摘要
目的分析肺癌患者免疫治疗期间呼吸道症状的变化轨迹及影响因素。方法采用前瞻性纵向研究设计,于2022年3月-2023年3月纳入复旦大学附属肿瘤医院114例首次免疫治疗的肺癌患者为研究对象。使用PRO-CTCAE量表中呼吸道症状条目分别在首次用药前以及用药后第1周、第2周、第3周、第6周、第9周、第12周、第15周、第18周、第21周、第24周收集患者的症状数据。根据改良动态症状模型,在首次用药前收集患者一般资料、自我护理能力、社会支持、焦虑抑郁和生活方式等影响因素。采用增长混合模型、logistic回归分析识别患者呼吸道症状的轨迹类别及其影响因素。结果识别出肺癌免疫治疗患者的咳嗽和呼吸急促均有3条变化轨迹,分别命名为“中度咳嗽缓解-加重组”“轻度咳嗽缓解组”“轻度咳嗽维持组”“轻中度呼吸急促缓解组”“轻度呼吸急促加重组”“极轻度呼吸急促维持组”。logistic回归分析结果显示:远处转移是咳嗽轨迹类别的影响因素(OR=0.065,P=0.010),中性粒细胞与淋巴细胞比值(OR=1.458,P=0.003)是呼吸急促轨迹类别的影响因素。结论肺癌免疫治疗患者在用药后24周内咳嗽和呼吸急促以轻度维持为主,不同的变化轨迹存在一定的群体异质性,医护人员可根据症状变化轨迹寻找可干预的时间点,并通过影响因素识别重点人群,有助于开展呼吸道症状管理的早期干预。
Objective To analyze the change trajectories of respiratory symptoms and their influencing factors during immunotherapy in lung cancer patients.Methods A prospective longitudinal study was designed.From March 2022 to March 2023,114 lung cancer patients who received the first immunotherapy in Fudan University Shanghai Cancer Center were selected as the research subjects.The symptom data of patients were collected before the first dose and 1,2,3,6,9,12,15,18,21,and 24 weeks after the first medication by using the respiratory symptom items from the PRO-CTCAE.According to the revised dynamic symptoms model,the patient's general information,self-care ability,social support,anxiety and depression,and lifestyle factors were collected before the first dose.The growth mixture model and logistic regression analysis were used to identify the trajectory categories of patients'respiratory symptoms and their influencing factors.Results The cough and shortness of breath in patients with immunotherapy for lung cancer were identified with three change trajectories,which were named"moderate cough relief-aggravation group","mild cough relief group","mild cough maintenance group","mild to moderate tachypnea remission group","mild tachypnea aggravation group",and"very mild tachypnea maintenance group".The results of logistic regression analysis showed that distant metastasis(OR=0.065,P=0.010)was the influencing factor of cough trajectory and neutrophil-to-lymphocyte ratio(OR=1.458,P=0.003)was the influencing factor of tachypnea trajectory.Conclusion Cough and shortness of breath in patients with lung cancer immunotherapy are mainly mildly maintained within 24 weeks after medication.There is certain group heterogeneity in different change trajectories.Healthcare professionals can find the time points that can be intervened according to the trajectory of symptoms,and identify key groups through influencing factors,which is helpful to carry out early intervention in the management of respiratory symptoms.
作者
彭娜娜
陆箴琦
陈凤珍
张晓菊
PENG Nana;LU Zhenqi;CHEN Fengzhen;ZHANG Xiaoju(Department of Nursing,Fudan University Shanghai Cancer Center&Department of Oncology,Shanghai Medical College Fudan University,Shanghai 200032,China)
出处
《护士进修杂志》
2023年第24期2262-2269,共8页
Journal of Nurses Training
基金
国家自然科学基金青年科学基金项目(编号:72004031)。
关键词
肺肿瘤
免疫治疗
咳嗽
呼吸急促
症状轨迹
增长混合模型
lung neoplasms
immunotherapy
cough
shortness of breath
symptom trajectory
growth mixture model
