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Item n/mean ± SD Percentage (%) Sex Man 132 58.9 Woman 92 41.1 Age 64.22 ± 7.93 < 65 111 49.6 ≥ 65 113 50.4 Education level Primary school or below 72 32.1 Junior high school 81 36.2 Senior high school/
Technical secondary school50 22.3 Junior college or above 21 9.4 BMI < 18.5 38 17.0 18.5–23.9 145 64.7 ≥ 24 41 18.3 Primary caregiver Spouse 129 57.6 Parents 7 3.1 Children 88 39.3 Siblings 0 0 Smoking history Yes 46 20.5 No 178 79.5 Alcohol consumption history Yes 72 32.1 No 152 67.9 Comorbid chronic diseases history Yes 132 58.9 No 92 41.1 Tumor location Head/neck of pancreas 147 65.6 Body/tail of pancreas 77 34.4 AJCC Stage I 28 12.5 II 140 62.5 III 39 17.4 IV 17 7.6 Metastasis Yes 87 38.8 No 137 61.2 Time since diagnosis (months) 11.28 ± 11.28 ≤ 12 148 66.1 12–24 47 21.0 > 24 29 12.9 Chemotherapy cycles 3.84 ± 2.44 ≤ 3 113 50.4 4–6 77 34.4 > 6 34 15.2 KPS score 81.70 ± 7.97 70 55 24.6 80 76 33.9 90 93 41.5 NRS-2002 score 2.97 ± 1.43 < 3 92 41.1 ≥ 3 132 58.9 HbA1c (%) 6.67 ± 1.36 WBC (× 10⁹/L) 7.65 ± 5.95 Hb (g/L) 103.80 ± 20.16 Platelets (× 109/L) 252.30 ± 129.50 AST (U/L) 31.31 ± 21.67 Neutrophils (× 109/L) 5.55 ± 7.87 Table 1.
Sociodemographic and clinical characteristics of the participants (N = 224).
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Item Occurrence n (%) Frequency (mean ± SD) Severity (mean ± SD) Distress (mean ± SD) Difficulty concentrating 131 (58.5) 1.79 ± 1.72 1.59 ± 1.62 1.52 ± 1.67 Pain 135 (60.3) 1.54 ± 1.52 1.37 ± 1.45 1.16 ± 1.51 Lack of energy 158 (70.5) 2.26 ± 1.72 1.88 ± 1.60 1.72 ± 1.68 Cough 41 (18.3a) 0.33 ± 0.80 0.29 ± 0.77 0.21 ± 0.76 Nervousness 171 (76.3) 2.28 ± 1.58 2.05 ± 1.55 2.02 ± 1.57 Dry mouth 140 (62.5) 1.60 ± 1.47 1.52 ± 1.45 1.59 ± 1.55 Nausea 136 (60.7) 1.36 ± 1.34 1.69 ± 1.60 1.77 ± 1.68 Drowsiness 141 (62.9) 1.71 ± 1.65 1.52 ± 1.53 1.39 ± 1.60 Numbness and tingling in hands/feet 117 (52.2) 1.37 ± 1.57 1.17 ± 1.37 1.22 ± 1.49 Difficulty sleeping 131 (58.5) 1.63 ± 1.62 1.33 ± 1.49 1.30 ± 1.54 Abdominal distension 144 (64.3) 1.53 ± 1.44 1.25 ± 1.25 1.29 ± 1.37 Difficulty urinating 33 (14.7a) 0.32 ± 0.90 0.29 ± 0.84 0.22 ± 0.76 Vomiting 138 (61.6) 1.08 ± 1.05 1.66 ± 1.57 1.75 ± 1.66 Shortness of breath 36 (16.1a) 0.30 ± 0.75 0.33 ± 0.87 0.30 ± 0.87 Diarrhea 128 (57.1) 1.31 ± 1.39 1.33 ± 1.38 1.43 ± 1.54 Feeling sad 168 (75.0) 1.81 ± 1.38 1.92±1.54 1.89 ± 1.56 Sweating 38 (17.0a) 0.45 ± 1.07 0.38 ± 0.92 0.39 ± 0.99 Anxiety 169 (75.4) 2.24 ± 1.58 1.90 ± 1.51 1.87 ± 1.55 Loss of interest in sex/sexual difficulties 39 (17.4a) 