Symptoms and quality of life of advanced cancer patients at home: a cross-sectional study in Shanghai, China

Symptom clusters and their impact on quality of life among Chinese patients with lung cancer: A cross-sectional study

PURPOSE

To investigate the symptom clusters of Chinese patients with lung cancer, and explore their impact on quality of life (QoL) and each of its functioning.

METHOD

A cross-sectional study was conducted between October 2022 and April 2023 among 219 lung cancer patients at a general hospital in Sichuan Province. Data were collected using a general information questionnaire, the MD Anderson Symptom Inventory, and the EORTC QLQ-C30. R within the RStudio platform was used to conduct descriptive statistics, exploratory factor analysis and multiple regression analysis.

RESULTS

Psychoneurological, respiratory, gastrointestinal and fatigue-related symptom clusters were identified, each of which was significantly negatively correlated with overall QoL, global health status/QoL and each functioning. The respiratory (β = -0.60, P = 0.02) and fatigue-related symptom cluster (β = -0.86, P = 0.02) were predictors of global health status/QoL; the fatigue-related symptom cluster predicted physical (β = -1.68, P < 0.01), role (β = -1.63, P < 0.01) and cognitive functioning (β = -1.45, P < 0.01); the psychoneurological symptom cluster was a predictor of patients' emotional functioning (β = -1.26, P < 0.01); and the psychoneurological (β = -0.81, P < 0.01) and gastrointestinal symptom cluster (β = -0.60, P = 0.05) predicted social functioning.

CONCLUSIONS

Respiratory and fatigue-related symptom clusters were strong predictors of global health status/QoL; fatigue-related, psychoneurological and gastrointestinal symptom clusters had a negative impact on patients' functioning. Nurse practitioners should pay more attention to monitoring respiratory and fatigue-related symptom clusters to identify high-risk populations in time, and tailored interventions based on symptom clusters are needed to synergistically reduce the symptom burden, thereby improving patients' QoL.

Quality of Life Assessment and Pain Severity in Breast Cancer Patients Prior to Palliative Oncology Treatment in Indonesia: A Cross-Sectional Study

PURPOSE

Studies assessing quality of life (QOL) in palliative care settings are still scarce. We assessed the QOL score and pain severity in advanced breast cancer patients at the National Cancer Hospital in Indonesia and associations between QOL domains with QOL and pain scores.

MATERIALS AND METHODS

A total of 160 patients who met the study inclusion criteria (female, >18 years old, diagnosed with stage III or IV breast cancer) answered the European Organization for Research and Treatment of Cancer QOL questionnaire (EORTC QLQ-C15-PAL) and the visual analogue scale (VAS) tool for pain severity, prior to palliative oncology treatment. Additionally, several sociodemographic and clinical characteristics were collected. Linear regression models, adjusted for age, the Karnofsky Performance Status (KPS) score, and specific QOL domains were used to explore the associations between the global QOL and VAS scores with the different QOL domains.

RESULTS

The patients had a mean age of 50 years (range: 29-76). The overall score for QOL and score for VAS was (mean ± SD) 78.02 ± 15.34 and 2.1 ± 2.4, respectively. The analysis demonstrated that the domains of emotional functioning (effect estimate: 0.25; 95% CI: 0.14 to 0.37), fatigue (-0.21; -0.33 to -0.09), pain (-0.13; -0.25 to -0.01), insomnia (-0.25; -0.37 to -0.13), and appetite loss (-0.13; -0.25 to -0.008) were associated with the QOL score. Only the KPS score (-0.28; -0.46 to -0.11) was associated with the VAS score.

CONCLUSION

Our study showed high QOL and low VAS scores in advanced breast cancer patients prior to palliative oncology treatment. Several QOL domains (emotional functioning, fatigue, pain, insomnia, and appetite loss) were associated with QOL and the KPS was associated with the pain score. Therefore, these specific QOL domains should be given priority in improving QOL in this patient group.

Quality of life of cancer patients at palliative care units in developing countries: systematic review of the published literature

Purpose

This systematic review aims to summarize factors that influence the quality of life (QOL) of advanced cancer patients in palliative care (PC) in developing countries. Understanding this context in developing countries milieu is necessary; however, this outcome is rarely reported.

