Unit:
Department of NursingLibrary of the School of Health Sciences
Dissertation committee:
Πατηράκη Ελισάβετ, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Μπούμπας Δημήτριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σταματάκης Αντώνιος, Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Τσιόδρας Σωτήριος, Καθηγητής, Καθηγητής, Τμήμα Ιατρικής, ΕΚΠΑ
Αντωνιάδου Αναστασία, Καθηγήτρια, Τμήμα Ιατρικής, ΕΚΠΑ
Γιαννακοπούλου Μαργαρίτα, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Κατσαραγάκης Στυλιανός, Αναπληρωτής Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Original Title:
Συμπλέγματα Συμπτωμάτων (ΣΣ) ασθενών με καρκίνο παχέος εντέρου: Μελέτη των προσδιοριστών της βιωμένης εμπειρίας τους
Translated title:
Symptom Clusters (SCs) patients with colorectal cancer: A stydy of determinants of their lived experience
Summary:
Background: Cancer patients experience a large number of co-occurring symptoms. The concept of the Symptom Complex (SC) has clarified synergistic relationships between symptoms and underlying biological mechanisms. The relevant studies are quantitative. It is worth investigating whether a qualitative method can be used to identify a patient's SS, and the relationship of SS with markers of inflammation.
Purpose: The objectives of the present study were: 1) Identification of multiple symptoms that occur simultaneously and organized in SC, with a quantitative and qualitative method, 2) Investigation of the determinants that influence the experience of symptoms, 3) Investigation of the relationship between the severity of the symptoms of a SC with laboratory markers of inflammation.
Method: The study is cross-sectional mixed methodology. Sampling was purposive, involving quantitative data of 64 outpatients under chemotherapy with a documented diagnosis of colorectal cancer. A blood sample was taken in the first and fourth cycles of chemotherapy before the administration of cytostatic drugs, to measure CRP, cytokines (IL-6, IL-8, IL17A, TGFβ), oxytocin and white blood cells (neutrophils-lymphocytes). Patients completed two questionnaires (System of Beliefs Inventory _SBR-15 and Life Orientation Test Revised _LOT-R), to assess religiosity and optimism respectively. The evaluation of symptoms was done in the fourth cycle of HCV, with the MD Anderson Symptom Inventory (MDASI) scale. Twenty-three (23) of the 64 patients agreed to give a semi-structured interview. The statistical package SPSS 22 was used for the identification of SCs and determinants of the experience, and as methods correlation test, principal component analysis and cluster analysis. The analysis of the qualitative data followed the interpretive phenomenological approach.
Results: Prevalence and severity data of 14 symptoms were used to identify SCs by principal component analysis and cluster analysis. The same number of SCs was recognized with a slight variation of the composition. The SCs identified by principal component analysis (PCA) using the severity data were: 1) Vomit-nausea-xerostomia-anorexia, 2) Sadness-anxiety, 3) Peripheral neuropathy-sleep disturbance-memory problems and 4) Drowsiness-fatigue- pain. Cluster analysis for differences in symptom severity between patients distinguished three groups of patients with different symptom profiles. There were differences between patients with severe disease and patients with mild disease, in terms of cytokine concentration and individual and clinical characteristics. Principal component analysis and correlation testing confirmed that age was the most important determinant of S composition. The analysis of quantitative and qualitative data elucidated the importance of the SC sadness-anxiety for the experience of patients with colorectal cancer. There was a correlation between inflammatory markers and symptoms' severity. IL-17A was associated with fatigue-memory problem, TGFβ with dry mouth while oxytoxin had a positive association with symptom pair peripheral neuropathy-sleep disturbance and a negative association with SC sadness- anxiety. The cytokine IL-8 was not associated with symptoms' severity, but with a high tumor burden. Patients during interviews described associations between symptoms. They described nuclear symptoms common to those of quantitative analysis. SCs were identified for each patient, based on correlations between symptoms and time of onset. Interpretive phenomenological analysis revealed the following categories of themes: symbolic language, self-transcendence, cancer meaning-making, coping mechanisms, suffering, and symptoms' impact.
Significance of the study - limitations: The present study is a first attempt to study the relationships between symptoms in the Greek cancer population, using the Symptom Cluster as a tool. The main limitation of the study was the organization of SCs with different criteria in the quantitative and the qualitative approach which makes the comparison of SCs difficult.
Conclusion: Despite the identification of SCs with different criteria in the quantitative and qualitative part of the study, the most frequent and stable SC is the sadness-anxiety pair. The negative association between optimism and this symptom cluster advocates for the design of cognitive nursing interventions targeting the cluster, to reduce the distress of all symptoms. Related studies had positive results. The negative association of sadness-anxiety with oxytocin is consistent with recent data for the association of the hormone with neuropsychiatric disorders, as a result of its central action in the CNS. There is correlation of cytokines with symptom severity eg TGFβ-xerostomia, IL17A with fatigue-memory problems. The value of measuring inflammatory markers prior to initiation of chemotherapy to predict symptoms needs to be further investigated. The initial measurement of IL-8 is indicative of the extent of the disease and may be used as diagnostic biomarker.
Main subject category:
Health Sciences
Keywords:
Symptom clusters, Colorectal cancer, Bioindicators
Number of references:
430
File:
File access is restricted until 2024-06-05.
Fytrou-Helen-thesis.pdf
1 MB
File access is restricted until 2024-06-05.
