Perioperative symptom clusters in patients with lung cancer: A longitudinal investigation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Huanhuan ¹ , ZHANG Na ¹ ,  LIU Yan ²

1. Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, P. R. China;
2. Department of Nursing, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, P. R. China;

Corresponding author：

LIU Yan, Email: 15201119199@139.com

Keywords：

Lung cancer; perioperative period; symptom cluster; longitudinal investigation

DOI：

10.7507/1007-4848.202303051

Video：

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Objective To investigate the incidence, severity and longitudinal trajectories of symptoms at various time points in the perioperative period of lung cancer patients, and to provide scientific basis for clinical staff to implement predictive nursing and dynamic management of symptom clusters. Methods A prospective longitudinal investigation was conducted. The patients with lung cancer who underwent thoracoscopic lung surgery in four wards of the Department of Thoracic Surgery in our hospital were investigated by face-to-face and telephone follow-up before surgery, 1-2 days after surgery, on the day of discharge and 2 weeks after discharge. The investigation tool was the revised Chinese version of MD Anderson Symptom Inventory lung cancer specific module. Results A total of 192 patients with lung cancer were included in this study, including 59 males and 133 females, with an average age of (55.68±11.01) years. There were two symptom clusters (respiratory-gastrointestinal and emotional/psychological-disturbed sleep symptom clusters) before surgery, three symptom clusters (respiratory, gastrointestinal, and emotional/psychological-disturbed sleep symptom clusters) 1-2 days after surgery, three symptom clusters (pain-fatigue-emotional/psychological, respiratory, and gastrointestinal symptom clusters) on the day of discharge, and two symptom clusters (pain-fatigue-respiratory and respiratory symptom clusters) 2 weeks after discharge. The composition of symptoms was different in each time point during perioperative period. Conclusion There are four symptom clusters in patients with lung cancer during perioperative period, which are pain-fatigue-disturbed sleep symptoms, gastrointestinal symptoms, respiratory symptoms and emotional/psychological symptoms. The symptom clusters of lung cancer patients at different time points are relatively stable, but the symptoms within the symptom clusters show dynamic changes. Medical staff should attach great importance to and continuously monitor the dynamic changes of perioperative symptom groups of lung cancer patients, do relevant education and nursing in advance, and timely adjust the management plan according to the symptom group evaluation results.

