Abstract
ObjectivesAlthough studies shows that symptom clusters and illness perceptions are negatively associated with quality of life (QoL), it is unclear how these variables of cervical cancer patients who receive concurrent chemoradiotherapy (CCRT) relate to each other. This study aimed to identify the symptom clusters in cervical cancer patients who receive CCRT and evaluate the mediating effect of illness perceptions on the relationship between symptom clusters and QoL.MethodsA cross-sectional survey was conducted on 286 cervical cancer patients receiving CCRT from October 2019 to October 2020. M.D. Anderson Symptom Inventory, Brief Illness Perception Questionnaire, and Functional Assessment Cancer Therapy-Cervix were applied to investigate the symptom clusters, illness perceptions and QoL of the participants, respectively. Exploratory factor analysis was conducted to identify symptom clusters. The relationships among symptom clusters, illness perceptions, and QoL were analyzed with the structural equation modeling.ResultsA total of four symptom clusters were identified, including psychological status symptom cluster, therapy side-effect symptom cluster, sickness symptom cluster, and gastrointestinal symptom cluster (χ2 = 1,552.282, Df = 78, P < 0.001). Symptom clusters, illness perceptions, and QoL were significantly correlated. Symptom clusters had significant direct (β = −0.38, P < 0.001) and indirect effects (β = −0.21, P < 0.001) on QoL.ConclusionIllness perceptions played a significant mediating role between symptom clusters and QoL in cervical cancer patients receiving CCRT. Strategies like prompting effective symptom management for the purposes of alleviating illness perceptions may contribute to improving their QoL.
Highlights
According to the Global Cancer Statistics Report, there were an estimated 570,000 new cases and 311,000 deaths by cervical cancer in 2018 worldwide [1]
To the best of our knowledge, this is the first study to explore the relationship between symptom clusters and quality of life (QoL) through the mediating effect of illness perceptions in cervical cancer patients receiving concurrent chemoradiotherapy (CCRT) according to the CommonSense Model (CSM)
Our study demonstrated that symptom clusters were negatively associated with QoL, that was, greater symptom burden led to a poor QoL
Summary
According to the Global Cancer Statistics Report, there were an estimated 570,000 new cases and 311,000 deaths by cervical cancer in 2018 worldwide [1]. Advancements in early detection and treatment for cervical cancer have improved the overall survival rates of patients and some of them had even achieved the permanent survival phase [3, 4]. Survival is no longer the single purpose of treatment for cervical cancer, and quality of life (QoL) has become a substantial concern for long-term post-treatment life, which in turn would impact the outcomes of illness. National Comprehensive Cancer Network guidelines reported that 60% to 80% of patients with locally advanced cervical cancer can achieve satisfied medical outcomes through concurrent chemoradiotherapy (CCRT) [5]. The cervical cancer women who were undertaking CCRT would suffer more complications and side effects than those receiving surgery alone [6,7,8,9]. Most studies on cervical cancer placed their focus on the impact of certain single symptom rather than symptom clusters on QoL [11,12,13]
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