0.24 ± 0.63 0.20 ± 0.46 0.12 ± 0.36 Itchy skin 128 (57.1) 0.92 ± 1.05 1.00 ± 1.13 0.94 ± 1.30 Lack of appetite 150 (67.0) 1.82 ± 1.56 1.76 ± 1.53 1.85 ± 1.60 Dizziness 40 (17.9a) 0.36 ± 0.86 0.36 ± 0.88 0.33 ± 0.90 Difficulty swallowing 40 (17.9a) 0.46 ± 1.06 0.42 ± 0.99 0.42 ± 1.05 Irritability 134 (59.8) 1.52 ± 1.58 1.45 ± 1.51 1.44 ± 1.54 Mouth ulcers 30 (13.4a) − 0.18 ± 0.50 0.18 ± 0.61 Changes in taste 136 (60.7) − 1.31±1.41 1.33 ± 1.47 Weight loss 39 (17.4a) − 0.24 ± 0.63 0.21 ± 0.68 Hair loss 130 (58.0) − 1.26 ± 1.37 1.42 ± 1.59 Constipation 39 (17.4a) − 0.33 ± 0.87 0.29 ± 0.80 Swelling in arms or legs 107 (47.8) − 1.05 ± 1.30 1.15 ± 1.45 Feeling 'I don't look like myself' 125 (55.8) − 1.04 ± 1.21 1.17 ± 1.44 Skin changes (hyperpigmentation) 42 (18.8a) − 0.33 ± 0.82 0.25 ± 0.82 '−' indicates that the frequency of the symptom was not assessed. a Symptoms with an occurrence rate < 20%. Table 2.
Symptom occurrence, frequency, severity, and distress in pancreatic cancer patients (N = 224).
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Symptom Factor loading Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Lack of appetite 0.932 −0.086 0.032 0.025 0.079 Nausea 0.912 −0.123 0.024 −0.056 0.131 Vomiting 0.884 −0.135 −0.003 −0.027 0.134 Dry mouth 0.828 −0.074 0.066 0.118 −0.033 Diarrhea 0.608 0.137 0.058 0.239 −0.019 Abdominal distension 0.569 0.181 0.008 0.247 −0.105 Feeling sad −0.007 0.928 0.128 0.066 −0.049 Anxiety −0.035 0.922 0.103 −0.002 −0.064 Nervousness 0.01 0.859 0.241 0.091 0.043 Irritability −0.093 0.721 0.009 −0.052 0.177 Drowsiness −0.024 0.157 0.897 0.095 −0.048 Difficulty concentrating −0.019 0.164 0.865 0.154 0.042 Lack of energy 0.013 0.122 0.85 −0.049 0.014 Changes in taste 0.394 −0.092 0.592 0.052 0.172 Difficulty sleeping 0.051 0.496 0.566 0.093 −0.24 Swelling in arms or legs 0.082 0.073 0.078 0.913 0.05 Numbness and tingling in hands/feet 0.136 0.111 0.114 0.868 0.094 Itchy skin 0.023 −0.09 0.078 0.724 0.333 Pain 0.157 −0.013 −0.005 0.626 −0.256 Feeling 'I don't look like myself' 0.071 0.155 0.021 0.121 0.859 Hair loss 0.082 −0.066 −0.003 0.012 0.851 Eigenvalue 4.776 4.261 2.309 2.068 1.733 Percentage of variance (%) 19.479 16.394 14.593 12.931 8.731 Cumulative percentage of variance (%) 19.479 35.873 50.467 63.397 72.129 Cronbach's α 0.892 0.898 0.846 0.807 0.760 A factor loading of 0.40 was used as the cutoff criterion. Rotation converged in five iterations. Bold values indicate factor loadings with an absolute value ≥ 0.40, which was the prespecified cutoff for symptom-cluster assignment. Table 3.
