Symptom burden survey and symptom clusters in patients with cervical cancer: a cross-sectional survey

PURPOSE

The purpose of this study is to determine the incidence and severity of symptoms of patients with cervical cancer within 6 months after radiotherapy and chemotherapy, form a symptom burden report, evaluate the distribution characteristics of symptoms, identify symptom clusters, and provide a basis for clinical doctors and nurses to improve the symptom management of patients with cervical cancer after radiotherapy and chemotherapy.

METHODS

The patients with cervical cancer within 6 months after radiotherapy and chemotherapy were recruited to investigate their symptom burden. Exploratory factor analysis was used to identify symptom clusters.

RESULTS

A total of 250 patients participated in the study. The study found that the most common symptom among the 40 symptoms was fatigue, and the most serious symptom was nocturia. Based on the occurrence rate and severity of symptoms, nine symptom clusters were identified, including psycho-emotion-related symptom cluster, pain-disturbed sleep-related symptom cluster, menopausal symptom cluster, tinnitus-dizziness-related symptom cluster, urinary-related symptom cluster, dry mouth-bitter taste-related symptom cluster, intestinal-related symptom cluster, memory loss-numbness-related symptom cluster, and emaciation-related symptom cluster. The three most serious symptom clusters are pain-disturbed sleep-related symptom cluster, urinary-related symptom cluster, and memory loss-numbness-related symptom cluster.

CONCLUSION

The symptoms of patients with cervical cancer within 6 months after radiotherapy and chemotherapy are complex, and nine symptom clusters can be identified according to the incidence and severity of symptoms. We can find the potential biological mechanism of each symptom cluster through the discussion of previous mechanism research and clinical research. The number of symptom clusters and the number of symptoms within the symptom cluster are closely related to the symptom evaluation scale selected for the study. Therefore, the symptom cluster study urgently needs a targeted symptom evaluation scale that can comprehensively reflect the patient's condition.

Reliability, validity and sensitivity of the Chinese (simple) short form 36 health survey version 2 (SF-36v2) in patients with chronic hepatitis B

The purpose of the study was to evaluate reliability, validity and sensitivity of the Chinese (simple) SF-36v2 in patients with chronic hepatitis B (CHB). Four hundred and sixty patients were recruited and allocated to CHB (CHB without cirrhosis) (n = 323) and CHB-related cirrhosis (n = 137) groups. Internal consistency reliability was estimated with Cronbach's α-coefficient. Convergent and discriminant validity were assessed by item-scale-component correlation. Factorial validity was explored by principal component factor analysis with varimax rotation. Sensitivity was measured with Cohen's effect size (ES), and independent sample t-test between the CHB and CHB-related cirrhosis groups and between alanine aminotransferase (ALT) normal and abnormal groups after stratifying illness stages. The results showed that Cronbach's α of the total SF-36v2 was 0.92, with the range from 0.72 to 0.87 in the eight scales and 0.76 to 0.77 in the two summary components. Most of the hypothesized item-scale-component correlations were 0.40 or over, and all of such hypothesized correlations were higher than the alternative ones, indicating satisfactory convergent and discriminant validity. Two and seven factors were extracted after varimax rotation at the scale level and item level. The eligible ES with statistically significant independent sample t-test was found in the physical component summary (PCS) and physical function (PF), role-physical (RP), general health (GH), vitality (VT), social functioning (SF) scales by comparison between CHB and CHB-related cirrhosis groups, and in the PCS and PF, GH, SF scales by comparison between the ALT normal and abnormal groups in the stratification of patients with CHB. In conclusion, the Chinese (simple) SF-36v2 has acceptable reliability, validity and sensitivity in patients with CHB.