Correlation Study Between Symptom Clusters And TCM Syndrome Types At Different Time Points In Patients With Lung Cancer During Chemotherapy

Objective:1.To investigate the changes of symptoms of lung cancer patients during chemotherapy,and extract the relevant symptom clusters;2.To investigate the changes of the symptom clusters and Traditional Chinese Medicine(TCM)syndrome types during chemotherapy;3.To analyze the correlation between the symptom clusters and TCM syndrome types.By exploring its correlation,it can provide reference indications for TCM syndrome differentiation and clinical medication,so as to better manage patients' symptoms and create conditions for TCM to provide evidence-based medicine for the prevention and treatment of tumors.Methods:This study was a prospective longitudinal investigation,101 lung cancer patients scheduled for chemotherapy were collected in the department of oncology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences from September 2020 to January 2021 by convenience sampling method.The general information questionnaire was collected and used at the three time points of 1 day before chemotherapy(D0),7 days after chemotherapy(D7)and 14 days after chemotherapy(D14),we collected the four diagnostic information of TCM to fill in the Syndrome Elements Survey Form to determine the type of TCM syndromes,and filled in The MDASI-TCM Symptoms and Common Tumor Symptoms Inventory(MDASI-TCM)to collect the severity of common symptoms and the degree of disturbance to daily life during chemotherapy.All data were recorded into EpiData3.0 database and analyzed with IBM SPSS Statistics 22.0 software.Results:A total of 101 patients were investigated in this study,of which 1 fell off(death).The effective rate was 99.01%.(1)Symptom changes:Cough(71%)and fatigue(68%)were the most common symptoms in lung cancer chemotherapy patients at D0,and mild symptoms were the main ones;constipation(88%),fatigue(87%)and anorexia(85%)were the most common symptoms at D7,and moderate to severe symptoms were the main ones;fatigue(91%)and dry mouth(82%)and cough(74%)were the most common symptoms at D14,and mild symptoms were the main ones.Constipation,nausea,flatulence and anorexia were the four symptoms with the largest increase at D 7,with an increase rate of 42%?60%,and the largest decrease at D14,with a decrease rate of 40%?51%.Compared with D0,D14 showed the largest increase in dry mouth,fatigue,constipation and oral ulcer,with an increase rate of at least 20%.In addition,vomiting did not occur at D0.After repeated measure analysis of variance(ANOVA)analysis,it was found that the severity of these symptoms(except pain,forgetfulness,bitter mouth,diarrhea,palpitation,feverish sensation over the palm and sole,numbness,soreness and weakness of waist and knees,dizziness)and the degree of disturbance to "emotion" and "general activities"in daily life changed with the time of chemotherapy(P<0.05).(2)Symptom clusters changes:Exploratory factor analysis was used to find that there were 6 symptom clusters in lung cancer patients during chemotherapy,which were lung cancer specific symptom cluster,chemotherapy-related symptom cluster,sickness behavior symptom cluster,nerve-related symptom cluster,gastrointestinal symptom cluster,and somatic symptom cluster.The first five symptom clusters were found at all three time points,while the somatic symptom cluster was only found at D7.These symptom clusters are composed of 2-6 different symptoms.Among these symptom clusters,the first 3 symptom clusters were most common in D0,D7 and D14,with the incidence of 86%,91%and 80%respectively.In the overall trend of change,the incidence of lung cancer specific symptom cluster gradually decreased with time.The incidence of chemotherapy-related symptom cluster,sickness behavior symptom cluster and gastrointestinal symptom cluster increased first and then decreased over time,while the incidence of nerve-related symptom cluster was just the opposite.In terms of severity,compared with D0 and D14,chemotherapy-related symptom cluster,gastrointestinal symptom cluster and lung cancer-specific symptom cluster were more severe at D7,while nerve-related symptom cluster were less severe.By repeated measurement ANOVA,it was found that the distribution of these symptom clusters was different in time,and the difference was significant(P<0.01).that is,the symptom clusters changed with the change of chemotherapy time.