肺癌化疗患者住院期间体力活动水平和症状群的相关性分析

doi:10.19983/j.issn.2096-8493.2024048

摘要/Abstract

摘要：

目的: 了解肺癌化疗患者的运动意愿及体力活动水平,并分析患者体力活动水平与症状群的相关性。方法: 2022年6—8月,采用一般资料调查表、国际体力活动问卷、中文版安德森症状评估量表、修订版肺癌特异性症状模块对上海市肺科医院住院的232例肺癌化疗患者进行横断面调查。共回收有效问卷229份,有效回收率为98.71%。采用探索性因子分析提取症状群的种类,通过Spearman秩相关分析探讨体力活动水平与症状群的关系。结果: 调查显示,肺癌化疗患者存在6个症状群,分别为:呼吸道症状群、睡眠相关症状群、心理症状群、消化道症状群、肺癌特异性症状群和恶病质症状群。中强度体力活动水平与心理症状群及恶病质症状群呈负相关(r=-0.153、-0.159,P值均<0.05);步行体力活动水平与呼吸道症状群、睡眠相关症状群、心理症状群及肺癌特异性症状群呈负相关(r=-0.257、-0.222、-0.284、-0.181, P值均<0.05);总体力活动水平与呼吸道症状群、睡眠相关症状群、心理症状群及恶病质症状群呈负相关(r=-0.252、-0.218、-0.304、-0.132, P值均<0.05)。结论: 肺癌化疗患者的体力活动水平与症状群呈负相关,体力活动水平高的患者其症状群负担较轻,建议根据患者的体力活动水平及症状负担进行个性化运动处方设计,健康教育和运动指导,提高患者体力活动水平,从而减轻症状负担。

关键词: 肺肿瘤, 物理治疗技术, 运动, 康复护理

Abstract:

Objective: Investigate the patients’ willingness to engage in exercise and level of physical activity with patients with lung cancer undergoing chemotherapy, and analyze the correlation between their physical activity level and symptom clusters. Methods: A cross-sectional survey was conducted from June to August 2022 among 232 lung cancer chemotherapy patients hospitalized at the Department of Respiratory Medicine, Shanghai Pulmonary Hospital, using a general questionnaire, the International Physical Activity Questionnaire (IPAQ), the revised version of the lung cancer module of the M.D. Anderson Symptom Inventory (MDASI-LC). A total of 229 valid questionnaires were collected, with an effective recovery rate of 98.71%. Exploratory factor analysis was employed to identify the categories of symptom clusters, and Spearman’s rank correlation analysis was used to examine the correlation between their physical activity level and symptom clusters. Results: Six symptom clusters were identified in patients with lung cancer undergoing chemotherapy: respiratory symptom cluster, sleep-related symptom cluster, psychological symptom cluster, gastrointestinal symptom cluster, lung cancer-specific symptom cluster and cachexia symptom cluster. Moderate-intensity physical activity was negatively associated with psychological and cachexia symptoms (r=-0.153, -0.159; both P<0.05), while walking activity was negatively correlated with respiratory, sleep-related, psychological, and lung cancer-specific symptom clusters (r=-0.257, -0.222, -0.284, -0.181; all P<0.05). Total physical activity level was also negatively correlated with the respiratory, sleep-related, psychological, and cachexia symptom clusters (r=-0.252, -0.218, -0.304, -0.132; all P<0.05). Conclusion: The level of physical activity in lung cancer chemotherapy patients was negatively correlated with symptom clusters, with higher activity levels corresponding to lower symptom burden. It is recommended to design personalized exercise prescriptions, health education, and exercise guidance based on patients’ activity levels and symptom load, aiming to increase physical activity and alleviate symptom burden.

