventions. |
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