以质量求发展，以服务铸品牌

护理学报 ›› 2025, Vol. 32 ›› Issue (1): 1-6.doi: 10.16460/j.issn1008-9969.2025.01.001

• 研究生园地 •    下一篇

鼻咽癌患者诱导化疗序贯同期放化疗期间躯体-心理症状负担轨迹及影响因素研究

刘琪1, 刘佳丽2a, 刘玉2a, 杨丽敏3, 范育英2b, 吕星2b, 覃惠英2a   

  1. 1.中山大学 护理学院,广东 广州 510060;
    2.中山大学肿瘤防治中心 a.护理部; b.鼻咽科,广东 广州 510060;
    3.贵州医科大学附属医院 护理部,贵州 贵阳 561113
  • 收稿日期:2024-08-11 出版日期:2025-01-10 发布日期:2025-02-20
  • 通讯作者: 覃惠英（1966-）,女,广东广州人,硕士,主任护师,护理部主任。E-mail：qinhy@sysucc.org.cn
  • 作者简介:刘琪（1998-）,女,江西赣州人,本科学历,硕士研究生在读。
  • 基金资助:
    国家自然科学基金面上项目（82172863）; 广东省医学科学技术研究基金（A2022020）

Physical-psychological symptom burden trajectories and influencing factors in nasopharyngeal carcinoma patients during induction chemotherapy plus concurrent chemoradiotherapy

LIU Qi1, LIU Jia-li2a, LIU Yu2a, YANG Li-min3, FAN Yu-ying2b, LV Xing2b, JIN Hui-ying2a   

  1. 1. School of Nursing, Sun Yat-sen University, Guangzhou 510060, China;
    2a. Dept. of Nursing Administration; 2b. Dept. of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China;
    3. Dept. of Nursing Administration, Affiliated Hospital of Guizhou Medical University, Guiyang 561113, China
  • Received:2024-08-11 Online:2025-01-10 Published:2025-02-20

PDF (PC)

19

赞

摘要： 目的 调查鼻咽癌患者诱导化疗序贯同期放化疗期间躯体、心理症状负担轨迹及影响因素。 方法 便利选取广州某三级甲等医院行诱导化疗序贯同期放化疗的212例鼻咽癌患者为研究对象,于诱导化疗期、放疗第5次、放疗第10次、放疗第15次、放疗第20次、放疗第25次、放疗结束、放疗结束后 1个月末收集患者报告的不良事件通用术语标准。采用潜类别增长模型分析躯体、心理症状负担轨迹及潜在类别。 结果 躯体症状负担识别为高躯体症状负担组（89.2%）、中高躯体症状负担组（10.8%）;心理症状负担识别为中高心理症状负担组（22.7%）、低心理症状负担组（47.6%）、无心理症状负担组（29.7%）。高躯体症状负担组和中高心理症状负担组在诱导化疗期的症状负担均高于其他组（P<0.05）。logistic回归分析显示,年龄、是否合并其他慢性病、信息获取能力是躯体症状负担轨迹的影响因素;意义感、信息获取能力是心理症状负担轨迹的影响因素（P<0.05）。 结论 鼻咽癌患者治疗期间的躯体、心理症状负担轨迹存在异质性。年龄低、合并其他慢性病、低信息获取能力的鼻咽癌患者更可能属于高躯体症状负担组;低意义感、低信息获取能力的患者更可能属于症状负担更高的心理症状负担组。

关键词: 鼻咽癌, 诱导化疗序贯同期放化疗, 症状负担轨迹, 潜类别增长模型, 健康素养, 心理一致感

Abstract: Objective To identify physical-psychological symptom burden trajectories and influencing factors of nasopharyngeal carcinoma patients during induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT). Methods Nasopharyngeal carcinoma patients who received IC plus CCRT (n=212) in a tertiary grade-A hospital of Guangzhou were selected as research subjects. The Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events were collected during IC, at the 5th, 10th, 15th, 20th, and 25th radiotherapy, at the end of radiotherapy, and one month after radiotherapy. Latent class growth modeling was applied to analyze the trajectoy categories of physical and psychological symptom burden. Results Two physical symptom burden trajectories were identified, labeling “high physical symptom burden group” (89.2%) and “moderate-high physical symptom burden group” (10.8%). Three psychological symptom burden trajectories were identified as “moderate-high psychological symptom burden group” (22.7%), “low psychological symptom burden group” (47.6%), and “no psychological symptom burden group” (29.7%). The symptom burden of the high physical symptom burden group and the medium-high psychological symptom burden group was higher than that of the other groups during IC (P<0.05). Logistic regression analysis showed that age, the presence or absence of other chronic diseases and information acquisition ability were the influencing factors of physical symptom burden trajectories, while information acquisition ability and sense of meaning were the influencing factors of the psychological symptom burden trajectories (P<0.05). Conclusion There is heterogeneity in the trajectories of physical and psychological symptom burden during treatment. Younger patients, and those with other chronic diseases or poor information acquisition ability are more likely to have a sustained high physical symptom burden. Patients with poor information acquisition ability or lower sense of meaning are more likely to have a sustained higher psychological symptom burden.