Methods

Following the PRISMA guidelines, the electronic databases MEDLINE, Embase, CINAHL, and Web of Science were systematically searched using the search terms: QOL, cancer, PC, and names of all developing countries. Studies with less than ten subjects, qualitative or pilot studies, reviews, conference abstracts, and that reported validation of QOL questionnaires were excluded.

Results

Fifty-five studies from 15 developing countries in the African (n = 5), Latin America and the Caribbean (n = 10), and Asian (n = 40) region were included in the narrative synthesis. 65.4% were cross-sectional, 27.3% were cohort studies, 7.3% were RCTs or quasi-experimental studies. Around 30 QOL factors were studied with 20 different types of QOL instruments. Advanced cancer patients who were older, married/ever married, participated in additional care within PC, used complementary and alternative medicine (CAM), and practiced spirituality/religiosity showed higher QOL score. Low educational level and high depression were associated with a lower QOL.

Conclusion

Various factors affect QOL among cancer patients in PC. Patients valued the use of CAMs; however, the quality and safety aspects should be properly addressed. Important factors that influenced the QOL score were social and spiritual support. While there is a general need to develop PC strategies further, recognizing patients’ needs should be prioritized in national cancer programs.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02633-z) contains supplementary material, which is available to authorized users.

Health-related quality of life and health utility score of patients with gastric cancer: A multi-centre cross-sectional survey in China

OBJECTIVE

To evaluate the health-related quality of life (HRQoL) and health state utility scores of gastric cancer patients in daily life at different clinical stages after treatment, and to explore influencing factors associated with HRQoL.

METHODS

Gastric cancer patients discharged from hospitals and healthy controls identified by screening were recruited. The three-level EQ-5D was employed to assess HRQoL and was scored using two Chinese-specific tariffs published in 2014 and 2018.

RESULTS

A total of 1,399 patients and 2,179 healthy controls were recruited. The likelihood of reporting problems in the five dimensions for patients was 4.0-23.8 times higher than controls. Based on the 2014/2018 tariff, the mean EQ-5D utility score was 0.321/0.163 lower than controls, and the mean utility scores of each patient subgroup were 0.077/0.039 (high-grade intraepithelial neoplasia/carcinoma in situ), 0.254/0.121 (Stage I), 0.249/0.123 (Stage II), 0.353/0.182 (Stage III) and 0.591/0.309 (Stage IV) lower than controls (all statistically significant). Age, occupation, duration of illness, other chronic disease status and therapeutic regimen had a significant impact upon different aspects of HRQoL in patients.

CONCLUSIONS

Gastric cancer significantly impaired patients' HRQoL in daily life after treatment. More advanced cancer stages were associated with larger decrements on health state utility.

Effect of Baduanjin Qigong Exercise on Cancer-Related Fatigue in Patients with Colorectal Cancer Undergoing Chemotherapy: A Randomized Controlled Trial

BACKGROUND

Cancer-related fatigue (CRF) is one of the most troubling symptoms of cancer patients during chemotherapy, and no gold standard for the treatment of CRF has been established.

OBJECTIVE

This study aimed to examine the effects of the Baduanjin qigong on patients with colorectal cancer and CRF, and to explore its intervention effects.

METHODS

This was an open-label, randomized controlled clinical trial. Ninety patients with chemotherapy-treated colorectal cancer and CRF were randomized to a Baduanjin exercise group or a routine care group. The primary outcome was the Brief Fatigue Inventory (BFI) score at 24 weeks. The secondary outcomes were the Karnofsky Performance Status (KPS) and Pittsburgh Sleep Quality Index (PSQI) scores at 24 weeks.