Symptom clusters in patients with pancreatic cancer based on severity.
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Item Gastrointestinal
SCs (mean ± SD)Psychological SCs
(mean ± SD)Physiological energy
depletion SCs (mean ± SD)Neuromuscular
SCs (mean ± SD)Body image disturbance
SCs (mean ± SD)Sex Man 1.56 ± 1.20 1.89 ± 1.31 1.47 ± 1.22 1.21 ± 1.05 1.13 ± 1.12 Woman 1.50 ± 1.17 1.74 ± 1.38 1.60 ± 1.19 1.06 ± 1.05 1.18 ± 1.21 Test statistic 0.346a 0.830a −0.768a 1.013a −0.293a p value 0.730 0.407 0.443 0.312 0.770 Age < 65 1.57 ± 1.14 1.65 ± 1.34 1.49 ± 1.18 1.28 ± 1.08 1.11 ± 1.18 ≥ 65 1.51 ± 1.23 2.00 ± 1.32 1.56 ± 1.24 1.02 ± 1.00 1.19 ± 1.14 Test statistic 0.389a −1.977a −0.440a 1.882a −0.501a p value 0.697 0.049* 0.660 0.061 0.617 Education level Primary school or below 1.59 ± 1.19 1.93 ± 1.37 1.52 ± 1.15 1.25 ± 1.14 1.39 ± 1.27 Junior high school 1.61 ± 1.16 1.84 ± 1.34 1.47 ± 1.17 1.12 ± 1.04 1.35 ± 1.11 Senior high school/
technical secondary school1.43 ± 1.23 1.81 ± 1.35 1.64 ± 1.36 1.08 ± 0.96 0.81 ± 1.04 Junior college or above 1.32 ± 1.20 1.50 ± 1.26 1.50 ± 1.23 1.05 ± 0.95 0.38 ± 0.65 Test statistic 0.527b 0.564b 0.205b 0.394b 6.861b p value 0.664 0.639 0.893 0.757 < 0.001**† BMI < 18.5 1.71 ± 1.09 2.02 ± 1.41 1.69 ± 1.25 1.03 ± 0.88 1.20 ± 1.19 18.5−23.9 1.49 ± 1.22 1.79 ± 1.28 1.44 ± 1.17 1.13 ± 1.07 1.21 ± 1.17 ≥ 24 1.56 ± 1.16 1.80 ± 1.48 1.68 ± 1.30 1.32 ± 1.10 0.89 ± 1.08 Test statistic 0.534b 0.468b 1.080b 0.787b 1.285b p value 0.587 0.627 0.341 0.456 0.279 Primary caregiver Spouse 1.61 ± 1.16 1.87 ± 1.30 1.60 ± 1.15 1.11 ± 0.95 1.37 ± 1.23 Parents 1.55 ± 1.37 1.86 ± 1.57 1.17 ± 1.63 1.57 ± 1.30 0.79 ± 1.32 Children 1.42 ± 1.21 1.77 ± 1.39 1.44 ± 1.25 1.17 ± 1.16 0.86 ± 0.97 Siblings 0 0 0 0 0 Test statistic 0.682b 0.150b 0.763b 0.684b 5.746b p value 0.506 0.861 0.467 0.506 0.004* Smoking history Yes 1.64 ± 1.13 2.22 ± 1.35 2.09 ± 1.30 1.30 ± 1.09 1.02 ± 1.06 No 1.51 ± 1.20 1.73 ± 1.32 1.38 ± 1.14 1.11 ± 1.04 1.19 ± 1.18 Test statistic −0.673a −2.265a −3.639a −1.143a 0.853a p value 0.501 0.024* < 0.001**† 0.254 0.394 Alcohol consumption
historyYes 1.56 ± 1.19 1.94 ± 1.37 1.67 ± 1.24 1.68 ± 1.14 1.07 ± 1.18 No 1.53 ± 1.18 1.78 ± 1.33 1.46 ± 1.19 0.90 ± 0.90 1.19 ± 1.15 Test statistic −0.166a −0.841a −1.229a −5.134a 0.731a p value 0.868 0.401 0.220 < 0.001**† 0.465 Comorbid chronic diseases history Yes 1.54 ± 1.21 1.99 ± 1.34 1.81 ± 1.23 1.19 ± 1.05 1.10 ± 1.13 No 1.53 ± 1.16 1.59 ± 1.31 1.13 ± 1.05 1.09 ± 1.04 1.23 ± 1.20 Test statistic −0.060a −2.246a −4.430a −0.688a 0.883a p value 0.952 0.026* < 0.001**† 