癌症病患之症狀群集

Symptom Clusters in Cancer Patients

癌症病患常經驗到相當多的症狀，這些症狀可能單獨或甚至是一起影響病患的感受。因此近十幾年來，許多學者開始致力於症狀群集的研究。本文的目的是在整理癌症症狀群集的現況，並提供未來臨床照護及研究的方向。目前症狀群集的定義是指由兩個或以上症狀所組成，且症狀彼此間有相關性。研究方式主要分成三類：(1)以過去的研究或經驗，找出一些經常同時發生或相關連的症狀，將這幾個症狀視為一個症狀群集；(2)利用統計方式找出不同的症狀群集；及(3)依症狀群集，找尋有相同症狀表現的病患群。此外，在動物試驗中發現的“不適行為＂與癌症所引發的症狀相似，故有學者假設這樣的病因學存在。目前研究發現某些病患特性傾向有較嚴重的症狀群集，且症狀群集可能會對病患造成負面的影響。處理策略上，有學者提出利用症狀重疊的關係及阻斷生理機制這兩種方式來處置。在症狀群集的研究上，本文也討論了一些仍待解決的議題。

Cancer patients often experience multiple symptoms simultaneously. These symptoms can, either individually or jointly, exert significant impacts on patients' lives. Recently, the focus of symptom research has shifted from individual symptoms to symptom clusters. The purposes of the current paper are to review the studies on symptom clusters and to provide suggestions for clinical practice and research. The symptom cluster has been defined as two or more symptoms that are correlated. Research on symptom clusters can be classified into three types. The first type usually identifies, on the basis of researchers' experience or previous studies, a single symptom cluster containing three to four correlated symptoms. The second type focuses on using statistical methods to identify multiple symptom clusters. The third type uses statistical methods to classify patients in accordance with their symptom profiles. The sickness behaviors induced by pro-inflammatory cytokines found in animal studies have been reported to be similar to symptoms experienced by cancer patients. This finding suggests a common etiology for cancer symptom clusters. Studies have identified some patient factors that correlate with the severity of symptom clusters, and have reported that some symptom clusters may exert a negative effect on the patient. The literature suggests two approaches to managing symptom clusters: utilizing the phenomenon of symptom overlap or utilizing potentially common physiological mechanisms. This paper also discusses unresolved issues in symptom cluster research.