Key words: Lung neoplasms, Physical therapy modalities, Exercise, Rehabilitation nursing

中图分类号:

R473.73

谌欣欣, 刘国凤, 杨英姿, 胡亚晨, 金瑛, 李玉梅. 肺癌化疗患者住院期间体力活动水平和症状群的相关性分析[J]. 结核与肺部疾病杂志, 2024, 5(3): 197-206. doi: 10.19983/j.issn.2096-8493.2024048

Chen Xinxin, Liu Guofeng, Yang Yingzi, Hu Yachen, Jin Ying, Li Yumei. Correlation analysis of physical activity levels and symptom clusters in lung cancer chemotherapy patients during hospitalization[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(3): 197-206. doi: 10.19983/j.issn.2096-8493.2024048

图/表 5

表1

229例肺癌化疗患者参加运动锻炼意愿情况

类别	例数	愿意参加运动锻炼 [例,构成比(%)]
类别	例数	是	否	可能
年龄组(岁)
<60	85	39(45.88)	19(22.35)	27(31.77)
≥60	144	57(39.58)	37(25.69)	50(34.73)
性别
男性	184	78(42.39)	50(27.17)	56(30.44)
女性	45	18(40.00)	6(13.33)	21(46.67)
癌症类型
腺癌	117	59(50.43)	23(19.66)	35(29.91)
鳞癌	82	28(34.15)	22(26.83)	32(39.02)
小细胞癌	30	9(30.00)	11(36.67)	10(33.33)
癌症分期
Ⅲ期	78	30(38.46)	16(20.51)	32(41.03)
Ⅳ期	151	66(43.71)	40(26.49)	45(29.80)
居住地
市区	117	53(45.30)	28(23.93)	36(30.77)
县城	45	16(35.55)	12(26.67)	17(37.78)
乡镇	67	27(40.30)	16(23.88)	24(35.82)
居住情况
夫妻同住	118	47(39.83)	29(24.58)	42(35.59)
与子女同住	19	5(26.31)	6(31.58)	8(42.11)
与夫妻及子女同住	72	33(45.83)	17(23.61)	22(30.56)
自己住	16	8(50.00)	4(25.00)	4(25.00)
偶尔与其他人同住	4	3(3/4)	0(0.00)	1(1/4)
学历
小学	78	29(37.18)	21(26.92)	28(35.90)
中学	89	38(42.70)	23(25.84)	28(31.46)
高中/中专	46	23(50.00)	8(17.39)	15(32.61)
大专及以上	16	6(37.50)	4(25.00)	6(37.50)
婚姻状态
未婚	3	1(1/3)	1(1/3)	1(1/3)
已婚	208	87(41.83)	49(23.56)	72(34.61)
丧偶	18	8(44.44)	6(33.33)	4(33.33)
工作状态
继续工作	32	14(43.75)	10(31.25)	8(25.00)
放弃工作	56	27(48.21)	11(19.64)	18(32.14)
退休	141	55(39.01)	35(24.82)	51(36.17)
体质量指数(BMI)
瘦^a	8	2(2/8)	3(3/8)	3(3/8)
正常^b	152	63(41.45)	35(23.02)	54(35.53)
超体质量^c	62	26(41.94)	17(27.42)	19(30.64)
肥胖^d	7	2(2/7)	1(1/7)	4(4/7)
收入(元)
<5000	106	46(43.40)	22(20.75)	38(35.85)
5000~9999	89	38(42.70)	25(28.09)	26(29.21)
≥10000	34	12(35.29)	9(26.47)	13(38.24)
吸烟史
无	57	24(42.11)	10(17.54)	23(40.35)
有	172	72(41.86)	46(26.74)	54(31.40)
饮酒史
无	83	36(43.37)	21(25.30)	26(31.33)
有	146	60(41.10)	35(23.97)	51(34.93)
医疗费用
自费	6	1(1/6)	2(2/6)	3(3/6)
公费	4	1(1/4)	0(0.00)	3(3/4)
城镇医疗保险	136	53(38.97)	35(25.74)	48(35.29)
职工医疗保险	60	31(51.67)	9(15.00)	20(33.33)
新农合	23	10(43.48)	10(43.48)	3(13.04)
疾病确诊时间(月)
1~12	190	81(42.63)	51(26.84)	58(30.53)
>12	39	15(38.46)	5(12.82)	19(48.72)
并发症
肺结核	5	4(4/5)	1(1/5)	0(0.00)
糖尿病	20	11(55.00)	4(20.00)	5(25.00)
心脏病	15	3(20.00)	5(33.33)	7(46.67)
肺气肿	16	6(37.50)	4(25.00)	6(37.50)
高血压	38	10(26.32)	16(42.11)	12(31.57)
体力活动水平
活跃	27	17(62.96)	6(22.22)	4(14.82)
不活跃	202	79(39.11)	50(24.75)	73(36.14)