RESULTS

There were no significant differences between the two groups in CRF level at baseline and 12 weeks. At 24 weeks, the proportion of patients with moderate-to-severe CRF was significantly smaller in the exercise group than in the control group (23.2 vs. 59.1%, p < 0.01). The KPS and PSQI scores were similar in the two groups at baseline and 12 weeks, but they were significantly higher and lower, respectively, at 24 weeks in the exercise group compared with the control group (KPS score: 89.3 ± 8.3 vs. 75.2 ± 11.5, p < 0.01; PSQI score: 4.1 ± 1.1 vs. 6.9 ± 2.0, p < 0.01). Significant time-group interactions were observed for all three scores (all p < 0.01).

CONCLUSIONS

Baduanjin qigong exercise can relieve CRF in patients with colorectal cancer undergoing chemotherapy and can improve their physical activity level and their quality of sleep.

Multidimensional Comparison of Cancer-Related Fatigue and Chronic Fatigue Syndrome: The Role of Psychophysiological Markers

OBJECTIVE

The present study compared cancer-related fatigue (CRF) and chronic fatigue syndrome (CFS) using multidimensional measurements with the aim of better understanding characteristics and exploring markers of two similar fatigue syndromes.

METHODS

Twenty-five patients with CRF and twenty patients with CFS completed questionnaires, including the Fatigue Severity Scale (FSS), Hospital Anxiety Depression Scale (HADS), Perceived Stress Scale (PSS), and Pittsburgh Sleep Quality Index (PSQI). Additionally, levels of high sensitivity C-reactive protein (hs-CRP), heart rate variability (HRV), and electroencephalography (EEG) were obtained. Neurocognitive functioning was also evaluated.

RESULTS

Both groups showed comparable levels of psychological variables, including fatigue. Compared to CFS subjects, CRF patients had significantly higher hs-CRP levels and a reduced HRV-index. The within-group analyses revealed that the FSS score of the CRF group was significantly related to scores on the HADS-anxiety, HADS-depression, and PSQI scales. In the CFS group, FSS scores were significantly associated with scores on the PSS and the absolute delta, theta, and alpha powers in frontal EEG.

CONCLUSION

Findings indicate that different pathophysiological mechanisms underlie CFS and CRF. Inflammatory marker and HRV may be potential biomarkers for distinguishing two fatigue syndromes and frontal EEG parameters may be quantitative biomarkers for CFS.

Current Research Status of Palliative Care in Mainland China

Objectives:

This study aimed to obtain an overview of the current research status of palliative care in Mainland China and identify research directions for future studies by characterizing palliative care studies conducted among patients with any life-limiting illness in Mainland China and published in a peer-reviewed journal before November 2016.

Methods:

A review guide with 7 categories was initially developed based on existing international palliative care definitions and guidelines through content analysis. Ten databases were used to identify relevant studies from the inception of online cataloging to November 2016. Studies conducted in Mainland China and their research topic that fell within one of the categories of the review guide were included for further analysis. Descriptive analysis was adopted to summarize the relevant findings.

Results:

54 studies found to be relevant were included for the analysis. Three studies on “palliative care education and training” (category 1) asserted that education and training programs were scant in Mainland China and that only 1 program had been devised within the health-care context of Shanghai. Five studies on “palliative care screening and timely identification” (category 2) highlighted the absence of early screening criteria or checklists and referral procedures for palliative care. Thirty-one studies on “palliative care needs assessment (n = 12/31) and implementation (n = 19/31)” (category 3) were identified, and various methodological flaws were observed in most of these included studies. Twelve studies on “advanced decision-making” (category 4) were identified, all of which focused on investigating the attitudes of patients with cancer, their families, and/or health-care professionals toward advanced decision-making only. The percentage of patients, family members, and health-care professionals who held positive attitudes toward advanced decision-making were varied and suboptimal, particularly for family members (51.4%-58.0%). Five studies on “caring for patients at the end of life” (category 5) were identified, and the experience of health-care professionals in caring for those patients was explored. No studies relating to “death and bereavement care” (Category 6) and “psychological support for palliative care providers” (Category 7) were identified.

Conclusion:

The current research status of palliative care in Mainland China remains at an early stage with minimal palliative care services used. Although several knowledge gaps were identified, the first step, which should be addressed, is assessing the palliative care needs. An appropriate and ongoing needs assessment could provide important information for constructing comprehensive education and training programs of palliative care, identifying prognostic factors of timely palliative care referral, and developing evidence-based and tailored palliative care services.

