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中华乳腺病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 224 -230. doi: 10.3877/cma.j.issn.1674-0807.2024.04.006

论著

乳腺癌新辅助化疗患者支持性照顾需求与症状群及应对方式的相关性
杨焕1, 马靓2,(), 沈俊1, 董丽丽1, 孙文雯1   
  1. 1. 222002 连云港,徐州医科大学附属连云港医院乳腺外科
    2. 222002 连云港,徐州医科大学附属连云港医院护理部
  • 收稿日期:2023-08-17 出版日期:2024-08-01
  • 通信作者: 马靓

Correlation of supportive care needs with symptom clusters and coping strategies in breast cancer patients undergoing neoadjuvant chemotherapy

Huan Yang1, Liang Ma2,(), Jun Shen1, Lili Dong1, Wenwen Sun1   

  1. 1. Department of Breast Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222002, China
    2. Department of Nursing, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222002, China
  • Received:2023-08-17 Published:2024-08-01
  • Corresponding author: Liang Ma
引用本文:

杨焕, 马靓, 沈俊, 董丽丽, 孙文雯. 乳腺癌新辅助化疗患者支持性照顾需求与症状群及应对方式的相关性[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(04): 224-230.

Huan Yang, Liang Ma, Jun Shen, Lili Dong, Wenwen Sun. Correlation of supportive care needs with symptom clusters and coping strategies in breast cancer patients undergoing neoadjuvant chemotherapy[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(04): 224-230.

目的

探讨乳腺癌新辅助化疗患者支持性照顾需求现状与患者症状群、应对方式之间的相关性。

方法

采用方便抽样法选取2021年11月至2022年10月在连云港市第一人民医院乳腺外科接受新辅助化疗的123例乳腺癌患者为研究对象,进行横断面调查。用支持性照顾需求量表(SCNS-SF34)、记忆症状评价量表(MSAS)、简易应对方式量表(SCSQ)等对患者的相关指标进行测量。采用探索性因子分析提取患者症状群;采用t检验或单因素方差分析比较不同临床特征患者的SCNS-SF34、MSAS、SCSQ评分的差异;采用Pearson相关性分析法比较SCNS-SF34及各维度与应对方式、MSAS、症状群的相关性;运用多元线性回归分析临床特征、MSAS及SCSQ评分对SCNS-SF34评分的影响。

结果

本次研究共发放问卷123份,回收有效问卷114份,有效率92.7%。114例患者各项评分总分:MSAS为100.27±25.60,SCSQ为2.46±4.77,SCNS-SF34为106.94±12.49。新辅助化疗期间的主要症状群包括胃肠道症状群,心理-睡眠障碍症状群,癌因性疲乏群。不同家庭居住地、家庭月收入、有无慢性既往史的患者间比较,MSAS评分,SCSQ评分及SCNS-SF34评分的差异均具有统计学意义(MSAS:t=-3.025,P=0.003;F=14.885,P<0.001;t=-3.552,P<0.001;SCSQ:t=4.346,P<0.001;F=47.481,P<0.001;t=5.322,P<0.001;SCNS-SF34:t=-2.907,P=0.004;F=16.505,P<0.001;t=-4.684,P<0.001);且不同年龄与文化程度的患者SCSQ评分及SCNS-SF34评分差异也有统计学意义(SCSQ:F=20.908,P<0.001;F=10.200,P<0.001;SCNS-SF34:F=4.614,P=0.012;F=3.363,P=0.038);不同化疗周期的患者MSAS评分及SCNS-SF34评分差异具有统计学意义(F=14.050,P<0.001;F=3.792,P=0.026)。除性需求外,MSAS总分及各症状群评分和SCNS-SF34总分和其他维度评分呈正相关(P均<0.050),SCSQ评分与SCNS-SF34总分和其他维度评分呈负相关(P均<0.050)。担忧和应对方式是乳腺癌新辅助化疗患者SCNS-SF34评分的影响因素(B=1.573,95%CI:0.587~2.559,P=0.002;B=-0.857,95%CI:-1.523~-0.192,P=0.012)。

结论

乳腺癌新辅助化疗患者的存在较多未满足的支持性照顾需求,应对方式积极的患者支持性照顾需求较低,化疗期的主要症状为胃肠道症状、心理-睡眠症状以及疲乏症状,且均会导致患者的支持性照顾需求增高。

Objective

To investigate the current status of supportive care needs in breast cancer patients undergoing neoadjuvant chemotherapy, as well as the correlations with patients’symptom clusters and coping strategies.

Methods

A cross-sectional study was conducted among 114 breast cancer patients who received neoadjuvant chemotherapy in the First People's Hospital of Lianyungang from November 2021 to October 2022, using convenience sampling.The Supportive Care Needs Survey-Short Form 34 (SCNS-SF34), the Memorial Symptom Assessment Scale (MSAS) and the Simplified Coping Style Questionnaire (SCSQ) were applied for the surveys of enrolled patients.Exploratory factor analysis was used to extract symptom clusters.The scores of SCNS-SF34, MSAS, and SCSQ between patients with different clinical characteristics were compared using t test or one-way analysis of variance.Pearson correlation analysis was used for the correlation between SCNS-SF34 (total score and scores for different dimensions) and coping strategies, MSAS and symptom clusters.Multiple linear regression was used to analyze the effects of clinical characteristics, MSAS and SCSQ scores on SCNS-SF34 scores.