表1

表2

表3

表4

表5

参考文献 53

[1]	Thai AA, Solomon BJ, Sequist LV, et al. Lung cancer. Lancet, 2021, 398(10299):535-554. doi:10.1016/S0140-6736(21)00312-3. pmid: 34273294
[2]	Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin, 2024, 74(1):12-49. doi:10.3322/caac.21820.
[3]	Daly ME, Singh N, Ismaila N, et al. Management of Stage Ⅲ Non-Small-Cell Lung Cancer: ASCO Guideline. J Clin Oncol, 2022, 40(12):1356-1384. doi:10.1200/JCO.21.02528.
[4]	严蓓蕾, 刘军军, 羊晨, 等. 基于密切值法和秩和比法的慢性病病人自我管理能力评价. 护理研究, 2021, 35(22):3973-3977. doi:10.12102/j.issn.1009-6493.2021.22.005.
[5]	Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters: concept analysis and clinical implications for cancer nursing. Cancer Nurs, 2005, 28(4):270-282. doi:10.1097/00002820-200507000-00005.
[6]	Molassiotis A, Yates P, Yorke J. Editorial: Quality of Life and Side Effects Management in Lung Cancer Treatment. Front Oncol, 2021,11:651797. doi:10.3389/fonc.2021.651797.
[7]	Tsuji K, Matsuoka Y, Ogawa A. SY02- 2 Japan’s Cancer Survivorship Guidelines: Exercise edition. Annals of Oncology, 2022, 33(Suppl 6): S425. doi:10.1016/j.annonc.2022.05.432.
[8]	Patel AV, Friedenreich CM, Moore SC, et al. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Med Sci Sports Exerc, 2019, 51(11):2391-2402. doi:10.1249/MSS.0000000000002117.
[9]	Gravier FE, Smondack P, Prieur G, et al. Effects of exercise training in people with non-small cell lung cancer before lung resection: a systematic review and meta-analysis. Thorax, 2022, 77(5):486-496. doi:10.1136/thoraxjnl-2021-217242.
[10]	Lavin-Perez AM, Collado-Mateo D, Mayo X, et al. Effects of high-intensity training on the quality of life of cancer patients and survivors: a systematic review with meta-analysis. Sci Rep, 2021, 11(1):15089. doi:10.1038/s41598-021-94476-y.
[11]	James Huang, Jamie Ostroff. Overview of approach to lung cancer survivors[EB/OL]. [2021-07-28]. https://www.uptodate.com/contents/overview-of-approach-to-lung-cancer-survivors.
[12]	Edbrooke L, Granger CL, Denehy L. Physical activity for people with lung cancer. Aust J Gen Pract, 2020, 49(4):175-181. doi:10.31128/AJGP-09-19-5060. pmid: 32233342
[13]	Rock CL, Thomson CA, Sullivan KR, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin, 2022, 72(3):230-262. doi:10.3322/caac.21719.
[14]	Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA, 2018, 320(19):2020-2028. doi:10.1001/jama.2018.14854. pmid: 30418471
[15]	Hayes SC, Newton RU, Spence RR, et al. The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management. J Sci Med Sport, 2019, 22(11):1175-1199. doi:10.1016/j.jsams.2019.05.003. pmid: 31277921
[16]	Ch’Ng SN, Mcveigh JA, Manners D, et al. Sedentary Behaviour, Physical Activity, and Their Associations with Health Outcomes at the Time of Diagnosis in People with Inoperable Lung Cancer. J Clin Med, 2022, 11(19):5870. doi:10.3390/jcm11195870.
[17]	Li N, Wu J, Zhou J, et al. Symptom Clusters Change Over Time in Patients With Lung Cancer During Perichemotherapy. Cancer Nurs, 2021, 44(4):272-280. doi:10.1097/NCC.0000000000000787.
[18]	Fairman CM, Owens OL, Kendall KL, et al. Study protocol: investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer. Pilot Feasibility Stud, 2022, 8(1):102. doi:10.1186/s40814-022-01065-5. pmid: 35585562
[19]	Zhang G, Weng H, Li Y, et al. Symptom clusters and their predictors in patients with lung cancer and treated with programmed cell death protein 1 immunotherapy. Asia Pac J Oncol Nurs, 2022, 9(8):100103. doi:10.1016/j.apjon.2022.100103.
[20]	Molassiotis A, Vu DV, Ching SSY. The Effectiveness of Qigong in Managing a Cluster of Symptoms (Breathlessness-Fatigue-Anxiety) in Patients with Lung Cancer: A Randomized Controlled Trial. Integr Cancer Ther, 2021,20:153473542110 08253. doi:10.1177/15347354211008253.
[21]	Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr, 2006, 9(6):755-762. doi:10.1079/phn2005898. pmid: 16925881
[22]	Craig CL, Marshall AL, Sjostrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc, 2003, 35(8):1381-1395. doi:10.1249/01.MSS.0000078924.61453.
[23]	屈宁宁, 李可基. 国际体力活动问卷中文版的信度和效度研究. 中华流行病学杂志, 2004, 25(3):265-268. doi:10.3760/j.issn:0254-6450.2004.03.021.
[24]	Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer, 2000, 89(7):1634-1646. doi:10.1002/1097-0142(20001001)89:7<1634::aid-cncr29>3.0.co;2-v. pmid: 11013380
[25]	Mendoza TR, Wang XS, Lu C, et al. Measuring the symptom burden of lung cancer: the validity and utility of the lung cancer module of the M. D. Anderson Symptom Inventory. Oncologist, 2011, 16(2):217-227. doi:10.1634/theoncologist.2010-0193. pmid: 21285393
[26]	张立力, 臧瑜. MD安德森症状评估量表肺癌模块的修订和考评. 肿瘤, 2013, 33(5):434-438. doi:10.3781/j.issn.1000-7431.2013.05.009.
[27]	Li N, Wu J, Zhou J, et al. Symptom Clusters Change Over Time in Patients With Lung Cancer During Perichemotherapy. Cancer Nurs, 2021, 44(4):272-280. doi:10.1097/NCC.0000000000000787.
[28]	李京京, 吕晓晴, 刘杉杉, 等. 围手术期肺癌患者症状群与生活质量相关性的纵向研究. 中华护理杂志, 2020, 55(11):1635-1641. doi:10.3761/j.issn.0254-1769.2020.11.006.
