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Symptom clusters and symptom interference of HCC patients undergoing TACE: a cross-sectional study in China

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Abstract

Objective

The aim of this study was to investigate the symptom and symptom clusters of patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE), and to discuss the relationship between symptoms, symptom clusters, and symptom interference.

Materials and methods

Patients with HCC who received TACE were asked to rate their symptoms using the M. D. Anderson Symptom Inventory and the symptom checklist particularly for HCC. To determine the interrelationships among symptoms and identify the symptom clusters, a principal component analysis with varimax rotation was carried out on the symptom items. Spearman correlation analysis was done to assess the relationship between symptom clusters and symptom interference.

Results

A total of 155 patients finished the whole procedure between November 2010 and May 2011. Before TACE, the five most severe symptoms, ranked in order, were fatigue (3.40 ± 2.26), distress (3.35 ± 2.60), sadness (3.01 ± 2.66), sleep disturbance (2.63 ± 2.57), and lack of appetite (2.26 ± 2.38). After TACE, fatigue (4.88 ± 2.31) was the most serious symptom, followed by sleep disturbance (4.80 ± 2.25), distress (4.59 ± 2.32), sadness (4.45 ± 2.16), lack of appetite (4.25 ± 2.51). Two symptom clusters were found before TACE: psychological symptom cluster and sickness symptom cluster. Two new symptom clusters were found after TACE: upper gastrointestinal symptom cluster and liver function impairment symptom cluster, with the two original symptom clusters remained relatively stable. The highest symptom interference items pre- and post-TACE were work and enjoyment of life, followed by mood. The symptoms of distress, sadness, fatigue, sleep disturbance, and lack of appetite were all significantly associated with the total interference (r = 0.443–0.615, p < 0.01 or p < 0.05). Symptom clusters were significantly correlated with the total symptom interference before and after TACE (r = 0.176–0.638, p < 0.01 or p < 0.05).

Conclusion

Psychological symptom cluster and sickness symptom cluster are common for HCC patients before and after TACE. Liver function impairment and upper gastrointestinal symptom clusters are directly related to TACE treatment. Both the symptoms and symptom clusters have significant interference on the daily life of HCC patients undergoing TACE. However, more work is needed to further clarify the symptom clusters associated with TACE and to test the effectiveness of TACE in easing symptoms and improving quality of life of HCC patients.

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Acknowledgments

The research was supported by Shanghai Leading Academic Discipline Project (No. B90302ZD), the Research Grant of Shanghai Municipal Health Bureau (No.2008JG007), and Innovation Project of Shanghai Municipal Education Commission (No.10ZS56).

Conflict of interest

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work; there is no professional or other personal interest of any nature or kind in any product, service, and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled.

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Authors and Affiliations

  1. Nursing School, Second Military Medical University, Room 314, No.800 Xiangyin Road, Yangpu District, Shanghai, 200433, People’s Republic of China

    Wenting Cao, Juan Li, Chen Hu, Jie Shen, Xiangyan Liu, Yan Xu & Zhixia Ye

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  1. Wenting Cao
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  2. Juan Li
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  3. Chen Hu
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  4. Jie Shen
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  5. Xiangyan Liu
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  6. Yan Xu
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  7. Zhixia Ye
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Corresponding authors

Correspondence to Yan Xu or Zhixia Ye.

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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 21, 475–483 (2013). https://doi.org/10.1007/s00520-012-1541-5

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  • DOI: https://doi.org/10.1007/s00520-012-1541-5

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