鼻咽癌患者同步放化疗期间症状群的变化研究

Study on the changes of symptom clusters in patients with nasopharyngeal carcinoma during con T2T3 current chemoradiotherapy

目的探讨鼻咽癌患者在同步放化疗的不同时期各症状群的评分变化,及不同时期评分变化的相关性,为延续性症状管理提供依据。方法本研究为前瞻性研究。采用记忆症状评估量表(MSAS)、医学应对方式问卷(MCMQ)、欧洲癌症研究与治疗组织生命质量核心量表(EORTC QLQ-C30)、病史问卷(MHQ)及主观全面评定(SGA)5种问卷评价,选取2020年1月至2021年12月在广州市番禺区中心医院肿瘤科进行同步放化疗的80例鼻咽癌患者,其中男60例,女20例,年龄(48.43±11.80)岁,对同步放化疗的不同时期[治疗前(T1)、治疗第14天(T2)、治疗第28天(T3)、治疗结束当天(T4)、治疗结束后1个月(T5)]各种症状群发生的频率、强度等进行评分,并根据患者在同步放化疗的不同时期及临床分期(Ⅰ和Ⅱ期为早期组,Ⅲ期为中期组,Ⅳ期为晚期组)进行分组,采用重复测量方差分析、单向方差分析及Pearson相关性分析评估5种问卷评分的变化情况及其相关性。结果MSAS、EORTC QLQ-C30、MHQ及SGA的评分在不同时间点间比较差异均有统计学意义(MSAS:F=109.295,P<0.001;EORTC QLQ-C30:F=3.526,P=0.019;MHQ:F=195.156,P<0.001;SGA:F=82.605,P<0.001)。多个症状群评分不同时间点间均存在显著相关性(MSAS症状群T1比T2、T1比T3、T2比T3、T2比T4、T3比T4、T3比T5、T4比T5:均P<0.05;MCMQ症状群T3比T4、T4比T5:均P<0.001;EORTC QLQ-C30症状群T1比T2、T3比T4、T3比T5、T4比T5:均P<0.001;MHQ症状群T1比T4、T2比T3、T2比T4、T3比T4、T3比T5、T4比T5:均P<0.05;SGA症状群T2比T3、T2比T4、T3比T4:均P<0.05)。结论鼻咽癌患者同步放化疗期间症状群随着治疗的不同时间点其症状是显著变化的,并存在时间相关性,临床上可对患者进行症状管理,并根据症状群动态变化实施个体化干预,在减轻患者症状的同时,提高患者的生存期及生活质量。

Objective To discuss the changes of symptom clusters scores and the correlations between different time points in patients with nasopharyngeal carcinoma during concurrent chemoradiotherapy,so as to provide evidences for continuous symptom management.Methods Through the prospective study,Memorial Symptom Assessment Scale(MSAS),Medical Coping Modes Questionnaire(MCMQ),European Organization for Research and Treatment of Cancer Quality of Life Core Scale(EORTC QLQ-C30),Medical history questionnaire(MHQ),and Subjective Global Assessment(SGA)were scored as the occurrence frequency and intensity of various symptom clusters in 80 patients[60 males and 20 females,aged(48.43±11.80)years]with nasopharyngeal carcinoma in different periods of concurrent chemoradiotherapy[before treatment(T1),on the 14th day of concurrent treatment(T2),on the 28th day of concurrent treatment(T3),on the day of the end of treatment(T4),and one month after treatment(T5)]in Department of Oncology,Panyu Central Hospital from January 2020 to December 2021,and the patients were grouped according to different periods of concurrent chemoradiotherapy and different clinical stages(stage I and II as early group,stage III as middle group,and stage IV as advanced group).Repeated measure analysis of variance,oneway analysis of variance,and Pearson correlation analysis were used to analyze the score changes and correlations.Results The scores of MSAS,EORTC QLQ-C30,MHQ,and SGA were significantly different at different time points(MSAS:F=109.295,P<0.001;EORTC QLQ-C30:F=3.526,P=0.019;MHQ:F=195.156,P<0.001;SGA:F=82.605,P<0.001).There were significant correlations between different time points in the scores of multiple symptom clusters(MSAS:T1 to T2,T1 to T3,T2 to T3,T2 to T4,T3 to T4,T3 to T5,T4 to T5:all P<0.05;MCMQ:T3 to T4,T4 to T5:both P<0.001;EORTC QLQ-C30:T1 to T2,T3 to T4,T3 to T5,T4 to T5:all P<0.001;MHQ:T1 to T4,T2 to T3,T2 to T4,T3 to T4,T3 to T5,T4 to T5:all P<0.05;SGA:T2 to T3,T2 to T4,T3 to T4:all P<0.05).Conclusions The symptom clusters of nasopharyngeal carcinoma patients during concurrent chemoradiotherapy change significantly with different time points of treatment,and there is a time correlation.Clinically,the symptom management can be performed on patients and the individualized intervention can be implemented according to the dynamic changes of symptom clusters,so as to improve the patients'survival time and quality of life while alleviating their symptoms.