[29]	Ligibel JA, Bohlke K, May AM, et al. Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. J Clin Oncol, 2022, 40(22):2491-2507. doi:10.1200/JCO.22.00687. pmid: 35576506
[30]	Haack M, Simpson N, Sethna N, et al. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology, 2020, 45(1):205-216. doi:10.1038/s41386-019-0439-z. pmid: 31207606
[31]	Ma J, Xu H, Liu S, et al. An Investigation of Symptom Clusters and Sentinel Symptoms During the First 2 Cycles of Postoperative Chemotherapy in Patients With Lung Cancer. Cancer Nurs, 2022, 45(6):488-496. doi:10.1097/NCC.0000000000001058. pmid: 35089876
[32]	Riba MB, Donovan KA, Ahmed K, et al. NCCN Guidelines Insights: Distress Management, Version 2.2023. J Natl Compr Canc Netw, 2023, 21(5):450-457. doi:10.6004/jnccn.2023.0026.
[33]	Choi S, Ryu E. Effects of symptom clusters and depression on the quality of life in patients with advanced lung cancer. Eur J Cancer Care (Engl), 2018, 27(1):e12508. doi:10.1111/ecc.12508.
[34]	Li JJ, Li JR, Wu JM, et al. Change in symptom clusters perioperatively in patients with lung cancer. Eur J Oncol Nurs, 2021, 55(11):102046. doi:10.1016/j.ejon.2021.102046.
[35]	Marx W, Ried K, Mccarthy AL, et al. Ginger-Mechanism of action in chemotherapy-induced nausea and vomiting: A review. Crit Rev Food Sci Nutr, 2017, 57(1):141-146. doi:10.1080/10408398.2013.865590. pmid: 25848702
[36]	臧瑜, 于虹, 李妍, 等. 肺癌患者症状群的调查研究. 中华护理杂志, 2016, 51(3):316-320. doi:10.3761/j.issn.0254-1769.2016.03.012.
[37]	Russell J, Wong ML, Mackin L, et al. Stability of Symptom Clusters in Patients With Lung Cancer Receiving Chemotherapy. J Pain Symptom Manage, 2019, 57(5):909-922. doi:10.1016/j.jpainsymman.2019.02.002.
[38]	Phillips I, Stares M, Allan L, et al. Optimising Outcomes in Non Small Cell Lung Cancer: Targeting Cancer Cachexia. Front Biosci (Landmark Ed), 2022, 27(4):129. doi:10.31083/j.fbl2704129. pmid: 35468688
[39]	Avancini A, Sartori G, Gkountakos A, et al. Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled?. Oncologist, 2020, 25(3):e555-e569. doi:10.1634/theoncologist.2019-0463.
[40]	Yoo JS, Yang HC, Lee JM, et al. The association of physical function and quality of life on physical activity for non-small cell lung cancer survivors. Support Care Cancer, 2020, 28(10):4847-4856. doi:10.1007/s00520-020-05302-6. pmid: 31980896
[41]	Sloan JA, Cheville AL, Liu H, et al. Impact of self-reported physical activity and health promotion behaviors on lung cancer survivorship. Health Qual Life Outcomes, 2016, 14(1):66. doi:10.1186/s12955-016-0461-3.
[42]	Bland KA, Krishnasamy M, Parr EB, et al. “I want to get myself as fit as I can and not die just yet”-Perceptions of exercise in people with advanced cancer and cachexia: a qualitative study. BMC Palliat Care, 2022, 21(1):75. doi:10.1186/s12904-022-00948-x.
[43]	Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc, 2019, 51(11):2375-2390. doi:10.1249/MSS.0000000000002116.
[44]	Solheim TS, Laird B, Balstad TR, et al. A randomized phase Ⅱ feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer. J Cachexia Sarcopenia Muscle, 2017, 8(5):778-788. doi:10.1002/jcsm.12201. pmid: 28614627
[45]	Grande AJ, Silva V, Sawaris NL, et al. Exercise for cancer cachexia in adults. Cochrane Database Syst Rev, 2021, 3(3):CD010804. doi:10.1002/14651858.CD010804.pub3.
[46]	Cavalheri V, Granger CL. Exercise training as part of lung cancer therapy. Respirology, 2020, 25(Suppl 2):80-87. doi:10.1111/resp.13869.
[47]	Wei X, Yu H, Dai W, et al. Discrepancy in the perception of symptoms among patients and healthcare providers after lung cancer surgery. Support Care Cancer, 2022, 30(2):1169-1179. doi:10.1007/s00520-021-06506-0.
[48]	Sullivan DR, Medysky ME, Tyzik AL, et al. Feasibility and potential benefits of partner-supported yoga on psychosocial and physical function among lung cancer patients. Psychooncology, 2021, 30(5):789-793. doi:10.1002/pon.5628. pmid: 33452752
[49]	van Waart H, Stuiver MM, van Harten WH, et al. Effect of Low-Intensity Physical Activity and Moderate-to High-Intensity Physical Exercise During Adjuvant Chemotherapy on Physical Fitness, Fatigue, and Chemotherapy Completion Rates: Results of the PACES Randomized Clinical Trial. J Clin Oncol, 2015, 33(17):1918-1927. doi:10.1200/JCO.2014.59.1081.
[50]	American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 11th ed. Philadelphia:Lippincott Williams & Wilkins, 2021.
[51]	Sprod LK, Mohile SG, Demark-Wahnefried W, et al. Exercise and Cancer Treatment Symptoms in 408 Newly Diagnosed Older Cancer Patients. J Geriatr Oncol, 2012, 3(2):90-97. doi:10.1016/j.jgo.2012.01.002. pmid: 22712028
[52]	Mavropalias G, Sim M, Taaffe DR, et al. Exercise medicine for cancer cachexia: targeted exercise to counteract mechanisms and treatment side effects. J Cancer Res Clin Oncol, 2022, 148(6):1389-1406. doi:10.1007/s00432-022-03927-0.
[53]	Mustian KM, Cole CL, Lin PJ, et al. Exercise Recommendations for the Management of Symptoms Clusters Resulting From Cancer and Cancer Treatments. Semin Oncol Nurs, 2016, 32(4):383-393. doi:10.1016/j.soncn.2016.09.002. pmid: 27776835