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2.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
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5.	刘杰, 周慧灵, 宋丽君, 等. 肺癌患者不同治疗阶段症状群研究现状. 世界科学技术-中医药现代化, 2020, 22(4): 926-930.Liu J, Zhou HL, Song LJ, et al. Research status of symptom clusters in lung cancer patients at different treatment stages. World Sci Technol-Mod Tradit Chin Med, 2020, 22(4): 926-930.
6.	Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nurs, 2005, 28(4): 270-282.
7.	魏栋, 李铮, 宋翔. 肺癌症状群纵向研究英文文献计量分析. 中国药物与临床, 2020, 20(13): 2263-2266.Wei D, Li Z, Song X. Bibliometric analysis of English literature on longitudinal studies of symptom clusters in lung cancer. Chin Remedies Clin, 2020, 20(13): 2263-2266.
8.	李京京. 基于不悦症状理论的围手术期肺癌患者症状群及其与生活质量相关性的纵向研究. 安徽医科大学, 2020.Li JJ. A longitudinal study of symptom clusters and their correlation with quality of life in perioperative lung cancer patients based on the unpleasant symptoms theory. Anhui Medical University, 2020.
9.	Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients. Cancer, 2000, 89(7): 1634-1646.
10.	臧瑜. 安德森症状评估量表肺癌模块的修订及肺癌患者症状群研究. 南方医科大学, 2013.Zang Y. Revision of the MD Anderson Symptom Inventory lung cancer module and study of symptom clusters in lung cancer patients. Southern Medical University, 2013.
11.	李京京, 吕晓晴, 刘杉杉等. 围手术期肺癌患者症状群与生活质量相关性的纵向研究. 中华护理杂志, 2020, 55(11): 1635-1641.Li JJ, Lyu XQ, Liu SS, et al. A longitudinal study on the correlation between symptom clusters and quality of life in perioperative lung cancer patients. Chin J Nurs, 2020, 55(11): 1635-1641.
12.	王建华, 袁聚祥, 高晓华, 主编. 预防医学(第3版). 北京: 北京大学医学出版社, 2013. 189.Wang JH, Yuan JX, Gao XH, eds. Preventive Medicine (3rd edition). Beijing: Peking University Medical Press, 2013. 189.
13.	Cao W, Li J, Hu C, et al. Symptom clusters and symptom interference of HCC patients undergoing TACE: A cross-sectional study in China. Support Care Cancer, 2013, 21(2): 475-483.
14.	吴雪梅. 人性化护理对老年肺癌并发慢性阻塞性肺疾病患者舒适度及负性心理的影响. 实用医技杂志, 2019, 26(2): 240-241.Wu XM. The impact of humanized nursing on comfort and negative emotions in elderly lung cancer patients with chronic obstructive pulmonary disease. J Pract Med Tech, 2019, 26(2): 240-241.
15.	田梦白, 刘燕, 马凤艳, 等. 加速康复外科理念下肺癌胸腔镜手术病人出院时症状群调查及影响因素分析. 全科护理, 2022, 20(29): 4058-4062.Tian MB, Liu Y, Ma FY, et al. Investigation and influencing factors analysis of symptom clusters in lung cancer patients undergoing thoracoscopic surgery at discharge under the concept of enhanced recovery after surgery. J Gen Pract Nurs, 2022, 20(29): 4058-4062.
16.	秦莉媛, 侯晓婷, 杨萍. 肺癌患者症状群的研究进展. 中华护理杂志, 2019, 54(1): 119-124.Qin LY, Hou XT, Yang P. Research progress on symptom clusters in lung cancer patients. Chin J Nurs, 2019, 54(1): 119-124.
17.	Wong ML, Cooper BA, Paul SM, et al. Differences in symptom clusters identified using ratings of symptom occurrence vs. severity in lung cancer patients receiving chemotherapy. J Pain Symptom Manage, 2017, 54(2): 194-203.
18.	李春燕, 丁倩, 杨慧. 肺癌病人症状群纵向研究进展. 全科护理, 2022, 20(23): 3237-3240.Li CY, Ding Q, Yang H. Research progress on longitudinal studies of symptom clusters in lung cancer patients. J Gen Pract Nurs, 2022, 20(23): 3237-3240.
19.	冯竞, 葛玲, 金凤霞, 等. 肺癌手术患者出院期间症状群的调查研究. 河北医药, 2022, 44(8): 1252-1254, 1259.Feng J, Ge L, Jin FX, et al. Investigation of symptom clusters in lung cancer patients during discharge after surgery. Hebei Med J, 2022, 44(8): 1252.
20.	Chow E, Fan G, Hadi S, et al. Symptom clusters in cancer patients with brain metastases. Clin Oncol (R Coll Radiol), 2008, 20(1): 76-82.
21.	项春雁, 侯春艳, 胥微, 等. 肺癌癌因性疲乏护理的研究现状. 护理研究, 2017, 31(27): 3359-3361.Xiang CY, Hou CY, Xu W, et al. Research status of cancer-related fatigue nursing in lung cancer patients. Chin Nurs Res, 2017, 31(27): 3359-3361.
22.	米雪, 张立力, 缪景霞. 基于指南的肺癌患者疲乏、疼痛、睡眠障碍症状群管理方案的应用及效果评价. 中国实用护理杂志, 2018, 34(25): 1947-1951.Mi X, Zhang LL, Miao JX. Application and effect evaluation of a guideline-based symptom cluster management program for fatigue, pain, and sleep disturbance in lung cancer patients. Chin J Pract Nurs, 2018, 34(25): 1947-1951.
23.	Yorke J, Lloyd-Williams M, Smith J, et al. Management of the respiratory distress symptom cluster in lung cancer: A randomised controlled feasibility trial. Support Care Cancer, 2015, 23(11): 3373-3384.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
3. 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肿瘤学分会肺癌临床诊疗指南(2021版). 中华肿瘤杂志, 2021, 43(6): 591-621.Chinese Society of Oncology, Chinese Medical Association Press. Chinese Society of Oncology clinical guidelines for lung cancer diagnosis and treatment (2021 edition). Chin J Oncol, 2021, 43(6): 591-621.
