| [Objective]To investigate the prevalence and intensity of symptoms and explore the changes of symptom clusters in gastric cancer patients receiving chemotherapy after operation at different time points,based on the patient's experience of symptom intensity in symptom groups at different time points,cluster analysis was used to identify subgroups of symptom groups.The research explore whether patients in the subgroups differed on general demographic data and clinical data of patients,to identify high-risk groups with various symptom groups in patients with postoperative chemotherapy for gastric cancer,and provide a basis for targeted symptom management strategies.[Methods]The study was a prospective longitudinal study.A convenient sample of 213 patients with gastric cancer undergoing chemotherapy after operation hospitalized in a hospital in jiangsu was selected between December 2016 and November 2018.The basic details of the patients were documented and a survey was carried out with MDASI-GI and KPS to examine frequency and severity of symptoms and Functional status at four time points.The four time points were:the day before chemotherapy(Tl),chemotherapy cycle#1(T2),chemotherapy cycle#3(T3),chemotherapy cycle#6(T4).Data were performed using SPSS version 20.0.Descriptive statistics was used to describe patient demographic and clinical characteristics and the frequency and severity of symptoms Cluster analysis was used to analyze the subgroups of symptom clusters based on their experiences with symptoms.One-way analysis of variance(ANOVA)was used to test for differences among subgroups in quantitative demographic characteristics and symptom scores.Chi-squared test and Kruskal-Wallis Test were used to examine differences among subgroups in categorical variable demographic characteristics.[Results]1.There is a difference in the incidence and severity of symptoms at different time points in patients with gastric cancer undergoing chemotherapy after operation.T1:the three highest incidence symptoms were worrying,change of appetite and sadness;the highest severity symptoms were lack of appetite(3.0911.99),worrying(2.81±1.63),difficulty sleeping(2.7712.14).T2:the three highest incidence symptoms were fatigue,worrying,lack of appetite;the highest severity symptoms were fatigue(3.87±2.37).difficulty sleeping(3.38±2.28)and worrying(3.31:±1.84).T3:the three highest incidence symptoms were nausea,worrying and sadness;the highest severity symptoms were fatigue(4.02±2.1 7),difficulty sleeping(3.93±2.27),lack of appetite(3.52±1.73).T4:the three highest incidence symptoms were fatigue,nausea and lack of appetite;the highest severity symptoms were fatigue(5.77±2.13),difficulty sleeping(4.49±2.62).lack of appetite(4.20±1.84).2.Five symptom clusters were indentified in gastric cancer p.atients receliving chemotherapy at 4 time points,including sickness symptom cluster,emotional symptom cluster,gastrointestinal symptom cluster,gastric cancer-specific symptom cluster and neurologic symptom cluster.Among them,sickness symptom cluster,emotional symptom cluster,gastrointestinal symptom cluster and gastric cancer-specific symptom cluster exist from T1 to T4,and neurologic symptom cluster only exists at T4.The sickness symptom cluster was characterized by pain,fatigue,and restlessness as stable symptoms.The emotional symptom cluster was characterized by distress,shortness of breath,and sorrow as stable symptoms.The gastrointestinal symptom cluster was characterized by nausea,vomiting,and dry mouth as stable symptoms.The gastric cancer-specific symptom cluster was characterized by swelling and difficulty in swallowing as stable symptoms.The neurologic symptom cluster was characterized by drowsiness and numbness as stable symptoms.The gastrointestinal symptom cluster and gastric cancer-specific symptoms appeared alternately.3.Cluster analysis was used to analyze the subgroups of symptom clusters based on patients'experiences with symptoms.Sickness symptom cluster can be divided into two types at T1(“all low symptoms","low pain and moderate fatigue"),"moderate pain and high fatigue'occurs at T2 and T3 and "all high symptoms"occurs at T4.The patients' symptom experience in the emotional symptom cluster is relatively stable,and emotional symptom cluster are classified into two subgroups from T1 to T4.Gastrointestinal symptom cluster and gastric cancer-specific symptom cluster are divided into two types at T1 and T2("all low symptoms"and "moderate appetite reduction''),and,.high appetite reduction"occurs at T3 and T4.Neurologic symptom cluster was divided into "all low symptoms,"low lethargy and moderate numbness".Different subgroups have statistical significance in symptom scores(P<0.05).4.There are differences in demography and clinical characteristics of patients in each subgroup of symptom cluster.Patients with different types of sickness symptom cluster had differences in operation methods,chronic diseases and KPS scores at T1(P<0.05),differences in chronic diseases and KPS scores at T2(P<0.05)5 differences in educational level at T3(P<0.05),and differences in educational level and tumor staging at T4.Patients with different types of emotional symptom cluster had differences in gender,economic status and residence at T1(P<0.05),differences in gender and KPS scores at T2(P<0.05),differences in disease diagnosis at T3(P<0.05),and differences in tumor staging and chronic diseases at T4(P<0.05).Patients with different types of gastrointestinal and gastric cancer-specific symptom cluster had differences in chronic diseases at T1(P<0.05),differences in surgical methods and KPS scores at T2(P<0.05),differences in chemotherapy regimen at T3(P<0.05),and differences in diagnosis duration,tumor stage,chemotherapy scheme and KPS score at T4(P<0.05).Patients with different types of neurologic symptom cluster had significant differences in diagnosis duration and chemotherapy regimen at T4(P<0.05).[Conclusions]1.Taking the number and prevalence and severity of the symptoms into account,which brought considerable burden to gastric cancer patients undergoing chemotherapy,more attention should be paid to clinical symptom assessment and management of gastric patients.2.Symptoms of gastric cancer undergoing chemotherapy at different time points during chemotherapy can be clustered,includ:ing sickness symptom cluster,emotional symptom cluster,gastrointestinal symptom cluster,gastric cancer-specific symptom cluster and neurologic symptom cluster.Among them,sickness symptom cluster,emotional symptom cluster,gastrointestinal symptom cluster and gastric cancer-specific symptom cluster exist from T1 to T4,and neurologic symptom cluster only exists at T4.3.Cluster analysis were used to identify the subgroups based on experience of patients on the intensity of symptoms in each symptom cluster.The subgroup of symptom clusters may help to strengthen the understanding of the patient's symptom characteristics and formulate the more targeted symptom management intervention.4.There are differences in demography and clinical characteristics among patients in each subgroup of sy:mptom groups.Identifying the characteristics of high-risk groups of patients can provide basis for improving the quality of life of patients and formulating targeted symptom intervention.On the other hand,it also lays a foundation for predicting the patient's symptoms according to the differences of these characteristics. |
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