Symptom Clusters, Fear of Disease Progression and Quality of Life in Gastric Cancer Patients: A Cross-Sectional Study

Abstract

Purpose Although gastric cancer is one of the most common tumors worldwide, little is known about the symptom clusters, fear of disease progression, and quality of life in this population. The objectives were to identify the symptom clusters, fear of disease progression, and quality of life in gastric cancer patients, to explore the correlation between the symptom clusters, fear of disease progression, and quality of life, and to explore the effects of quality of life. Methods Gastric cancer patients were recruited. Data were collected using the self-designed General Information Evaluation Form, the M.D. Anderson Symptom Inventory-Gastrointestinal Cancer Module (MDASI-GI), the Fear of Progression Questionnaire-Short Form, and the Functional Assessment of Cancer Therapy-General (FACT-G). Data were recorded and analyzed using EpiData 3.1 and SPSS 25.0 respectively. The symptom clusters were extracted through the exploratory factor analysis. Univariate analysis was performed by t-test or one-way analysis of variance to demonstrate differences between or among quality of life (QoL) based on patients’ characteristics. Correlation among symptom clusters, fear of disease progression, and quality of life of gastric cancer patients were identified using Pearson correlation analysis. The affecting factors of QoL were identified using multiple linear regression analysis. Results A total of 203 subjects from one medical center were enrolled. Three factors were identified in this exploratory factor analysis based on symptom prevalence and named as emotional-sickness symptom cluster, energy deficiency symptom cluster, and digestive tract symptom cluster. The total score of fear of disease progression in gastric cancer patients was 37.80 ± 6.66 and the mean quality of life score in gastric cancer patients was 52.34 ± 10.61. One-way ANOVA showed that quality of life was affected by gender, age, marital status, first diagnosis, presence of complications, average monthly household income, cancer stages, and physical status (all p < 0.05). The total score of symptom clusters of gastric cancer patients was significantly correlated with both fear of disease progression and quality of life (p < 0.01). Fear of disease progression correlated with quality of life (p < 0.05). Multiple linear regression analysis showed that patients with high physical status scores and higher severity of symptom clusters had lower quality of life (R2 = 37.5%)。 Conclusion Three symptom clusters were identified in gastric cancer patients in mainland China. Fear of disease progression in gastric cancer patients was at a medium-high level, and the quality of life was at a medium level. The high incidence of symptoms in patients with gastric cancer was fatigue, pain, and worry. Clinical staff can take targeted measures to intervene and improve the symptom experiences in gastric cancer patients. Demographic factors, such as gender, age, marital status, first diagnosis, presence of complications, average monthly household income, cancer stage, and physical state, affect the quality of life in gastric cancer patients. Symptom clusters and fear of disease progression affect the quality of life. However, physical state and symptom clusters are important factors affecting quality of life. Based on our findings, clinical interventions are expected to improve the quality of life of gastric cancer patients.