BACKGROUND:This study aims to evaluate the symptom burden of advanced liver cancer, explore factors related to quality of life (QoL), and investigate the relationship between insomnia and QoL. METHODS:This is a secondary analysis of a multicenter cross-sectional study that included data from patients with advanced liver cancer (n = 364) recruited from 10 cancer centers across China. Participants were required to complete Patient Health Questionnaire-9 (PHQ-9), MD Anderson Symptom Inventory (MDASI), Insomnia Severity Index (ISI), 5-level EQ-5D (EQ-5D-5L). Factors associated with QoL were identified through a multiple stepwise linear regression model and the LASSO regression approach. The mediating effect between insomnia and quality of life was tested using the bootstrap method. RESULTS:The three most prevalent symptoms were fatigue (17.0%), sleep disturbance (16.2%), and pain (15.8%). Insomnia, depression, and the 13 core symptoms in the MDASI were strongly correlated with reduced QoL (all p < 0.001). The mediating effect analysis showed that depression, dry mouth, pain, forgetfulness and fatigue were partial mediating variables between insomnia and QoL. CONCLUSION:Various physical and psychological symptoms could affect the QoL in patients with advanced liver cancer. Insomnia and related symptoms such as depression, dry mouth, pain, forgetfulness and fatigue should be identified and appropriately addressed to improve QoL for this population.

Background:Online communities, platforms that facilitate social connections, have gained attention in the medical field, particularly for their potential to support patients. However, there is currently no online community specifically designed for patients with cancer receiving outpatient care. This study introduces a customized online community aimed at providing companionship and sharing to enhance the quality of life (QOL) among these patients. Objective:The purpose of this study was to assess the feasibility and initial effectiveness of a newly developed online community app in improving the QOL of patients with cancer receiving outpatient care. Methods:This pilot intervention-only study involved patients with cancer participating in a 4-week online community intervention through a mobile app. Eligible patients were aged 18 years or older, diagnosed with cancer, with an Eastern Cooperative Oncology Group Performance Status score of ≤2. The feasibility of the intervention was evaluated by community task participation rate, community task completion rate, and community daily login rate. Patients completed a QOL questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, QLQ-C30) at baseline (T0), week 2 (T1), and week 4 (T2). After the intervention, participants were free to answer 3 questions about their user experience. Results:Baseline assessments were conducted on 30 patients, with 25 patients assessed at T1 (83.3%) and 22 at T2 (73.3%). The 4-week average community daily login rate was 60.37% (18.11/30 on average), with community task participation and community task completion rates reaching 42.25% (12.68/30 on average) and 22.38% (6.7/30 on average), respectively. Notably, after the study ended, participants continued logging into the app and completing tasks. Patients who actively engaged in community activities demonstrated significant improvements in global health status (mean 11.04, SD 10.3 vs mean -6.56, SD 11.58; P=.004), emotional function (mean 17.7, SD 22.93 vs mean -2.89, SD 13.9; P=.04), and constipation (mean 11, SD 16.5 vs mean 14.67, SD 17.39; P=.005) at T2, compared to those less active. The intervention enhanced emotional functioning and overall health and alleviated insomnia symptoms among active participants. Conclusions:The online community intervention, emphasizing companionship and sharing, was well accepted by patients with cancer and demonstrated initial effectiveness in enhancing the QOL. The study findings suggest that such interventions can provide a supportive environment for patients to cope with psychological, social, and physical challenges. Future validation of its effectiveness will require well-designed randomized controlled trials, and continued optimization tailored to specific user groups will be crucial to meet the evolving needs of the community. The core value of the online community lies in companionship and sharing, which can serve as a foundation for future research and development in this area.

The aims of this study were to evaluate insomnia status in advanced cancer patients been served for 4 weeks symptom management in psycho-oncology service, and to explore predictors for the persistent or worsen insomnia. This was a real world longitudinal study among advanced cancer patients been referred to the psycho-oncology symptom management clinic in Peking University Cancer Hospital. Patients repeatedly completed the Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), and MD Anderson Symptom Inventory (MDASI) on Day 0 (baseline), Day 14, and Day 28 by using an electronic patient-reported outcomes (ePRO) system. At baseline, 50.6

AbstractObjectivesPatients with advanced colorectal cancer (CRC) have multiple concurrent physical and psychological symptoms. This study aimed to explore the relationship between anxiety, depression, and symptom burden in advanced CRC.MethodsA multicenter cross‐sectional study was conducted in 10 cancer centers from geographically and economically diverse sites in China. A total of 454 patients with advanced CRC completed the Hospital Anxiety and Depression Scale and the MD Anderson Symptom Inventory. Multiple regression analysis was applied to explore the relationship between anxiety, depression and symptom burden.ResultsAbout one‐third of the patients showed symptoms of anxiety or depression. Patients with anxiety or depression reported significantly higher symptom burden than those without (p < 0.001). Patients with anxiety or depression reported a higher proportion of moderate‐to‐severe (MS) symptom number than those without (p < 0.001). About 52% of the patients with anxiety or depression reported at least three MS symptoms. The prevalence of MS symptoms was ranging from 7.3% (shortness of breath) to 22% (disturbed sleep), and in patients with anxiety or depression was 2–10 times higher than in those without (p < 0.001). Disease stage (β = −2.55, p = 0.003), anxiety (β = 15.33, p < 0.001), and depression (β = 13.63, p < 0.001) were associated with higher symptom burden.ConclusionsAnxiety and depression in patients with advanced cancer correlated with higher symptom burden. Findings may lead oncology professionals to pay more attention to unrecognized and untreated psychological symptoms in symptom management for advanced cancer patients.