0.492 0.378 Tumor location Head/neck of pancreas 1.47 ± 1.20 2.00 ± 1.33 1.51 ± 1.20 1.16 ± 1.04 1.08 ± 1.11 Body/tail of pancreas 1.66 ± 1.15 1.50 ± 1.30 1.56 ± 1.23 1.12 ± 1.07 1.29 ± 1.24 Test statistic −1.113a 2.665a −0.292a 0.247a −1.315a p value 0.267 0.008* 0.771 0.805 0.190 AJCC stage I 1.69 ± 1.23 1.58 ± 1.37 1.50 ± 1.21 1.25 ± 1.18 1.23 ± 1.09 II 1.51 ± 1.14 1.67 ± 1.27 1.54 ± 1.22 1.13 ± 1.04 1.15 ± 1.19 III 1.58 ± 1.22 2.49 ± 1.29 1.74 ± 1.26 1.35 ± 1.06 1.06 ± 1.11 IV 1.36 ± 1.42 2.04 ± 1.57 0.98 ± 0.80 0.65 ± 0.72 1.21 ± 1.15 Test statistic 0.312b 4.576b 1.606b 1.888b 0.130b p value 0.816 0.004* 0.189 0.133 0.942 Metastasis Yes 1.51 ± 1.18 1.73 ± 1.31 1.45 ± 1.16 0.99 ± 0.96 1.21 ± 1.21 No 1.55 ± 1.19 1.89 ± 1.36 1.57 ± 1.23 1.25 ± 1.09 1.12 ± 1.13 Test statistic 0.251a 0.849a 0.745a 1.820a −0.566a p value 0.802 0.397 0.457 0.070 0.572 Time since diagnosis (months) ≤ 12 1.26 ± 1.15 1.82 ± 1.35 1.48 ± 1.19 1.13 ± 1.03 1.07 ± 1.11 12–24 1.82 ± 1.07 1.81 ± 1.36 1.56 ± 1.25 1.02 ± 0.97 1.09 ± 1.07 > 24 2.51 ± 0.87 1.91 ± 1.29 1.71 ± 1.22 1.47 ± 1.21 1.66 ± 1.45 Test statistic 17.737b 0.055b 0.462b 1.833b 3.208b p value < 0.001**† 0.947 0.630 0.162 0.042* Chemotherapy cycles ≤ 3 0.94 ± 1.03 1.62 ± 1.26 1.33 ± 1.12 0.95 ± 0.98 1.07 ± 1.08 4−6 1.99 ± 1.01 2.03 ± 1.40 1.79 ± 1.26 1.31 ± 1.05 1.13 ± 1.19 > 6 2.49 ± 0.96 2.07 ± 1.38 1.57 ± 1.26 1.43 ± 1.14 1.49 ± 1.31 Chemotherapy cycles Test statistic 41.946b 2.886b 3.391b 4.473b 1.741b p value < 0.001**† 0.058 0.035* 0.012* 0.178 KPS score Test statistic 0.097c −0.162c −0.275c 0.030c 0.025c p value 0.147 0.015* < 0.001**† 0.651 0.705 NRS-2002 score Test statistic 0.229c −0.042c 0.020c 0.166c 0.025c p value < 0.001**† 0.530 0.770 0.013* 0.705 HbA1c (%) Test statistic 0.030c 0.045c 0.058c −0.027c 0.025c p value 0.651 0.501 0.388 0.688 0.712 WBC (× 10⁹/L) Test statistic 0.023c −0.118c −0.051c 0.061c −0.004c p value 0.737 0.079 0.452 0.362 0.958 Hb (g/L) Test statistic 0.014c 0.020c −0.048c 0.082c −0.032c p value 0.840 0.768 0.473 0.222 0.633 AST (U/L) Test statistic 0.223c 0.066c −0.014c 0.152c −0.032c p value < 0.001**† 0.324 0.835 0.023* 0.634 Neutrophils (× 10⁹/L) Test statistic 0.014c −0.138c −0.045c 0.007c 0.017c p value 0.831 0.040* 0.502 0.919 0.803 a t-value, b F-value, c correlation coefficient r. Unadjusted univariate analysis: * p < 0.05, ** p < 0.001. †: significant after Bonferroni correction for multiple comparisons within each cluster (adjusted α = 0.05/20 = 0.0025). For reference only; variable selection for the regression models used unadjusted p < 0.05. Table 4.
