Symptom experience of patients with lung cancer in mainland China : adjustment to newly initiated treatments

Abstract

Symptom experience in cancer remains poorly understood from a psychological point of view. This thesis had the following objectives; Objectives: (1) To describe the symptom experience of Chinese patients with lung cancer, (2) to explore factors associated with symptom experience, particularly psychological, demographic and clinical factors, (3) to determine the nature of the mediation role of self-efficacy and illness perception in associations between physical symptom distress and health outcomes (depression, anxiety and global health status). Methods: Two-phase research projects were designed to address the objectives. Phase I comprised a qualitative study of 34 Mandarin-speaking lung cancer patients aged >18 years old recruited from Beijing University Cancer Hospital. Phase II involved quantitative study consisting of 236 lung cancer patients from the same hospital. All were awaiting Chemotherapy when recruited. Three sub-studies were based on this sample. Study IIa was a cross-sectional analysis of data from baseline interviews. Study IIb was a longitudinal study of 116 chemo-naive patients before hospitalization. Study IIc was a longitudinal study basing on 164 patients who managed to provide daily symptom reports during in hospital days. Analysis and Findings: Phase I: The phenomenological study was performed to describe the symptom experience of these patients. Their major concerns involved lung cancer as a life-threatening disease, challenge of chemotherapy including symptoms, and disrupted life with lung cancer. Phase IIa: This cross-sectional sample described symptom experience and associated covariates, including age, gender, diagnosis, stage, religion, and smoking history. The impact of symptom experience on health outcomes was also examined by serial mediation analysis. Illness perception and both cancer coping and symptom management self-efficacy mediated associations between physical symptom distress and health outcomes (Global health status, anxiety, and depression). Mediation models with two mediators were also tested. Indirect effects through Illness perception and both coping and symptom management self-efficacies was tested between physical symptom distress and health outcomes. Phase IIb: Four longitudinal interviews described patient symptom experience across four chemotherapy cycles. Longitudinal mediation modeling was applied to the data from the first three time points. Illness perception at T2 didn’t mediate the relationship between Physical symptom distress at T1 and Anxiety at T3. The other models were not fit. Phase IIc: Daily symptoms, including pain, fatigue, emotional disturbance, sleep disturbance, and nausea were modeled using Latent Growth Curve Analysis to explore individual trajectories of daily symptom severity and factors related to symptom severity. Emotional disturbance and nausea didn’t yield converged models with unconditional modeling. Individual variability of symptom trajectories of pain and fatigue was observed. Sleep disturbance was primarily due to impacts from psychological factors while the pain was largely attributable to disease type and stage. Conclusion: The studies described the symptom experience of patients with lung cancer in China and explored the psychological mechanism underpinning illness perception and self-efficacy. The finding of this study will be helpful for designing psychological and clinical intervention for Chinese patients with Lung cancer.