关键词: 胃肿瘤, 化放疗, 生活质量, 症状群, 纵向研究

Abstract: Background　Studying the longitudinal developmental changes of the symptom cluster can obtain the pattern of symptom cluster changes and stable symptom cluster，which is conducive to the continuous management of symptoms.At present，there is no longitudinal study report on the symptom cluster of gastric cancer.Objective　To longitudinally study the symptom clusters and quality of life（QOL）in patients with gastric cancer during chemotherapy in order to lay the foundation for guiding clinical management of continuous symptoms and improving patients' QOL.Methods　A longitudinal study was conducted among patients who underwent gastric cancer surgery and postoperative chemotherapy at the Second Affiliated Hospital of Zhengzhou University from September 2016 to May 2017.After completing the written informed consent form，they received questionnaire surveys for collecting the general clinical data with a self-developed General Clinical Data Questionnaire，investigating the symptom clusters with the Chinese version of Memorial Symptom Assessment Scale（MSAS）on the day prior to chemotherapy（T1），on the second day following the 3rd cycle of chemotherapy（T2），and on the second day following the 6th cycle of chemotherapy（T3），and obtaining the status of QOF with the Chinese version of Functional Assessment of Cancer Therapy-General（FACT-G）at T1，T2，T3.The latter two types of surveys achieved a response rate of 98.2%（224/228）at T1，a response rate of 99.1%（221/223）at T2〔the total number（223）of participants dropped by 5 cases（4 were lost to follow up，and 1 died）compared with at T1（228）〕，and a response rate of 98.2%（214/218）at T3〔the total number（218）of participants dropped by 5 cases（3 were lost to follow up，and 2 died）compared with at T2（223）〕.The correlations between symptom clusters and QOL were analyzed.Results　At T1，the average number of symptom clusters was 28.9（27.2，30.7），and the top three symptoms with the highest frequency were weight loss，dry mouth，pain（such as abdominal pain and low back pain）；and the top three symptoms with the highest severity scores were difficult concentrating，body swelling/bloated/abdominal distention，and swelling of arms or legs.At T2，the average number of symptom clusters was 17.8（15.7，20.4），the top three symptoms with the highest frequency were lack of energy，pain（such as abdominal pain，low back pain），and cough；and the top three symptoms with the highest severity scores were lack of energy，sweats，and pain（such as abdominal pain and low back pain）．At T3，the average number of symptom clusters was 21.8（20.7，22.9），and the top three symptoms with the highest frequency were lack of energy，weight loss，and lack of appetite，and the top three symptoms with the highest severity scores were lack of energy，lack of appetite，and sweats.Five symptom clusters（lack of energy，gastrointestinal，psychosomatic，surgery-related，neurological）were found in all the respondents at T2，and 4（lack of energy，gastrointestinal，psychosomatic，neurological）were found in them at T3.The symptoms included in the corresponding symptom clusters differed significantly over the treatment time.At different treatment time points，the differences in physical well-being，social/family well-being，emotional well-being，functional well-being scores and quality of life scores of gastric cancer patients were significant（P<0.05）．At T1，T2 and T3，the severity scores of symptom clusters were negatively correlated with physical well-being，social/family well-being，emotional well-being，functional well-being scores and total quality of life score（P<0.05）．Conclusion　Gastric cancer patients have multiple stable symptom clusters during chemotherapy，such as gastrointestinal symptom cluster，lack of energy symptom cluster，psychosomatic symptom cluster，and neurological symptom cluster，and the more serious these symptoms are，the lower the patients' quality of life will be.

Key words: Stomach neoplasms, Chemoradiotherapy, Quality of life, Symptom cluster, Longitudinal studies