Spiritual well-being of Italian advanced cancer patients in the home palliative care setting

This study evaluates the spiritual well-being (SpWB) in very advanced cancer patients assisted by the home palliative care program of ANT Foundation, a no-profit Italian organisation. SpWB was assessed by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp12), including Meaning, Peace, and Faith subscales. The quality-of-life (QoL) was evaluated by using the Functional Assessment of Cancer Therapy-General scale. Questionnaires were distributed to 1,055 patients and 683 were compiled and evaluable for analysis. The mean scores of FACIT-Sp12 as well as of QoL were notably lower than reference values for cancer survivors. The FACIT-Sp12 score was higher in patients with less impaired Karnofsky Performance Status, fully participating in religious rituals and living in central Italy. A high Pearson's correlation was found between QoL and FACIT-Sp12 (r = .60), Peace (r = .71) and Meaning (r = .52), while it was marginal for Faith (r = .27). The hierarchical regression analysis showed that FACIT-Sp12 is a significant predictor of QoL. The study suggests that Italian patients with advanced cancer assisted by expert multi-professional teams in the home palliative care setting have a low level of SpWB thereby highlighting the need for the integration of spiritual support as part of comprehensive cancer care.

Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis

CONTEXT

Cancer pain has a severe impact on quality of life and is associated with numerous psychosocial responses. Recent studies suggest that treatment of cancer pain has improved during the last decade.

OBJECTIVES

The aim of this review was to examine the present status of pain prevalence and pain severity in patients with cancer.

METHODS

A systematic search of the literature published between September 2005 and January 2014 was performed using the databases PubMed, Medline, Embase, CINAHL, and Cochrane. Articles in English or Dutch that reported on the prevalence of cancer pain in an adult population were included. Titles and abstracts were screened by two authors independently, after which full texts were evaluated and assessed on methodological quality. Study details and pain characteristics were extracted from the articles with adequate study quality. Prevalence rates were pooled with meta-analysis; meta-regression was performed to explore determinants of pain prevalence.

RESULTS

Of 4117 titles, 122 studies were selected for the meta-analyses on pain (117 studies, n = 63,533) and pain severity (52 studies, n = 32,261). Pain prevalence rates were 39.3% after curative treatment; 55.0% during anticancer treatment; and 66.4% in advanced, metastatic, or terminal disease. Moderate to severe pain (numerical rating scale score ≥5) was reported by 38.0% of all patients.

CONCLUSION

Despite increased attention on assessment and management, pain continues to be a prevalent symptom in patients with cancer. In the upcoming decade, we need to overcome barriers toward effective pain treatment and develop and implement interventions to optimally manage pain in patients with cancer.

Spirituality, quality of life, psychological adjustment in terminal cancer patients in hospice

The purpose of this study was to show the different components of spirituality in the last few weeks of life for advanced cancer patients admitted to hospice and to evaluate quality of life (QoL), pain, anxiety, depression and psychological adjustment to cancer. One hundred and fifteen patients were interviewed with a series of rating scales: the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale, the Hospital Anxiety and Depression Scale, the Visual Analogue Scale for pain, the Brief Coping Orientation to Problem Experienced and the Functional Assessment of Cancer Therapy Scale - General Measure. Workers and single patients with higher education level showed a worse QoL. Moreover, anxiety and pain were negatively associated with QoL, while spirituality and 'Instrumental Support' coping style were positively associated with QoL. In the Italian sample, it was observed that when patients are close to death, faith is a more important component of spirituality than meaning/peace. This study confirms that QoL could be related to physical and psychological symptoms, and this reiterates the importance of faith in end-of-life care.

Preoperative psychological distress, coping and quality of life in Chinese patients with newly diagnosed gastric cancer

AIMS AND OBJECTIVES

The purpose of this study was to investigate the prevalence of preoperative psychological distress and its relationship with coping style and quality of life in Chinese patients with newly diagnosed gastric cancer.