Results

A total of 123 questionnaires were distributed, with 114 valid questionnaires collected (92.7%).The total scores of MSAS, SCSQ, and SCNS-SF34 in 114 patients were 100.27±25.60, 2.46±4.77 and 106.94±12.49, respectively.The main symptom clusters during neoadjuvant chemotherapy included gastrointestinal symptoms, psychological-sleep disorders, and cancer-related fatigue.Statistically significant differences were observed in MSAS, SCSQ, and SCNS-SF34 scores among patients with different residences, monthly household income and chronic medical history (MSAS: t=-3.025, P=0.003; F=14.885, P<0.001; t=-3.552, P<0.001; SCSQ: t=4.346, P<0.001; F=47.481, P<0.001; t=5.322, P<0.001; SCNS-SF34: t=-2.907, P=0.004; F=16.505, P<0.001; t=-4.684, P<0.001).The SCSQ and SCNS-SF34 scores also showed a significant difference between patients with different ages and education backgrounds (SCSQ: F=20.908, P<0.001; F=10.200, P<0.001; SCNS-SF34: F=4.614, P=0.012; F=3.363, P=0.038). The patients with different chemotherapy cycles showed a significant difference in MSAS and SCNS-SF34 scores (F=14.050, P<0.001; F=3.792, P=0.026).Except for sexual demand, the total score of MSAS and the scores of each symptom cluster were positively correlated with the total score of SCNS-SF34 and the scores of other dimensions (all P<0.050), and the SCSQ score was negatively correlated with the total score of SCNS-SF34 and the scores of other dimensions (all P<0.050). Worries and coping strategies were influencing factors of SCNS-SF34 scores in breast cancer patients undergoing neoadjuvant chemotherapy(B=1.573, 95%CI: 0.587 to 2.559, P=0.002; B=-0.857, 95%CI: -1.523 to -0.192, P=0.012).

Conclusions

Breast cancer patients undergoing neoadjuvant chemotherapy have many unmet supportive care needs.Patients with positive coping strategies tend to have less supportive care needs.The main symptoms during chemotherapy are gastrointestinal symptoms, psychological-sleep symptoms and fatigue, all of which can increase patients’supportive care needs.

表1 114例乳腺癌新辅助化疗患者MSAS、SCSQ及SCNS-SF34评分情况(分,±s)
表2 探索性因子分析法旋转后因子载荷数
表3 不同临床特征的乳腺癌新辅助化疗患者MSAS、SCSQ及SCNS-SF34评分比较(分,±s)
临床特征 例数 记忆症状评分 应对方式评分 支持性照顾需求评分
MSAS 检验值 P SCSQ 检验值 P SCNS-SF34 检验值 P
年龄                    
18~44岁 21 91.52±26.92 F=2.789 0.066 6.62±4.20a F=20.908 <0.001 102.76±14.43a F=4.614 0.012
45~59岁 62 99.34±25.89 2.71±4.51a 105.68±12.21a
≥60岁 31 108.06±22.46 -0.84±3.02 112.29±10.01
居住地                    
城市 61 93.84±27.11 t=-3.025 0.003 4.15±4.54 t=4.346 <0.001 103.87±13.08 t=-2.907 0.004
农村或郊区 53 107.68±21.71 0.53±4.31 110.47±10.86
文化程度                    
高中及以上 25 95.52±25.19 F=1.371 0.258 4.56±5.00b F=10.200 <0.001 103.92±13.40b F=3.363 0.038
初中 47 98.34±30.65 3.49±4.82b 105.11±13.37b
小学及以下 42 105.26±18.35 0.07±3.01 110.79±9.98
婚姻状况                    
已婚 109 100.30±26.08 t=0.060 0.952 2.48±4.84 t=0.126 0.900 106.98±12.66 t=0.171 0.864
离异/丧偶 5 99.60±11.72 2.20±3.11 106.00±8.80
家庭收入                    
>5000元 29 87.17±28.37c F=14.885 <0.001 6.48±4.52c F=47.481 <0.001 99.03±15.51c F=16.505 <0.001
30001~4999元 59 97.92±20.75c 2.80±3.54c 106.75±9.60c
≤3000元 26 120.23±20.86 -2.77±1.90 116.19±7.78
慢性病既往史                    
79 94.87±25.38 t=-3.552 <0.001 3.89±4.61 t=5.322 <0.001 103.92±12.64 t=-4.684 <0.001
35 112.46±21.91 -0.74±3.42 113.74±9.11
病理分期                    
Ⅰ~Ⅱ期 74 100.05±25.85 t=-0.123 0.902 2.82±4.98 t=1.094 0.276 106.18±12.49 t=-0.886 0.377
≥Ⅲ期 40 100.68±25.45 1.80±4.34 108.35±12.52
化疗周期                    
1~2个 42 85.55±23.37 F=14.050 <0.001 3.05±5.08 F=1.123 0.329 103.07±10.57 F=3.792 0.026
3~4个 46 106.78±24.21d 1.65±4.40 108.17±11.54d
≥5个 26 112.54±20.31d 2.96±4.86 111.00±15.41d
表4 患者SCNS-SF34总分及各维度评分与其SCSQ、MSAS、症状群评分的相关性
表5 多元线性回归分析变量赋值表
表6 114例乳腺癌新辅助化疗患者支持性照顾需求的影响因素的多元线性回归分析结果
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