老年胃癌患者术后化疗期间症状群、心理痛苦及生存状态的相关性

Correlation of symptom clusters, psychological distress and quality of life in elderly patients with gastric cancer during postoperative chemotherapy

【摘要】目的 探讨老年及非老年胃癌患者术后化疗期间症状群、心理痛苦以及生活质量的差异,分析影响老年胃癌患者化疗期间生活质量的相关因素。方法 选择空军军医大学第二附属医院2020年4月至2023年4月收治的160例胃癌术后化疗患者为研究对象,根据患者年龄,将其分为老年组(≥60岁,n=83)与对照组(年龄＜60岁,n=77)。化疗完成后,采用中文版记忆症状评估量表(MSAS)评估患者化疗期间症状群及其严重程度,采用心理痛苦温度计(DT)评估心理痛苦程度,采用胃癌患者生命质量测定量表体系(QLICP-ST)评估生活质量。采用SPSS 25.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。采用Pearson相关性分析探讨老年胃癌患者术后化疗期间各症状群严重程度、心理痛苦及生活质量之间的相关性。采用多元线性回归模型分析影响老年胃癌患者化疗期间生活质量的相关因素。结果 老年组患者化疗期间能量不足症状群、身心症状群、消化道症状群、手术相关症状群以及神经症状群严重程度得分均高于对照组；DT量表平均得分及心理显著痛苦检出率均低于对照组；化疗后老年组生活质量QLICP-ST量表中心理态度维度得分高于对照组,其余维度及量表总得分均低于对照组,差异均有统计学意义(P<0.05)。Pearson相关性分析提示,老年组患者术后化疗期间的各症状群包括能量不足、身心症状、消化道症状群、手术相关症状群、神经症状群与其生活质量QLICP-ST量表总得分均呈负相关(r=-0.364,-0.411,-0.376,-0.268,-0.344；P＜0.001)。DT得分与生活质量QLICP-ST量表总得分之间呈负相关(r=-0.371；P<0.001)。患者各症状群与DT得分之间呈正相关(r=0.275,0.233,0.325,0.263,0.316；P<0.05)。多元线性回归分析提示,年龄≥79岁(β=-0.334；P<0.001)、肿瘤分期Ⅲ期(β=-0.241；P=0.007)能负向预测老年胃癌患者化疗期间生活质量；而家庭月收入≥5000元(β=0.316；P<0.001)能正向预测患者化疗期间生活质量,这些变量可共同解释生活质量39.40%的变异。结论 老年胃癌患者化疗期间心理痛苦程度较其他年龄段轻,但其化疗耐受力及整体生活质量更差,建议临床注重老年胃癌患者机体状态的评估与化疗期间各种症状群的预防与处理,以提高老年患者化疗期间生活质量。

基金项目:国家自然科学基金青年基金(82002061)

【Abstract】Objective To explore the differences in symptom clusters, psychological distress and quality of life between elderly and non-elderly patients with gastric cancer during postoperative chemotherapy, and to analyze the related factors affecting the quality of life in the elderly patients. Methods A total of 160 patients with gastric cancer undergoing postoperative chemotherapy in our hospital from April 2020 to April 2023 were enrolled, and according to their age, they were divided into elderly group (≥60 years, n=83) and control group (<60 years, n=77). After chemotherapy was completed, Chinese version of memory symptom assessment scale (MSAS) was used to evaluate the symptom clusters and severities during chemotherapy, and distress thermometer (DT) was applied to assess the psychological distress, and quality of life instruments for cancer patients-stomach cancer (QLICP-ST) was adopted to evaluate the quality of life of the patients. SPSS statistics 25.0 was used for data analysis. Depending on data type, t test or Chi-square test was used for intergroup comparison. Pearson correlation analysis was performed to explore the correlation of severity of each symptom cluster, psychological distress and quality of life during postoperative chemotherapy. Multivariate linear regression model was utilized to identify the related factors affecting the quality of life in these elderly patients. Results The scores of energy deficiency symptom cluster, psychosomatic symptom cluster, gastrointestinal symptom cluster, surgery-related symptom cluster and neurological symptom cluster during chemotherapy were significantly higher, while the average score of DT scale and detection rate of psychological significant distress were obviously lower in the elderly group than the control group (P<0.05). After chemotherapy, the elderly group had notably higher score of psychological attitude dimension of QLICP-ST scale and lower scores of other dimensions and total score when compared to the control group (P<0.05). Pearson correlation analysis showed that the symptom clusters during postoperative chemotherapy including energy deficiency, psychosomatic symptom, gastrointestinal symptom, surgery-related symptom and neurological symptom in the elderly group, were negatively correlated with total score of quality of life QLICP-ST scale (r=-0.364, -0.411, -0.376, -0.268, -0.344; P<0.001), the DT score was also negatively correlated with total score of QLICP-ST scale (r=-0.371; P<0.001), and various symptom clusters were positively correlated with DT score (r=0.275,0.233,0.325,0.263,0.316; P<0.05). Multivariate linear regression analysis suggested that age ≥79 years (β=-0.334; P<0.001) and tumor stage Ⅲ (β=-0.241; P=0.007) negatively predicted the quality of life in the elderly patients, while family monthly income ≥5 000 yuan (β=0.316; P<0.001) positivelyed predicted the quality of life of patients during chemotherapy, and these variables could explain 39.40% of the variation of quality of life. Conclusion For gastric cancer patients during chemotherapy, the elderly ones have milder psychological distress, but worse chemotherapy tolerance and overall quality of life than the other age groups. It is suggested that in clinical practice, attention should be paid to evaluating body state of these elderly patients and to preventing and treating various symptom clusters during chemotherapy, so as to improve their quality of life during the period.

This work was supported by the National Natural Science Foundation of China for Young Scholars (82002061).