症状	例数	发生率 (%)	严重程度评分 [分,M(Q₁,Q₃)]	症状	例数	发生率 (%)	严重程度评分 [分,M(Q₁,Q₃)]
疼痛	93	40.61	0.00(0.00,2.00)	悲伤	175	76.42	3.00(1.00,4.00)
乏力	177	77.29	3.00(1.00,5.00)	呕吐	57	24.98	0.00(0.00,0.50)
恶心	65	28.38	0.00(0.00,1.00)	麻木	99	43.23	0.00(0.00,2.00)
睡眠不安	160	69.87	3.00(0.00,4.00)	咳嗽	142	62.01	1.00(0.00,3.00)
苦恼	181	79.04	3.00(1.00,4.00)	咳痰	132	57.64	1.00(0.00,2.00)
气短	139	60.70	2.00(0.00,3.00)	咯血	21	9.17	0.00(0.00,0.00)
健忘	151	65.94	2.00(0.00,3.00)	胸闷	121	52.84	1.00(0.00,3.00)
食欲下降	148	64.63	2.00(0.00,3.00)	便秘	94	41.05	0.00(0.00,2.00)
嗜睡	142	62.01	1.00(0.00,3.00)	体质量下降	104	45.41	0.00(0.00,2.00)
口干	159	69.43	2.00(0.00,4.00)