BACKGROUND

Being newly diagnosed with cancer can be a source of psychological distress. Understanding the preoperative psychological distress may contribute to the development of appropriate interventions.

DESIGN

This is a descriptive correlational survey study.

METHODS

The study was conducted in two teaching hospitals in Anhui province, China. A total of 165 patients with gastric cancer completed a battery of self-report questionnaires including the Distress Thermometer, the revised Chinese version of the Quality of Life Questionnaire-Stomach 22 and the Cancer Coping Modes Questionnaire.

RESULTS

The prevalence of clinically significant preoperative psychological distress was 76·97% in this group. Statistically significant correlations were identified between the distress score and stomach pain, eating restrictions and anxiety subscale. Positive associations were found between the distress scores and four subdimensions of coping (avoidance and suppression, resignation, fantasy and catharsis), whereas a negative association was found between the distress scores and one subdimension of coping (Confrontation). There were also significant differences in the quality of life and coping style of patients who had different psychological distress statuses.

CONCLUSION

These findings indicate a relatively high prevalence of preoperative psychological distress among Chinese patients with gastric cancer. Patients with clinically psychological distress were more likely to have poor quality of life and to demonstrate negative coping styles.

RELEVANCE TO CLINICAL PRACTICE

Nursing professionals need to carefully assess the psychological status of patients with gastric cancer. Tailored interventions can be administered to help these patients appropriately cope with the disease and to enhance their quality of life.

Exploring the relationship between spiritual well-being and quality of life among patients newly diagnosed with advanced cancer

OBJECTIVE

In our context, existential plight refers to heightened concerns about life and death when people are diagnosed with cancer. Although the duration of existential plight has been proposed to be approximately 100 days, evidence from longitudinal studies raises questions about whether the impact of a diagnosis of advanced cancer may require a longer period of adjustment. The purpose of our study was to examine spiritual well-being (SpWB) and quality of life (QoL) as well as their interrelationship in 52 patients with advanced cancer after 100 days since the diagnosis at one and three months post-baseline.

METHOD

The study was designed as a secondary data analysis of a cluster randomized clinical trial involving patients with stage 3 or 4 cancer undergoing treatment. SpWB was measured using the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12); common factor analyses revealed a three-factor pattern on the FACIT-Sp-12. Quality of life was measured with the Functional Assessment of Cancer Therapy-General (FACT-G). We limited our sample to participants assigned to the control condition (n = 52).

RESULTS

SpWB and QoL remained stable between one and three months post-baseline, which were a median of 112 and 183 days after diagnosis, respectively. SpWB was found to be associated with QoL more strongly than physical and emotional well-being. Peace and Meaning each contributed unique variance to QoL, and their relative importance shifted over time. Faith was positively related to QoL initially. This association became insignificant at three months post-baseline.

SIGNIFICANCE OF RESULTS

This study underscores the significance of SpWB for people newly diagnosed with advanced cancer, and it highlights the dynamic pattern of Peace, Meaning, and Faith in association with QoL. Our results confirm that patients newly diagnosed with advanced cancer experience an existential crisis, improve and stabilize over time. Future studies with larger samples over a longer period of time are needed to verify these results.

Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference?

CONTEXT

In clinical practice, some symptoms and problems frequently occur in combination, which may have consequences for symptom management.

OBJECTIVES

Facing a growing number of non-cancer patients in palliative care, this study aimed to differentiate symptom clusters in the non-cancer population from those in cancer patients.

METHODS

Inpatient data from the German Hospice and Palliative Care Evaluation between 2007 and 2011 were used for a cluster analysis of a 16-item symptom and problem checklist. An agglomerative hierarchical method was chosen. Coefficients from distance matrix ranging between 0 and 1 were calculated to indicate the interrelationship of clustered symptoms.

RESULTS

The analysis identified five clusters in cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.125); 3) wound care and disorientation/confusion (d = 0.229); 4) organization of care and overburdening of family (d = 0.202); and 5) weakness, tiredness, need for assistance with activities of daily living, and loss of appetite (d = 0.207). Five comparable clusters were identified in non-cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.166); 3) organization of care and overburdening of family (d = 0.187); 4) weakness and need for assistance with activities of daily living (d = 0.139); and 5) tiredness and loss of appetite (d = 0.182).

