儿童青少年癌症患者多症状困扰潜在剖面分析及其对体力活动的影响

Latent profile analysis of multiple symptom distress in children and adolescents with cancer and its effect on their physical activity

目的描述儿童和青少年癌症患者多症状困扰及体力活动水平,并分析其多症状困扰的潜在剖面,探讨潜在剖面与体力活动的关系。方法采用方便抽样的方法,选取2021年11月—2023年3月在上海交通大学医学院附属上海儿童医学中心血液/肿瘤科和附属新华医院小儿血液肿瘤科住院治疗或门诊就诊的10~18岁且治疗时间>1个月的儿童及青少年癌症患者。采用一般资料问卷、记忆症状评估量表(Memorial Symptom Assessment Scale 10-18,MSAS 10-18)、修订版儿童休闲活动调查问卷(Modified Chinese Version of Children′s Leisure Time Activities Study Survey,CLASS-C)进行资料收集。采用潜在剖面分析识别癌症患儿多症状困扰的水平是否存在人群异质性及其外显特征,并分析不同潜在症状剖面间体力活动水平是否存在差异。结果共回收有效问卷165份,有效回收率91.7%。癌症患儿发生率前5位症状的困扰得分依次为缺乏体力1(1,2)分、恶心1(1,2)分、没有食欲2(2,3)分、出汗1(1,2)分、疼痛1(1,2)分。患儿以轻度体力活动为主,轻度体力活动水平中位数为2530.00(1577.50,3721.00)min/周;中重度体力活动较少,为70.00(10.00,197.50)min/周。癌症患儿多症状困扰可分为2个潜在剖面,“高疲乏-高恶心-高头发减少-高昏昏欲睡”和“高疲乏-低恶心-低呕吐-低昏昏欲睡”,分别命名为高水平症状困扰(n=47,30.6%)和低水平症状困扰(n=118,69.4%)。多元Logistic回归分析显示,急性淋巴细胞白血病患儿归类为高水平症状困扰组的可能性高,最近一次就诊方式为门诊就诊的患儿归类为低水平症状困扰组的可能性高(均P<0.05);进一步分析显示经历高症状困扰患儿轻体力活动更高(P<0.05),中重度体力活动水平更低,但差异无统计学意义。结论儿童和青少年癌症患者的多症状困扰水平存在人群异质性,疾病类型(急性淋巴细胞白血病)和最近一次就诊方式(门诊就诊)是癌症患儿症状困扰潜在剖面的预测因素;且经历高水平症状困扰的患儿轻度体力活动水平更高,中重度体力活动水平可能更低。

Objective To describe the level of multiple symptom distress and physical activity in children and adolescents with cancer,analyze symptom distress profiles,and explicit the relationship between latent profiles and physical activity.Methods From November 2021 to March 2023,the convenient sample method was used to recruit children and adolescents with cancer aged 10-18 years old,who had been treated for more than 1 month in the Departments of Hematology/Oncology,Shanghai Children′s Medical Center and Xin Hua Hospital,Shanghai Jiao Tong University School of Medicine.The questionnaires,including General Information Questionnaire,Memorial Symptom Assessment Scale 10-18(MSAS 10-18)and Modified Chinese Version of Children′s Leisure Time Activities Study Survey(CLASS-C),were used.Latent profile analysis was used to identify whether the level of multiple symptom distress in children and adolescents with cancer was population heterogeneity and its explicit characteristics.Whether there were differences in physical activity levels among different profiles of symptom distress was also analyzed.Results A total of 165 valid questionnaires were collected,with an effective response rate of 91.7%.The symptom distress scores of the top five occurrence rates of symptoms in children and adolescents with cancer were lack of energy with a median of 1(1,2)point,nausea 1(1,2)point,lack of appetite 2(2,3)points,sweat 1(1,2)point,and pain 1(1,2)point.The physical activity level of the patients was mainly light,with a median of 2530.00(1577.50,3721.00)min/week,and moderate to vigorous physical activity was relatively lower[70.00(10.00,197.50)min/week].The patients with cancer could be divided into two latent profiles:"high fatiguehigh nausea-high hair loss-high sleepy"and"high fatigue-low nausea-low vomiting-low sleepy",which were named as high symptom distress(n=47,30.6%)and low symptom distress(n=118,69.4%)separately.Multivariate Logistic regression analysis showed that patients with acute lymphoblastic leukemia were more likely to be classified as high symptom distress group,and outpatients in the latest hospital visit were more likely to classified as low symptom distress group(both P<0.05).In addition,patients with high symptom distress had a higher level of light physical activity(P<0.05),and had a lower level of moderate to vigorous physical activity,but the difference was not statistically significant.Conclusion There is population heterogeneity in the multiple symptom distress in children and adolescents with cancer.Disease type(acute leukemia)and the way of the latest hospital visit(through outpatient department)are the predictors of symptoms profiles of patients with cancer.Patients who experience high symptom distress have higher level of light physical activity,and perhaps lower level of moderate to vigorous physical activity.