症状	例数	发生率 (%)	严重程度评分 [分,M(Q₁,Q₃)]	症状	例数	发生率 (%)	严重程度评分 [分,M(Q₁,Q₃)]
活动	199	86.90	3.00(2.00,5.00)	人际交往	196	85.59	4.00(2.00,5.00)
情绪	198	86.46	3.00(1.00,5.00)	走路	107	46.72	0.00(0.00,2.00)
工作	174	75.98	3.00(1.00,4.00)	生活乐趣	208	90.83	4.00(2.00,5.00)

条目	因子载荷值
条目	呼吸道症状群	睡眠相关症状群	心理症状群	消化道症状群	肺癌特异性症状群	恶病质症状群
气短	0.833	0.037	0.135	0.029	0.285	-0.069
胸闷	0.798	0.090	0.064	0.084	0.277	-0.066
疼痛	0.586	0.158	0.029	0.080	-0.312	-0.003
乏力	0.463	0.375	0.150	0.314	-0.024	0.016
口干	0.413	0.289	0.151	0.124	0.086	0.371
麻木	0.413	0.161	0.061	0.285	-0.003	0.264
便秘	0.107	0.728	-0.169	0.094	0.074	-0.230
嗜睡	0.283	0.655	0.345	-0.052	0.037	0.158
睡眠不安	0.092	0.636	0.497	-0.017	0.018	0.147
健忘	0.090	0.570	0.023	0.254	0.136	0.172
悲伤	0.111	0.034	0.904	0.108	0.109	-0.035
苦恼	0.109	0.107	0.869	0.160	0.086	-0.025
恶心	0.118	0.112	0.042	0.862	-0.016	-0.006
呕吐	0.105	0.048	0.145	0.852	0.084	0.023
食欲下降	0.207	0.428	0.352	0.447	-0.008	-0.170
咳痰	0.074	0.080	0.112	0.082	0.870	0.044
咳嗽	0.144	0.103	0.069	-0.017	0.851	0.111
咯血	0.002	0.149	0.043	0.024	0.285	0.618
体质量下降	0.092	0.341	0.269	0.111	0.199	-0.580
因子特征值	5.107	1.802	1.590	1.354	1.230	1.042
方差贡献率(%)	12.975	12.313	11.988	10.593	10.097	5.846
累计方差贡献率(%)	12.975	25.288	37.276	47.868	57.966	63.811

体力活动水平	呼吸道症状群	睡眠相关症状群	心理症状群	消化道症状群	肺癌特异性症状群	恶病质症状群
中强度体力活动水平	-0.122	-0.119	-0.153^a	-0.074	0.007	-0.159^a
步行体力活动水平	-0.257^b	-0.222^b	-0.284^b	-0.082	-0.181^b	-0.095
总体力活动水平	-0.252^b	-0.218^b	-0.304^b	-0.108	-0.117	-0.132^a