Perioperative symptom clusters in patients with lung cancer: A longitudinal investigation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Huanhuan ¹ , ZHANG Na ¹ ,  LIU Yan ²

1. Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, P. R. China;
2. Department of Nursing, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, P. R. China;

Corresponding?author：

LIU Yan, Email: 15201119199@139.com

Keywords：

Lung cancer; perioperative period; symptom cluster; longitudinal investigation

DOI：

10.7507/1007-4848.202303051

Video：

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Objective To investigate the incidence, severity and longitudinal trajectories of symptoms at various time points in the perioperative period of lung cancer patients, and to provide scientific basis for clinical staff to implement predictive nursing and dynamic management of symptom clusters. Methods A prospective longitudinal investigation was conducted. The patients with lung cancer who underwent thoracoscopic lung surgery in four wards of the Department of Thoracic Surgery in our hospital were investigated by face-to-face and telephone follow-up before surgery, 1-2 days after surgery, on the day of discharge and 2 weeks after discharge. The investigation tool was the revised Chinese version of MD Anderson Symptom Inventory lung cancer specific module. Results A total of 192 patients with lung cancer were included in this study, including 59 males and 133 females, with an average age of (55.68±11.01) years. There were two symptom clusters (respiratory-gastrointestinal and emotional/psychological-disturbed sleep symptom clusters) before surgery, three symptom clusters (respiratory, gastrointestinal, and emotional/psychological-disturbed sleep symptom clusters) 1-2 days after surgery, three symptom clusters (pain-fatigue-emotional/psychological, respiratory, and gastrointestinal symptom clusters) on the day of discharge, and two symptom clusters (pain-fatigue-respiratory and respiratory symptom clusters) 2 weeks after discharge. The composition of symptoms was different in each time point during perioperative period. Conclusion There are four symptom clusters in patients with lung cancer during perioperative period, which are pain-fatigue-disturbed sleep symptoms, gastrointestinal symptoms, respiratory symptoms and emotional/psychological symptoms. The symptom clusters of lung cancer patients at different time points are relatively stable, but the symptoms within the symptom clusters show dynamic changes. Medical staff should attach great importance to and continuously monitor the dynamic changes of perioperative symptom groups of lung cancer patients, do relevant education and nursing in advance, and timely adjust the management plan according to the symptom group evaluation results.