Univariate analysis for symptom clusters in patients with pancreatic cancer (N = 224).
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Variable B SE β t P Tolerance VIF Gastrointestinal symptom cluster Constant −0.728 0.225 − −3.234 0.001 − − Chemotherapy cycles 0.636 0.094 0.393 6.772 < 0.001 0.866 1.155 Time since diagnosis 0.440 0.093 0.266 4.730 < 0.001 0.925 1.081 NRS-2002 0.121 0.046 0.147 2.665 0.008 0.958 1.044 AST 0.007 0.003 0.123 2.224 0.027 0.953 1.049 Psychological symptom cluster Constant 3.511 0.978 − 3.589 < 0.001 − − AJCC stage 0.276 0.115 0.155 2.405 0.017 0.985 1.015 Tumor location −0.505 0.182 −0.180 −2.778 0.006 0.975 1.025 Comorbid chronic diseases history 0.455 0.175 0.168 2.602 0.010 0.981 1.019 KPS score −0.023 0.011 −0.137 −2.134 0.034 0.991 1.010 Physiological energy depletion symptom cluster Constant 3.889 0.788 − 4.936 < 0.001 − − Comorbid chronic diseases history 0.622 0.150 0.254 4.147 < 0.001 0.994 1.006 KPS score −0.035 0.009 −0.230 −3.694 < 0.001 0.967 1.034 Smoking history 0.535 0.185 0.180 2.887 0.004 0.965 1.036 Neuromuscular symptom cluster Constant 0.215 0.196 − 1.097 0.274 − − Alcohol consumption history 0.785 0.137 0.351 5.739 < 0.001 0.998 1.002 Chemotherapy cycles 0.251 0.089 0.175 2.820 0.005 0.967 1.034 NRS-2002 0.090 0.045 0.123 1.972 0.050 0.966 1.035 Body image disturbance symptom cluster Constant 2.088 0.278 − 7.514 < 0.001 − − Education level −0.345 0.076 −0.285 −4.561 < 0.001 0.992 1.008 Primary caregiver −0.283 0.075 −0.237 −3.784 < 0.001 0.992 1.008 Time since diagnosis 0.204 0.101 0.126 2.015 0.045 0.998 1.002 Model: Gastrointestinal symptom cluster: D-W = 1.989, R2 = 0.362, adjusted R2 = 0.350. Psychological symptom cluster: D-W = 1.901, R2 = 0.107, adjusted R2 = 0.090. Physiological energy depletion symptom cluster: D-W = 1.857, R2 = 0.176, adjusted R2 = 0.165. Neuromuscular symptom cluster: D-W = 2.082, R2 = 0.177, adjusted R2 = 0.166. Body image disturbance symptom cluster: D-W = 1.883, R2 = 0.146, adjusted R2 = 0.134. Table 5.
Multiple linear regression for symptom clusters (N = 224).
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