title: Symptoms and quality of life of advanced cancer patients at home: a cross-sectional study in Shanghai, China.
abstract: OBJECTIVE
  The aims of this study were to assess the quality of life (QOL), symptom prevalence, and symptom severity of advanced cancer patients at home in Shanghai, China, to evaluate the impact of demographic, clinical, and socioeconomic factors on the QOL of the patients, to explore the cut-point for QOL, and to examine the possible roles of symptom assessment in relation to QOL.
  
  
  METHODS
  A cross-sectional survey was completed with a convenient sample of 201 patients from five community health service centers in Shanghai, China. Measures used included the Functional Assessment of Cancer Therapy-General Scale (FACT-G) and the M. D. Anderson Symptom Inventory. Univariate and multivariate analyses were performed to determine the relating factors of QOL; two-step cluster analysis was conducted to explore a cut-point for QOL and identify patient subgroups, and Spearman correlations were utilized to examine correlations between symptoms and QOL.
  
  
  RESULTS
  The mean score of quality of life was 62.2 ± 16.8. Three explanatory variables (KPS, cancer site, and cleanliness of households) explained 46.9% of the variance of the FACT-G total score regression model. The FACT-G total score of 60 was a cut-point to identify two patient subgroups as the lower- and higher-QOL subgroups (46.18 ± 8.91 and 74.50 ± 9.43, respectively). The most prevalent (88.6%) and severe (4.192.81) symptom was fatigue. The score of each symptom and the sum score of 13 symptoms were negatively correlated with the FACT-G total score (P < 0.05), and psychological symptoms such as distress (correlation coefficient = -0.645, P < 0.000) and sadness (correlation coefficient = -0.640, P < 0.000) were the most significant factors related to QOL.
  
  
  CONCLUSIONS
  The patients had relatively poorer QOL as compared with the US and Australian general populations. The factors related to QOL need to be considered in the palliative care of Chinese advanced cancer patients at home. QOL improvement can be achieved to some extent by effective symptom management, especially by alleviating emotional distress. The cut-point for QOL was statistically significant, and further studies are needed to define a clinically meaningful cut-point.
authors.affiliation: School of Nursing, Second Military Medical University, No. 800, Xiangyin Road, Shanghai, 200433, People's Republic of China.
authors.forename: Yixin
authors.initials: Y
authors.lastname: Wang
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.forename: Yan
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000473:pathology / Q000523:psychology*; D010166:Palliative Care / Q000379:methods*; D011594:Psychometrics; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000209:etiology