4. 国家卫生健康委办公厅. 原发性肺癌诊疗指南(2022年版). 协和医学杂志, 2022, 13(4): 549-570.National Health Commission of the People's Republic of China. Guidelines for the diagnosis and treatment of primary lung cancer (2022 edition). Med J Peking Union Med Coll Hosp, 2022, 13(4): 549-570.
5. 刘杰, 周慧灵, 宋丽君, 等. 肺癌患者不同治疗阶段症状群研究现状. 世界科学技术-中医药现代化, 2020, 22(4): 926-930.Liu J, Zhou HL, Song LJ, et al. Research status of symptom clusters in lung cancer patients at different treatment stages. World Sci Technol-Mod Tradit Chin Med, 2020, 22(4): 926-930.
6. Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nurs, 2005, 28(4): 270-282.
7. 魏栋, 李铮, 宋翔. 肺癌症状群纵向研究英文文献计量分析. 中国药物与临床, 2020, 20(13): 2263-2266.Wei D, Li Z, Song X. Bibliometric analysis of English literature on longitudinal studies of symptom clusters in lung cancer. Chin Remedies Clin, 2020, 20(13): 2263-2266.
8. 李京京. 基于不悦症状理论的围手术期肺癌患者症状群及其与生活质量相关性的纵向研究. 安徽医科大学, 2020.Li JJ. A longitudinal study of symptom clusters and their correlation with quality of life in perioperative lung cancer patients based on the unpleasant symptoms theory. Anhui Medical University, 2020.
9. Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients. Cancer, 2000, 89(7): 1634-1646.
10. 臧瑜. 安德森症状评估量表肺癌模块的修订及肺癌患者症状群研究. 南方医科大学, 2013.Zang Y. Revision of the MD Anderson Symptom Inventory lung cancer module and study of symptom clusters in lung cancer patients. Southern Medical University, 2013.
11. 李京京, 吕晓晴, 刘杉杉等. 围手术期肺癌患者症状群与生活质量相关性的纵向研究. 中华护理杂志, 2020, 55(11): 1635-1641.Li JJ, Lyu XQ, Liu SS, et al. A longitudinal study on the correlation between symptom clusters and quality of life in perioperative lung cancer patients. Chin J Nurs, 2020, 55(11): 1635-1641.
12. 王建华, 袁聚祥, 高晓华, 主编. 预防医学(第3版). 北京: 北京大学医学出版社, 2013. 189.Wang JH, Yuan JX, Gao XH, eds. Preventive Medicine (3rd edition). Beijing: Peking University Medical Press, 2013. 189.
13. Cao W, Li J, Hu C, et al. Symptom clusters and symptom interference of HCC patients undergoing TACE: A cross-sectional study in China. Support Care Cancer, 2013, 21(2): 475-483.
14. 吴雪梅. 人性化护理对老年肺癌并发慢性阻塞性肺疾病患者舒适度及负性心理的影响. 实用医技杂志, 2019, 26(2): 240-241.Wu XM. The impact of humanized nursing on comfort and negative emotions in elderly lung cancer patients with chronic obstructive pulmonary disease. J Pract Med Tech, 2019, 26(2): 240-241.
15. 田梦白, 刘燕, 马凤艳, 等. 加速康复外科理念下肺癌胸腔镜手术病人出院时症状群调查及影响因素分析. 全科护理, 2022, 20(29): 4058-4062.Tian MB, Liu Y, Ma FY, et al. Investigation and influencing factors analysis of symptom clusters in lung cancer patients undergoing thoracoscopic surgery at discharge under the concept of enhanced recovery after surgery. J Gen Pract Nurs, 2022, 20(29): 4058-4062.
16. 秦莉媛, 侯晓婷, 杨萍. 肺癌患者症状群的研究进展. 中华护理杂志, 2019, 54(1): 119-124.Qin LY, Hou XT, Yang P. Research progress on symptom clusters in lung cancer patients. Chin J Nurs, 2019, 54(1): 119-124.
17. Wong ML, Cooper BA, Paul SM, et al. Differences in symptom clusters identified using ratings of symptom occurrence vs. severity in lung cancer patients receiving chemotherapy. J Pain Symptom Manage, 2017, 54(2): 194-203.
18. 李春燕, 丁倩, 杨慧. 肺癌病人症状群纵向研究进展. 全科护理, 2022, 20(23): 3237-3240.Li CY, Ding Q, Yang H. Research progress on longitudinal studies of symptom clusters in lung cancer patients. J Gen Pract Nurs, 2022, 20(23): 3237-3240.
19. 冯竞, 葛玲, 金凤霞, 等. 肺癌手术患者出院期间症状群的调查研究. 河北医药, 2022, 44(8): 1252-1254, 1259.Feng J, Ge L, Jin FX, et al. Investigation of symptom clusters in lung cancer patients during discharge after surgery. Hebei Med J, 2022, 44(8): 1252.
20. Chow E, Fan G, Hadi S, et al. Symptom clusters in cancer patients with brain metastases. Clin Oncol (R Coll Radiol), 2008, 20(1): 76-82.
21. 项春雁, 侯春艳, 胥微, 等. 肺癌癌因性疲乏护理的研究现状. 护理研究, 2017, 31(27): 3359-3361.Xiang CY, Hou CY, Xu W, et al. Research status of cancer-related fatigue nursing in lung cancer patients. Chin Nurs Res, 2017, 31(27): 3359-3361.
22. 米雪, 张立力, 缪景霞. 基于指南的肺癌患者疲乏、疼痛、睡眠障碍症状群管理方案的应用及效果评价. 中国实用护理杂志, 2018, 34(25): 1947-1951.Mi X, Zhang LL, Miao JX. Application and effect evaluation of a guideline-based symptom cluster management program for fatigue, pain, and sleep disturbance in lung cancer patients. Chin J Pract Nurs, 2018, 34(25): 1947-1951.
23. Yorke J, Lloyd-Williams M, Smith J, et al. Management of the respiratory distress symptom cluster in lung cancer: A randomised controlled feasibility trial. Support Care Cancer, 2015, 23(11): 3373-3384.

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