Key words: nasopharyngeal carcinoma, induction chemotherapy plus concurrent chemoradiotherapy, symptom burden trajectories, latent class growth model, health literacy, sense of coherence

中图分类号: 

  • R473.73
[1] Hong RL, Hsiao CF, Ting LL, et al.Final results of a randomized phase III trial of induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in patients with stage IVA and IVB nasopharyngeal carcinoma-Taiwan Cooperative Oncology Group (TCOG) 1303 Study[J]. Ann Oncol, 2018, 29(9):1972-1979.DOI:10.1093/annonc/mdy249.
[2] Yao JJ, Zhang F, Gao TS, et al.Survival impact of radiotherapy interruption in nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: a big-data intelligence platform-based analysis[J]. Radiother Oncol, 2019, 132:178-187.DOI:10.1016/j.radonc.2018.10.018.
[3] Armstrong TS.Symptoms experience: a concept analysis[J]. Oncol Nurs Forum, 2003, 30(4):601-606. DOI:10.1188/03.ONF.601-606.
[4] 刘源,骆方,刘红云.多阶段混合增长模型的影响因素:距离与形态[J].心理学报,2014, 46(9):1400-1412.DOI:10.3724/SP.J.1041.2014.01400.
[5] Jordan JE, Buchbinder R, Briggs AM, et al.The Health Literacy Management Scale (HeLMS): a measure of an individual's capacity to seek, understand and use health information within the healthcare setting[J]. Patient Educ Couns, 2013, 91(2):228-235.DOI:10.1016/j.pec. 2013.01.013.
[6] 孙浩林,彭慧,傅华.慢性病患者健康素养量表信效度的研究[J].复旦学报(医学版), 2012, 39(3):268-272.DOI:10.3969/j.issn.1672-8467.2012.03.009.
[7] Antonovsky A.The structure and properties of the Sense of Coherence Scale[J]. Soc Sci Med, 1993, 36(6):725-733.DOI:10.1016/0277-9536(93)90033-Z.
[8] 包蕾萍,刘俊升.心理一致感量表(SOC-13)中文版的修订[J].中国临床心理学杂志,2005, 13(4):399-401.DOI:10.3969/j.issn.1005-3611.2005.04.007.
[9] Basch E, Reeve BB, Mitchell SA, et al.Development of the national cancer institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)[J]. J Natl Cancer Inst, 2014,106(9):244.DOI:10.1093/jnci/dju244.
[10] Kkf C, Mitchell SA, Chan N, et al.Linguistic validation of the simplified Chinese version of the US national cancer institute's Patient-reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAETM)[J]. BMC Cancer, 2020, 20(1): 1153.DOI:10.1186/s12885-020-07631-5.
[11] Basch E, Becker C, Rogak LJ, et al.Composite grading algorithm for the national cancer institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)[J]. Clin Trials, 2021, 18(1):104-114.DOI:10.1177/1740774520975120.
[12] Oswald LB, Gudenkauf LM, Li XY, et al.Patient-reported outcomes among multiple myeloma patients treated with standard of care idecabtagene vicleucel[J]. Cancers, 2023, 15(19):4711.DOI:10.3390/cancers15194711.
[13] Tang LL, Chen YP, Chen CB, et al.The Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma[J]. Cancer Commun, 2021, 41(11):1195-1227.DOI:10.1002/cac2.12218.
[14] 丁凤琴,田晶,孟冰霞,等.潜变量增长混合模型在慢性心衰患者生理症状变化轨迹研究中的应用[J].中国卫生统计,2023, 40(4):482-486.DOI:10.11783/j.issn.1002-3674.2023.04.001.
[15] 陈坚,王园,崔艳丽,等.缺血性脑卒中后吞咽障碍患者经口摄食功能发展轨迹及影响因素分析[J].护理学报, 2023, 30(24):1-6. DOI:10.16460/j.issn1008-9969.2023.24.001.
[16] 黄珂瑶,丁思妍,周海琴,等.肺移植患者衰弱变化轨迹及影响因素研究[J].中华护理杂志, 2023, 58(9):1088-1095.DOI:10.3761/j.issn.0254-1769.2023.09.010.
