Frailty Status In Postoperative Patients With Gastric Cancer And Its Influence On Symptom Clusters During The First Chemotherapy

ObjectiveThis study aimed to investigate the frailty and symptom clusters of patients with postoperative gastric cancer during the first cycle of chemotherapy,and to analyze the correlation between frailty and symptom clusters.MethodFrom October 2021 to October 2022,125 postoperative gastric cancer patients were selected at a Grade-A general hospital.Baseline data were collected before chemotherapy,including the general information and Frailty Phenotype(FP).The symptoms of patients before chemotherapy,on the 2nd day,7th day,and 14th day of chemotherapy were assessed with M.D.Anderson Symptom Inventory-Gastrointestinal Cancer Module(MDASI-GI).Exploratory factor analysis was used to extract symptom clusters.Univariate analysis was used to identify factors that influence symptom clusters.Hierarchical regression was used to further explore the correlation between frailty and symptom clusters at different time points.Result1.136 patients were investigated before chemotherapy,and 125 patients completed the survey.Patients ranged in age from 38 to 79 years,with an average age of 65.20±8.88 years.Fraity existed in 59 patients,accounting for 47%;Pre-frailty existed in 49 patients,accounting for 39%;non-frailty existed in 17 patients,accounting for 14%.2.There were 18 symptoms in postoperative patients with gastric cancer before chemotherapy,on the 2nd day,7th day,and 14th day of chemotherapy,including pain,fatigue,nausea,sleep disturbance,distress,shortness of breath,forgetfulness,decreased appetite,lethargy,dry mouth,sadness,vomiting,numbness,constipation,diarrhea,difficulty swallowing,appetite change and feeling of fullness.(1)Before chemotherapy,the incidence of the top three symptoms included appetite change(78.4%),forgetfulness(77.6%),and sleep restlessness(76.0%).Excluding nausea,lethargy,vomiting,numbness,dry mouth,and diarrhea,in which the incidence was less than 20%,the remaining symptoms were carried out exploratory factor analysis and 4 factors were extracted.They were named as emotional symptom cluster,gastrointestinal symptoms cluster,disease related symptom cluster,and neurological symptom cluster.(2)On the 2nd day of chemotherapy,the incidence of the top three symptoms included decreased appetite(96.0%),fatigue(95.2%),and constipation(93.6%).After excluding shortness of breath,lethargy,diarrhea,and difficulty swallowing,in which the incidence was less than 20%,the remaining symptoms were carried out exploratory factor analysis and 4 factors were extracted.They were named as emotional symptom cluster,gastrointestinal symptom cluster,disease related symptom cluster,and neurological symptom cluster.(3)On the 7th day of chemotherapy,the incidence of the top three symptoms were nausea(91.2%),fatigue(89.6%),and decreased appetite(87.2%).After excluding pain,sleep disturbance,shortness of breath,and diarrhea,in which the incidence was less than 20%,the remaining symptoms were carried out exploratory factor analysis and 4 factors were extracted.They were named as emotional symptom cluster,gastrointestinal symptoms cluster,gastric cancer specific symptom cluster,and neurological symptom cluster.(4)On the 14th day of chemotherapy,the incidence of the top three symptoms included fatigue(95.2%),forgetfulness(78.0%),and nausea(77.6%).After excluding shortness of breath,vomiting,numbness,and dry mouth,in which the incidence was less than 20%,the remaining symptoms were carried out exploratory factor analysis and 5 factors were extracted.They were named as emotional symptom cluster,gastrointestinal symptom cluster,disease related symptom cluster,gastric cancer specific symptom cluster and neurological symptom cluster.3.Frailty was an independent risk factor for the emotional symptom cluster,gastrointestinal sympyom cluster,and neurological symptom cluster in patients with postoperative gastric cancer during the first cycle of chemotherapy(P<0.05).The variation of the emotional symptom cluster that was explained by frailty was 19.1%before chemotherapy,8.8%on the 2nd day,18.1%on the 7th day,and 6.8%on the 14th day,respectively.The variation of the gastrointestinal symptom cluster that was explained by frailty was 9.8%on the 2nd day,23.8%on the 7th day,and 13.2%on the 14th day.The variance to explain the neurological symptom cluster was 3.7%before chemotherapy,9.5%on the 2nd day,16.0%on the 7th day,and 9.6%on the 14th day,respectively.However,there was no statistical significance in frailty on the disease related symptom cluster and gastrointestinal symptom cluster at different time points during the first cycle of chemotherapy(P>0.05).Conclusion1.There were 5 symptom clusters in the first cycle of chemotherapy in patients with postoperative gastric cancer.The emotional symptom cluster and nervous system related symptom cluster were stable.The gastrointestinal symptom cluster persisted from the 2nd day of chemotherapy.The disease related symptom cluster existed before chemotherapy,on the 2nd day,and on the 14th day of chemotherapy.The gastrointestinal symptom cluster existed before chemotherapy,on the 7th day,and on the 14th day of chemotherapy.2.The incidence of frailty in patients with postoperative gastric cancer was at a relatively high level,and frailty affects some symptom clusters during the first cycle of chemotherapy.The emotional symptom cluster,gastrointestinal symptom cluster,and nervous system related symptom cluster in patients with frailty were more serious at different time points.