Citation： ZHANG Huanhuan, ZHANG Na, LIU Yan. Perioperative symptom clusters in patients with lung cancer: A longitudinal investigation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(4): 508-514. doi: 10.7507/1007-4848.202303051 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
3.	中華醫學會腫瘤學分會, 中華醫學會雜志社. 中華醫學會腫瘤學分會肺癌臨床診療指南(2021版). 中華腫瘤雜志, 2021, 43(6): 591-621.Chinese Society of Oncology, Chinese Medical Association Press. Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2021 edition). Chin J Oncol, 2021, 43(6): 591-621.
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5.	劉杰, 周慧靈, 宋麗君, 等. 肺癌患者不同治療階段癥狀群研究現狀. 世界科學技術-中醫藥現代化, 2020, 22(4): 926-930.Liu J, Zhou HL, Song LJ, et al. Situation and progress: Study on symptom clusters of lung cancer patients at different treatment stages. World Sci Technol-Mod Tradit Chin Med, 2020, 22(4): 926-930.
6.	Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nurs, 2005, 28(4): 270-282.
7.	魏棟, 李錚, 宋翔. 肺癌癥狀群縱向研究英文文獻計量分析. 中國藥物與臨床, 2020, 20(13): 2263-2266.Wei D, Li Z, Song X. Bibliometric analysis of English literature on longitudinal studies of symptom clusters in lung cancer. Chin Remedies Clin, 2020, 20(13): 2263-2266.
8.	李京京. 基于不悅癥狀理論的圍手術期肺癌患者癥狀群及其與生活質量相關性的縱向研究. 安徽醫科大學, 2020.Li JJ. A longitudinal study on symptom cluster and its correlation with quality of life based on theory of unpleasant symptoms in perioperation patients with lung cancer. Anhui Medical University, 2020.
9.	Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients. Cancer, 2000, 89(7): 1634-1646.
10.	臧瑜. 安德森癥狀評估量表肺癌模塊的修訂及肺癌患者癥狀群研究. 南方醫科大學, 2013.Zang Y. Revision of the lung cancer module of M. D. Anderson symptom inventory and symptom clusters in patients with lung cancer. Southern Medical University, 2013.
11.	李京京, 呂曉晴, 劉杉杉等. 圍手術期肺癌患者癥狀群與生活質量相關性的縱向研究. 中華護理雜志, 2020, 55(11): 1635-1641.Li JJ, Lyu XQ, Liu SS, et al. A longitudinal study on the correlations between symptom clusters and quality of life in patients with lung cancer during perioperation. Chin J Nurs, 2020, 55(11): 1635-1641.
12.	王建華, 袁聚祥, 高曉華, 主編. 預防醫學(第3版). 北京: 北京大學醫學出版社, 2013. 189.Wang JH, Yuan JX, Gao XH, eds. Preventive Medicine (3rd edition). Beijing: Peking University Medical Press, 2013. 189.
13.	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, 2013, 21(2): 475-483.
14.	吳雪梅. 人性化護理對老年肺癌并發慢性阻塞性肺疾病患者舒適度及負性心理的影響. 實用醫技雜志, 2019, 26(2): 240-241.Wu XM. The impact of humanized nursing on comfort and negative emotions in elderly lung cancer patients with chronic obstructive pulmonary disease. J Pract Med Tech, 2019, 26(2): 240-241.
15.	田夢白, 劉燕, 馬鳳艷, 等. 加速康復外科理念下肺癌胸腔鏡手術病人出院時癥狀群調查及影響因素分析. 全科護理, 2022, 20(29): 4058-4062.Tian MB, Liu Y, Ma FY, et al. Investigation and influencing factors analysis of symptom clusters in lung cancer patients undergoing thoracoscopic surgery at discharge under the concept of enhanced recovery after surgery. J Gen Pract Nurs, 2022, 20(29): 4058-4062.
16.	秦莉媛, 侯曉婷, 楊萍. 肺癌患者癥狀群的研究進展. 中華護理雜志, 2019, 54(1): 119-124.Qin LY, Hou XT, Yang P. Research progress on symptom clusters in lung cancer patients. Chin J Nurs, 2019, 54(1): 119-124.
17.	Wong ML, Cooper BA, Paul SM, et al. Differences in symptom clusters identified using ratings of symptom occurrence vs. severity in lung cancer patients receiving chemotherapy. J Pain Symptom Manage, 2017, 54(2): 194-203.
18.	李春燕, 丁倩, 楊慧. 肺癌病人癥狀群縱向研究進展. 全科護理, 2022, 20(23): 3237-3240.Li CY, Ding Q, Yang H. Research progress on longitudinal studies of symptom clusters in lung cancer patients. J Gen Pract Nurs, 2022, 20(23): 3237-3240.
19.	馮競, 葛玲, 金鳳霞, 等. 肺癌手術患者出院期間癥狀群的調查研究. 河北醫藥, 2022, 44(8): 1252-1254, 1259.Feng J, Ge L, Jin FX, et al. A study on the symptom complex of patients with lung cancer during discharge from hospital. Hebei Med J, 2022, 44(8): 1252-1254, 1259.
20.	Chow E, Fan G, Hadi S, et al. Symptom clusters in cancer patients with brain metastases. Clin Oncol (R Coll Radiol), 2008, 20(1): 76-82.
21.	項春雁, 侯春艷, 胥微, 等. 肺癌癌因性疲乏護理的研究現狀. 護理研究, 2017, 31(27): 3359-3361.Xiang CY, Hou CY, Xu W, et al. Research status quo of cancer related fatigue nursing for lung cancer patients. Chin Nurs Res, 2017, 31(27): 3359-3361.
22.	米雪, 張立力, 繆景霞. 基于指南的肺癌患者疲乏、疼痛、睡眠障礙癥狀群管理方案的應用及效果評價. 中國實用護理雜志, 2018, 34(25): 1947-1951.Mi X, Zhang LL, Miao JX. Application and effect evaluation of guideline-based symptom cluster management program of fatigue, pain, and sleep disturbance in patients with lung cancer. Chin J Pract Nurs, 2018, 34(25): 1947-1951.
23.	Yorke J, Lloyd-Williams M, Smith J, et al. Management of the respiratory distress symptom cluster in lung cancer: A randomised controlled feasibility trial. Support Care Cancer, 2015, 23(11): 3373-3384.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