[17] Dunnack YH, Xu W, Lee JW, et al.Symptom patterning across the cancer care trajectory for patients receiving chemoradiation for head and neck cancer: a retrospective longitudinal study using latent transition analysis[J]. Cancer Nurs, 2023.DOI: 10.1097/NCC.0000000000001227. Online ahead of print.
[18] Wang CH, Chen JM, Su L, et al.The psychological status in patients with nasopharyngeal carcinoma during radiotherapy[J]. Eur Arch Oto-Rhino-L, 2022, 279(2):1035-1042.DOI: 10.1007/s00405-021-06892-5.
[19] Burns M, Campbell R, French S, et al.Trajectory of anxiety related to radiation therapy mask immobilization and treatment delivery in head and neck cancer and radiation therapists? Ability to detect this anxiety[J]. Adv Radiat Oncol, 2022, 7(5):100967.DOI: 10.1016/j.adro.2022.100967.
[20] Mcfarland DC, Doherty M, Atkinson TM, et al.Cancer-related inflammation and depressive symptoms: systematic review and Meta-analysis[J].Cancer-Am Cancer Soc, 2022, 128(13): 2504-2519.DOI:10.1002/cncr.34193.
[21] Person H, Keefer L.Psychological comorbidity in gastrointestinal diseases: update on the brain-gut-microbiome axis[J]. Prog Neuropsychopharmacol Biol Psychiatry, 2021, 107: 110209.DOI:10.1016/j.pnpbp.2020.110209.
[22] Tsuji D, Suzuki K, Kawasaki Y, et al.Risk factors associated with chemotherapy-induced nausea and vomiting in the triplet antiemetic regimen including palonosetron or granisetron for cisplatin-based chemotherapy: analysis of a randomized, double-blind controlled trial[J]. Support Care Cancer, 2019, 27(3):1139-1147.DOI:10.1007/s00520-018-4403-y.
[23] Wong ML, Paul SM, Cooper BA, et al.Predictors of the multidimensional symptom experience of lung cancer patients receiving chemotherapy[J].Support Care Cancer, 2017, 25(6):1931-1939.DOI:10.1007/s00520-017-3593-z.
[24] Grevenstein D, Aguilar RC, Schweitzer J, et al.Through the tunnel, to the light: why sense of coherence covers and exceeds resilience, optimism, and self-compassion[J]. Pers Indiv Differ,2016, 98:208-217.DOI:10.1016/j.paid.2016.04.001.
[1] 朱心悦, 嵇冰聪, 蓝雪芬, 季晓珍. 糖尿病患者电子健康素养研究进展[J]. 护理学报, 2024, 31(7): 36-39.
[2] 薛荣, 张开利, 陈保云, 马荣慧, 张雨欣. 中老年脑卒中患者多维衰弱发展轨迹及其影响因素研究[J]. 护理学报, 2024, 31(6): 6-12.
[3] 祁丽萍, 王文煊, 侯敏, 郑粤豪, 冯惠霞, 李济宾. 首诊鼻咽癌患者焦虑抑郁现状及其与恐惧疾病进展的关系[J]. 护理学报, 2024, 31(20): 67-72.
[4] 刘莎, 陈玲, 李甜甜, 张丹莉, 蔡文智. 孕产妇盆底肌训练自我效能发展轨迹及其对产后尿失禁的影响[J]. 护理学报, 2023, 30(3): 1-5.
[5] 陈坚, 王园, 崔艳丽, 罗彦嗣, 廖琳, 颜明玉, 张晓梅. 缺血性脑卒中后吞咽障碍患者经口摄食功能发展轨迹及影响因素分析[J]. 护理学报, 2023, 30(24): 1-6.
[6] 付爽, 刘祯, 崔玉顺. 中青年首发脑卒中患者心理一致感在领悟社会支持与创伤后应激障碍的中介效应[J]. 护理学报, 2023, 30(20): 43-47.
[7] 周贵玲, 徐蓉, 边旭娜, 郑维. 中青年2型糖尿病患者健康素养量表的研制及信效度检验[J]. 护理学报, 2023, 30(14): 73-78.
[8] 张咪, 吴艳妮, 黄秀娥, 杨晶, 王润, 杨玲莉, 赵慧慧, 周春兰. 失能老人和配偶照顾者健康素养与自我效能对生活质量的交互作用[J]. 护理学报, 2023, 30(13): 1-5.
[9] 李家燕, 杨丽, 朱静文, 张妍欣, 梁秋婷, 周溢, 卢佳美. 200例鼻咽癌同步放化疗患者负面社会期望现状及影响因素分析[J]. 护理学报, 2023, 30(11): 65-70.
[10] 唐涵, 尚磊. 青少年癌症患者家庭照护者健康素养的研究进展[J]. 护理学报, 2023, 30(10): 31-34.
[11] 黄晓琳, 陈冬兰, 王毅, 杨玉颖. 438例中青年鼻咽癌患者疾病感知现状及影响因素分析[J]. 护理学报, 2022, 29(24): 55-58.
[12] 徐帆, 张继权, 谢绍菊, 刘洁. 积极应对在女性乳腺癌幸存者心理一致感与创伤后应激反应间的中介效应[J]. 护理学报, 2022, 29(21): 55-60.
[13] 张榆, 李菀丹, 罗迎霞, 谢杨微. 放化疗鼻咽癌患者消化道症状管理的最佳证据总结[J]. 护理学报, 2022, 29(2): 35-39.
[14] 张畅, 陈纳川, 昌敬惠. 同群效应对老年人电子健康素养的影响及启示[J]. 护理学报, 2022, 29(12): 75-78.
[15] 葛树敏, 国仁秀, 方敏. 1例鼻咽癌终末期患者的安宁疗护[J]. 护理学报, 2021, 28(10): 77-78.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!