CONCLUSION

As symptom clusters do not significantly differ between cancer and non-cancer patients, specific frequent symptoms in non-cancer patients should be assessed. Identification of symptom clusters may help to target therapies and focus the use of medications to improve patients' quality of life.

Application of genetic algorithm for discovery of core effective formulae in TCM clinical data

Research on core and effective formulae (CEF) does not only summarize traditional Chinese medicine (TCM) treatment experience, it also helps to reveal the underlying knowledge in the formulation of a TCM prescription. In this paper, CEF discovery from tumor clinical data is discussed. The concepts of confidence, support, and effectiveness of the CEF are defined. Genetic algorithm (GA) is applied to find the CEF from a lung cancer dataset with 595 records from 161 patients. The results had 9 CEF with positive fitness values with 15 distinct herbs. The CEF have all had relative high average confidence and support. A herb-herb network was constructed and it shows that all the herbs in CEF are core herbs. The dataset was divided into CEF group and non-CEF group. The effective proportions of former group are significantly greater than those of latter group. A Synergy index (SI) was defined to evaluate the interaction between two herbs. There were 4 pairs of herbs with high SI values to indicate the synergy between the herbs. All the results agreed with the TCM theory, which demonstrates the feasibility of our approach.

Oral health-related quality of life and traumatic dental injuries in Brazilian adolescents

OBJECTIVES

To evaluate the impact of traumatic dental injuries (TDI) on oral health-related quality of life (OHRQoL) among Brazilian adolescents.

METHODS

A population-based case-control study was carried out, which was nested to a cross-sectional study with a sample of 1215 adolescents aged 11-14 years from Belo Horizonte, Brazil. OHRQoL was measured using the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14 )--Impact Short Form (ISF:16). Two-step cluster analysis was performed to define cases and controls based on CPQ11-14--ISF:16 scores. This method considers the pattern of responses for each item separately and how important each item is to the formation of clusters. The case group included those adolescents who presented higher negative impact on OHRQoL (n=405), while the control group included those with lower negative impact (n=810). Two controls for each case were individually matched from the same school and gender. The main independent variable was TDI, diagnosed by the Andreasen's classification. Untreated dental caries, malocclusion, and age were confounding variables. Conditional logistic regression analysis was performed with the significance level set at 5%.

RESULTS

A multiple conditional logistic regression model demonstrates that adolescents diagnosed with fracture involving dentin and/or pulp had a 2.40-fold greater chance of presenting high negative impact on QHRQoL [95% CI=1.26-4.58; P=0.008] than those without evidence of fractures. Enamel fracture only [P=0.065] and restored fractures [P=0.072] were not statistically associated with OHRQoL.

CONCLUSIONS

Adolescents with more severe untreated TDI, such as fractures involving dentin and/or pulp, were more likely to self-report a higher negative impact on their OHRQoL than those without TDI.

Prevalence, intensity, and prognostic significance of common symptoms in terminally ill cancer patients

BACKGROUND

Quality of life and palliative management of end-stage cancer patients should improve with greater understanding of the prevalence, intensity, and prognostic significance of their symptoms.

OBJECTIVE

We investigated the association between prevalence and intensity of common symptoms and overall survival in Chinese end-stage cancer patients.

DESIGN

For this cross-sectional study, 163 Chinese patients with end-stage cancer completed an Edmonton Symptom Assessment questionnaire, and each was given a Karnofsky Performance Status (KPS) score. Overall survival was estimated via the Kaplan-Meier method. Factors affecting overall survival were determined by univariate and multivariate Cox regression analyses.

