胃癌术后化疗患者症状严重度与困扰度调查研究

Symptom severity and distress in patients with gastric cancer undergoing chemotherapy

目的分析基于症状困扰形成的症状群与基于症状严重程度形成的症状群的异同,为形成适合我国人群的胃癌管理方案奠定基础。方法采用安德森症状评估量表胃癌特异性模块对85例胃癌术后首次化疗患者进行调查,分别基于症状严重程度和症状困扰程度提取症状群,分析两者的异同。结果 18项症状中,严重程度得分前3位为疲乏、疼痛、苦恼;困扰程度得分前3位为疲乏、恶心、吞咽困难。因子分析,14项症状进入严重程度分析,形成病感症状群(3项)、消化道症状群(5项)、情绪症状群(3项)、胃癌特异性症状群(3项)4个因子,累计方差贡献率为83.49%;13项症状进入困扰程度分析,形成病感症状群(2项)、情绪症状群(4项)、消化道症状群(4项)、胃癌特异性症状群(3项)4个因子,累计方差贡献率为86.38%。结论两种分析模式均形成4种症状群;疲乏的严重度及困扰度均排第一,疼痛困扰度相对较轻,恶心等胃肠道症状困扰度高于严重度。在护理中除重视严重度及困扰度均高的疲乏等症状外,要特别关注严重度不高而困扰度较高的症状,以便采取措施缓解症状,利于患者顺利完成化疗疗程。

Objective To compare the similarities and differences between severity-derived and distress-derived symptom clusters in patients with gastric cancer undergoing chemotherapy,and to provide reference for management of gastric cancer in China.Methods Eighty-five patients with gastric cancer receiving the first chemotherapy-course after surgery were invited to complete the M.D.Anderson Symptom Inventory in Patients with Gastrointestinal Cancer（MDASI-GI）.Symptom clusters were derived from severity and distress respectively and were compared.Results Of the 18 symptoms investigated,the top 3 ranked severe symptoms in order were fatigue,pain,and distress.Fatigue was also the most distressing symptom,followed by nausea and difficult swallowing.Four symptom clusters were identified from 14 symptoms by factor analysis based on severity：sickness（3 symptoms）,gastrointestinal（5 symptoms）,emotional（3 symptoms）and gastric cancer specific（3 symptoms）,with a total cumulative variance of83.49%.Symptom distress analysis with 13 distressing symptoms demonstrated a similar pattern：sickness（2 symptoms）,emotional（4 symptoms）,gastrointestinal（4 symptoms）,and gastric cancer specific（3 symptoms）,accounting for 86.38% of the variance.Conclusion Four symptom clusters were obtained both through using symptom severity and through symptom distress.Fatigue was the most severe and distressing symptom,and pain was rated more severe than distressing,but gastrointestinal symptoms were rated more distressing than severe.Fatigue should be focused for its severity and impact on patients.In addition,distressing,but not severe,symptoms should be paid attention and take measures to relieve,thus to help patients complete treatment successfully.