Abstract
PurposeTo explore how symptom perception affects functioning in patients with advanced cancer.Materials and methodsWe conducted a cross-sectional observational study of 459 advanced cancer patients at the national cancer center. Functioning was assessed using the World Health Organization Disability Assessment Schedule (WHODAS) II, and symptoms were evaluated using the Memorial Symptom Assessment Scale-Short Form. Confirmatory factor analysis was conducted to develop a structural model based on different symptom perceptions, such as somatic sensation and experienced symptoms.ResultsThe structural model of disability revealed a significant direct pathway involving somatic sensation (β = 16.11, p < 0.001). Experienced symptoms significantly affected somatic sensations (β = 0.717, p < 0.001) but were not directly associated with disability. Unidimensional models exhibited a poor fit. In contrast, a complex model with first-order (somatic sensation) and second-order (experienced symptoms) factors provided an excellent fit, with comparative fit indexes (CFIs) and Tucker Lewis indexes (TLI) of more than 0.950 threshold.ConclusionsOur findings suggest that relationships to functioning may vary between somatic sensations versus experienced symptoms. The structure of symptoms is best conceptualized by direct somatic sensation and indirect experienced symptoms. A better understanding of symptom perception and the relationship between symptoms and function would facilitate the development of effective rehabilitation programs.
Highlights
Advanced cancer patients are burdened with both cancer and cancer treatment-related morbidities
Our findings suggest that relationships to functioning may vary between somatic sensations versus experienced symptoms
The structure of symptoms is best conceptualized by direct somatic sensation and indirect experienced symptoms
Summary
Advanced cancer patients are burdened with both cancer and cancer treatment-related morbidities. Severe disease-related symptoms include nausea, pain, fatigue, lack of energy, and sleep disorders. Chemotherapy-related side effects such as anorexia, nausea, and peripheral neuropathy restrict physical activity. Patients experience progressively poorer physical function, reduced mobility, and severe restriction of the activities of daily living [1]. The presence of multiple symptoms in patients with advanced cancer [2, 3] may significantly impact functioning [4,5,6,7] and quality of life [8,9,10]. All clinicians involved in the care of patients with cancer should be competent in the assessment and management of symptoms [11]
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