RESULTS

Mean survival of these patients was 51 days. Pain, lack of appetite, and poor well-being were the most frequent symptoms, in 90.2%, 88.3%, and 87.7%, respectively. The most severe symptoms were fatigue, lack of appetite, drowsiness, and poor well-being. Fatigue, lack of appetite, drowsiness, shortness of breath, poor well-being, depression, and KPS score significantly affected overall survival rate, with a relative risk of dying of 1.560, 2.320, 1.684, 1.295, 1.912, 1.414, and 0.487, respectively (Cox regression coefficients: 0.361, 0.827, 0.539, 0.185, 0.694, 0.318, and -0.602). Fatigue, lack of appetite, shortness of breath, age, and KPS score were independent risk factors of overall survival, with a relative risk of dying of 1.581, 1.122, 1.123, 1.022, and 0.797, respectively (Cox regression coefficients: 0.458, 0.115, 0.116, 0.022, and -0.227).

CONCLUSION

Fatigue, shortness of breath, lack of appetite, age, and KPS score were associated with overall survival of end-stage Chinese cancer patients.

Symptom clusters in Chinese patients with primary liver cancer

PURPOSE/OBJECTIVES

To derive symptom clusters and their clinical meanings in Chinese patients with primary liver cancer (PLC), to examine the factors related to the identified symptom clusters, and to validate the impact of the identified symptom clusters on patients' quality of life (QOL).

DESIGN

Cross-sectional.

SETTING

Inpatient departments at a medical center for hepatobiliary disease in China.

SAMPLE

277 patients with PLC, aged 18-77 years.

METHODS

Data were collected from a number of measures, including demographic and disease characteristics, the MD Anderson Symptom Inventory, six additional symptom items specific to PLC, and the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire. Factor analysis was used to derive symptom clusters, independent-samples t test or one-way analysis of variance was performed to identify the factors related to each symptom cluster, and multivariate regression models were applied to examine the predictive impact of the identified symptom clusters on PLC.

MAIN RESEARCH VARIABLES

Demographic and medical variables, symptom clusters, and QOL.

FINDINGS

Three symptom clusters were identified: gastrointestinal sickness, neuropsychological, and liver dysfunction. Patients who received liver protection treatment, received more than one kind of treatment, and had poorer physical performance, worse liver function, and more advanced cancer scored higher in severity across all three symptom clusters. All of the symptom clusters explained 48% of the QOL variance, and the liver dysfunction symptom cluster (adjusted R2 = 0.425) showed a superior influence.

CONCLUSIONS

The liver dysfunction symptom cluster may be unique to Chinese patients with PLC. Patients with certain demographic and disease characteristics could be at risk for experiencing severe symptom clusters. In addition, a differential impact of the symptom clusters on QOL was noted in these patients.

IMPLICATIONS FOR NURSING

The factors related to severity should be considered when managing symptom clusters. Because the predictive impacts of the three individual symptom clusters on QOL were varied and ordered in magnitude, healthcare providers should first alleviate the primary symptom cluster. This approach could be cost-effective and improve QOL.

Quality of Life in Patients with Advanced Cancer Using the Functional Assessment of Cancer Therapy-General Assessment Tool: A Literature Review

Quality of life (QOL) has become an increasingly meaningful endpoint in advanced cancer research. Clinicians assess QOL to help them select appropriate treatment options and regimens. The present review aims to compare QOL scores of the Functional Assessment of Cancer Therapy-General Assessment Tool (FACT-G) in relation to clinical and socio-demographic features in patients with advanced cancer. A literature search in MEDLINE and EMBASE was conducted; a total of 33 studies encompassing 39 study arms were identified that reported FACT-G scores. Four statistically significant parameters were identified with respect to FACT-G scores: education, national per capita healthcare expenditures, admittance status and previous radiation therapy. A greater percentage of patients completing higher education programs were correlated to significantly better emotional well-being and global QOL. Cohorts from countries with higher national per capita healthcare expenditures had better physical well-being, social/family well-being and improved relationships with their doctors. Patient samples comprised of purely outpatients had better levels of emotional well-being and global QOL when compared to samples with a mix of outpatients and inpatients. A greater percentage of patients previously receiving radiation therapy were correlated to a better relationship with doctor score. Although limitations of the present review exist, differences in QOL scores based on socio-demographic and clinical factors are observed; certain correlations described in the present work have been described previously in the literature while others have not. Future work aimed at either determining confounding parameters or cause and effect relationships is recommended.