3. 中華醫學會腫瘤學分會, 中華醫學會雜志社. 中華醫學會腫瘤學分會肺癌臨床診療指南(2021版). 中華腫瘤雜志, 2021, 43(6): 591-621.Chinese Society of Oncology, Chinese Medical Association Press. Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2021 edition). Chin J Oncol, 2021, 43(6): 591-621.
4. 國家衛生健康委辦公廳. 原發性肺癌診療指南(2022年版). 協和醫學雜志, 2022, 13(4): 549-570.General Office of the National Health Commission of the People's Republic of China. Clinical practice guideline for primary lung cancer ( 2022 version). Med J Peking Union Med Coll Hosp, 2022, 13(4): 549-570.
5. 劉杰, 周慧靈, 宋麗君, 等. 肺癌患者不同治療階段癥狀群研究現狀. 世界科學技術-中醫藥現代化, 2020, 22(4): 926-930.Liu J, Zhou HL, Song LJ, et al. Situation and progress: Study on symptom clusters of lung cancer patients at different treatment stages. World Sci Technol-Mod Tradit Chin Med, 2020, 22(4): 926-930.
6. Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nurs, 2005, 28(4): 270-282.
7. 魏棟, 李錚, 宋翔. 肺癌癥狀群縱向研究英文文獻計量分析. 中國藥物與臨床, 2020, 20(13): 2263-2266.Wei D, Li Z, Song X. Bibliometric analysis of English literature on longitudinal studies of symptom clusters in lung cancer. Chin Remedies Clin, 2020, 20(13): 2263-2266.
8. 李京京. 基于不悅癥狀理論的圍手術期肺癌患者癥狀群及其與生活質量相關性的縱向研究. 安徽醫科大學, 2020.Li JJ. A longitudinal study on symptom cluster and its correlation with quality of life based on theory of unpleasant symptoms in perioperation patients with lung cancer. Anhui Medical University, 2020.
9. Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients. Cancer, 2000, 89(7): 1634-1646.
10. 臧瑜. 安德森癥狀評估量表肺癌模塊的修訂及肺癌患者癥狀群研究. 南方醫科大學, 2013.Zang Y. Revision of the lung cancer module of M. D. Anderson symptom inventory and symptom clusters in patients with lung cancer. Southern Medical University, 2013.
11. 李京京, 呂曉晴, 劉杉杉等. 圍手術期肺癌患者癥狀群與生活質量相關性的縱向研究. 中華護理雜志, 2020, 55(11): 1635-1641.Li JJ, Lyu XQ, Liu SS, et al. A longitudinal study on the correlations between symptom clusters and quality of life in patients with lung cancer during perioperation. Chin J Nurs, 2020, 55(11): 1635-1641.
12. 王建華, 袁聚祥, 高曉華, 主編. 預防醫學(第3版). 北京: 北京大學醫學出版社, 2013. 189.Wang JH, Yuan JX, Gao XH, eds. Preventive Medicine (3rd edition). Beijing: Peking University Medical Press, 2013. 189.
13. 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, 2013, 21(2): 475-483.
14. 吳雪梅. 人性化護理對老年肺癌并發慢性阻塞性肺疾病患者舒適度及負性心理的影響. 實用醫技雜志, 2019, 26(2): 240-241.Wu XM. The impact of humanized nursing on comfort and negative emotions in elderly lung cancer patients with chronic obstructive pulmonary disease. J Pract Med Tech, 2019, 26(2): 240-241.
15. 田夢白, 劉燕, 馬鳳艷, 等. 加速康復外科理念下肺癌胸腔鏡手術病人出院時癥狀群調查及影響因素分析. 全科護理, 2022, 20(29): 4058-4062.Tian MB, Liu Y, Ma FY, et al. Investigation and influencing factors analysis of symptom clusters in lung cancer patients undergoing thoracoscopic surgery at discharge under the concept of enhanced recovery after surgery. J Gen Pract Nurs, 2022, 20(29): 4058-4062.
16. 秦莉媛, 侯曉婷, 楊萍. 肺癌患者癥狀群的研究進展. 中華護理雜志, 2019, 54(1): 119-124.Qin LY, Hou XT, Yang P. Research progress on symptom clusters in lung cancer patients. Chin J Nurs, 2019, 54(1): 119-124.
17. Wong ML, Cooper BA, Paul SM, et al. Differences in symptom clusters identified using ratings of symptom occurrence vs. severity in lung cancer patients receiving chemotherapy. J Pain Symptom Manage, 2017, 54(2): 194-203.
18. 李春燕, 丁倩, 楊慧. 肺癌病人癥狀群縱向研究進展. 全科護理, 2022, 20(23): 3237-3240.Li CY, Ding Q, Yang H. Research progress on longitudinal studies of symptom clusters in lung cancer patients. J Gen Pract Nurs, 2022, 20(23): 3237-3240.
19. 馮競, 葛玲, 金鳳霞, 等. 肺癌手術患者出院期間癥狀群的調查研究. 河北醫藥, 2022, 44(8): 1252-1254, 1259.Feng J, Ge L, Jin FX, et al. A study on the symptom complex of patients with lung cancer during discharge from hospital. Hebei Med J, 2022, 44(8): 1252-1254, 1259.
20. Chow E, Fan G, Hadi S, et al. Symptom clusters in cancer patients with brain metastases. Clin Oncol (R Coll Radiol), 2008, 20(1): 76-82.
21. 項春雁, 侯春艷, 胥微, 等. 肺癌癌因性疲乏護理的研究現狀. 護理研究, 2017, 31(27): 3359-3361.Xiang CY, Hou CY, Xu W, et al. Research status quo of cancer related fatigue nursing for lung cancer patients. Chin Nurs Res, 2017, 31(27): 3359-3361.
22. 米雪, 張立力, 繆景霞. 基于指南的肺癌患者疲乏、疼痛、睡眠障礙癥狀群管理方案的應用及效果評價. 中國實用護理雜志, 2018, 34(25): 1947-1951.Mi X, Zhang LL, Miao JX. Application and effect evaluation of guideline-based symptom cluster management program of fatigue, pain, and sleep disturbance in patients with lung cancer. Chin J Pract Nurs, 2018, 34(25): 1947-1951.
23. Yorke J, Lloyd-Williams M, Smith J, et al. Management of the respiratory distress symptom cluster in lung cancer: A randomised controlled feasibility trial. Support Care Cancer, 2015, 23(11): 3373-3384.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative symptom clusters in patients with lung cancer: A longitudinal investigation

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