(3)Changes of TCM syndrome types:There are 11 TCM syndrome types in lung cancer patients at three time points,which are Qi deficiency syndrome,Yin deficiency syndrome,Qi-Yin deficiency syndrome,Qi asthenia phlegmatic hygrosis,Qi deficiency and blood stasis syndrome,Qi asthenia and phlegm heat syndrome,Qi asthenia and phlegm-stasis syndrome,Qi-Yin deficiency and blood stasis syndrome,phlegm-heat accumulation syndrome,phlegm and blood Stasis Syndrome,sputum-heat and blood stasis obstruction.Qi-Yin deficiency syndrome(21%)and Qi asthenia phlegmatic hygrosis(18%)were predominant at D0;Qi asthenia and phlegm heat syndrome(23%)and Qi-Yin deficiency syndrome(23%)were predominant at D7;Qi-Yin deficiency syndrome(34%)were predominant at D14.Compared with D0,D7 had the largest increase in Qi asthenia and phlegm heat syndrome,from 6%to 23%,while Qi deficiency and Qi deficiency and blood stasis syndrome had the largest decrease.both decreased by 7%.Compared with D7,D14 had the largest growth rate of Qi-Yin deficiency syndrome,increased by 12%,while Qi asthenia and phlegm heat syndrome decreased by 9%,with the largest decline.On the whole,the incidence of Qi-Yin deficiency syndrome increased gradually with time,and the incidence of Qi asthenia and phlegm heat syndrome increased first and then decreased with time,and the change range was the largest.In addition,Fisher exact probability analysis showed that there was no difference in the distribution of TCM syndrome types between D0 and D14,and there was statistical difference in the distribution of TCM syndrome types between D0 and D7,or between D7 and D14(P<0.05).(4)Relationship between symptom clusters and TCM syndrome types of lung cancer:Spearman correlation analysis was used to find the correlation between symptom clusters and TCM syndrome types.Lung cancer specific symptom cluster was negatively correlated with Yin deficiency syndrome,Qi-Yin deficiency syndrome at D7 and D14(r=-0.387?-0.207),and negatively correlated with Yin deficiency syndrome at D0;it was positively correlated with Qi asthenia and phlegm heat syndrome,Qi asthenia and phlegm-stasis syndrome at three nodes(r=0.217?0.422).Chemotherapy-related symptom cluster were negatively correlated with Qi deficiency syndrome,Yin deficiency syndrome,Qi-Yin deficiency syndrome at D7 and D14(r=-0.338?-0.198),and positively correlated with Qi asthenia and phlegm heat syndrome,Qi asthenia and phlegm-stasis syndrome(r=0.199?0.349);negatively correlated with Yin deficiency syndrome,phlegm-heat accumulation syndrome,sputum-heat and blood stasis obstruction at D0,and positively correlated with Qi asthenia and phlegm-stasis syndrome.The sickness behavior symptom cluster was negatively correlated with Qi deficiency syndrome and Qi asthenia phlegmatic hygrosis at three time points(r=-0.368?-0.267);it was negatively correlated with Qi deficiency and blood stasis syndrome only at D14(r=-0.352);it was positively correlated with Qi asthenia and phlegm heat syndrome at D7 and D14(r=0.397?0.400);it was positively correlated with Qi asthenia and phlegm-stasis syndrome at D0 and significantly negatively correlated with D7;it was positively correlated with Qi-Yin deficiency and blood stasis syndrome at D0 and D14,there was a positive correlation on D7(r=0.269).Nerve-related symptom cluster were negatively correlated with Qi asthenia phlegmatic hygrosis at D0 and D14(r=-0.253?-0.233),and positively correlated with sputum-heat and blood stasis obstruction at D7(r=0.251).The gastrointestinal symptom cluster were negatively correlated with Yin deficiency syndrome at D7 and Qi asthenia phlegmatic hygrosis at D14.The somatic symptom cluster existed only in D7,which was negatively correlated with Yin deficiency syndrome,and positively correlated with Qi-Yin deficiency and blood stasis syndrome.There were statistically significant differences(P?0.05).Conclusion:The symptoms of lung cancer patients during chemotherapy varied with time.Before and after chemotherapy,the respiratory symptoms are mainly mild,while the digestive symptoms during chemotherapy are mainly moderate and severe.In terms of symptom cluster,except the somatic symptom cluster was found only at D7,the other 5 symptom cluster were also relatively stable in time.In terms of TCM syndromes types,deficiency syndromes and deficiency and excess syndromes were the main syndromes before and after chemotherapy,and deficiency and excess syndromes were the main syndromes during chemotherapy.The syndromes involved Qi deficiency,Yin deficiency,phlegm dampness and blood stasis.In addition,there is a correlation between symptom cluster and TCM syndromes.Overall,lung cancer-specific symptom cluster,chemotherapy-related symptom cluster,and sickness behavior symptom cluster are negatively correlated with deficiency syndromes and positively correlated with deficiency and excess syndromes.However,there is no significant correlation between nerve-related symptom cluster,somatic symptom cluster,gastrointestinal symptom cluster and TCM syndromes,and only partial deficiency syndrome type had negative correlation.Through understanding the changes of symptoms,symptom cluster and TCM syndromes,provide reference indications for TCM syndrome differentiation and clinical medication,so as to better take the measures of integrated traditional Chinese and Western medicine to intervene the symptoms,and improve the treatment effect and the quality of life of patients.