Background Little is understood about the association between psychosomatic symptoms and advanced cancer among older Chinese patients. Methods This secondary analysis was part of a multicenter cross-sectional study based on an electronic patient-reported outcome platform. Patients with advanced cancer were included between August 2019 and December 2020 in China. Participants (over 60 years) completed the MD Anderson Symptom Inventory (MDASI) and Hospital Anxiety and Depression Scale (HADS) to measure symptom burden. Network analysis was also conducted to investigate the network structure, centrality indices (strength, closeness, and betweenness) and network stability. Results A total of 1022 patients with a mean age of 66 (60–88) years were included; 727 (71.1%) were males, and 295 (28.9%) were females. A total of 64.9% of older patients with advanced cancer had one or more symptoms, and up to 80% had anxiety and depression. The generated network indicated that the physical symptoms, anxiety and depression symptom communities were well connected with each other. Based on an evaluation of the centrality indices, ‘distress/feeling upset’ (MDASI 5) appears to be a structurally important node in all three networks, and ‘I lost interest in my own appearance’ (HADS-D4) had the lowest centrality indices. The network stability was relatively high (> 0.7). Conclusion The symptom burden remains high in older patients with advanced cancer in China. Psychosomatic symptoms are highly interactive and often present as comorbidities. This network can be used to provide targeted interventions to optimize symptom management in older patients with advanced cancer in China. Trial registration Chinese Clinical Trial Registry (ChiCTR1900024957), registered on 06/12/2020.

Purpose The pathways underpinning suicide ideation (SI) and certain physical and psychological factors in patients with advanced breast cancer remain unclear. This study develops and validates a mediation model that delineates the associations between several multidimensional variables and SI in Chinese patients with advanced breast cancer. Methods Patients with advanced breast cancer ( n = 509) were recruited as study participants from 10 regional cancer centers across China from August 2019 to December 2020. Participants were required to complete five questionnaires using an electronic patient-reported outcomes (ePRO) system: 9 item- Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), 5-level EQ-5D (EQ-5D-5L), and MD Anderson Symptom Inventory (MDASI). Risk factors for SI were identified using multivariable logistic regression, and inputted into serial multiple mediation models to elucidate the pathways linking the risk factors to SI. Results SI prevalence was 22.8% (116/509). After adjusting for covariates, depression (odds ratio [OR] = 1.384), emotional distress (OR = 1.107), upset (OR = 0.842), and forgetfulness (OR = 1.236) were identified as significant independent risk factors (all p < 0.05). The ORs indicate that depression and distress have the strongest associations with SI. Health status has a significant indirect effect (OR=-0.044, p = 0.005) and a strong total effect (OR=-0.485, p < 0.001) on SI, mediated by insomnia severity and emotional distress. Conclusions There is a high SI prevalence among Chinese patients with advanced breast cancer. Our analysis revealed predictive pathways from poor health to heightened SI, mediated by emotional distress and insomnia. Regular management of distress and insomnia can decrease suicide risk in this vulnerable population.

OBJECTIVES:Care of the dying is an essential part of holistic cancer nursing. Improving nurses' attitudes and behaviors regarding care of the dying is one of the critical factors in increasing the quality of nursing service. This study aims to examine the impact of an educational program based on the CARES tool on nurses' attitudes and behaviors toward care of the dying. METHODS:A quasi-experimental study with pre- and post-intervention measures was conducted. A total of 222 oncology nurses from 14 hospitals in Beijing, China, were enrolled using a convenient sampling method. This online educational course developed based on the CARES framework comprised 7 modules and 10 sessions. Each session was carried out twice a week over 30-60 min. Data were collected using a sociodemographic characteristics questionnaire, the Frommelt Attitude Towards Care of the Dying Scale (FATCOD) and the Nurses' Practice Behavior Toward Care of the Dying Questionnaire (NPBTCOD). Reassessment of attitudes and behaviors was conducted when completed the learning and 6 months after the learning, respectively. The sociodemographic characteristics of the nurses were analyzed using descriptive statistics, and differences in attitudes and behaviors were reported and compared by the paired t-test. RESULTS:All the 222 oncology nurses completed educational courses, and 218 nurses (98.20%) completed the pre- and post-attitudes evaluation and 213 (95.9%) nurses completed the pre- and post-behaviors evaluation. The mean (SD) FATCOD score before and after the educational program was 108.83 (12.07) versus 115.09 (14.91), respectively (t = -8.546, p ≥ 0.001). The mean (SD) NPBTCOD score before and after the educational program was 69.14 (17.56) versus 73.40 (18.96), respectively (t = -3.231, p = 0.001). SIGNIFICANCE OF RESULTS:This educational intervention was found to be an effective method for improving oncology nurses' attitudes and behaviors toward caring for dying patients.

BackgroundPatients diagnosed with advanced stage cancer face an elevated risk of suicide. We aimed to develop a suicidal ideation (SI) risk prediction model in patients with advanced cancer for early warning of their SI and facilitate suicide prevention in this population.Patients and MethodsWe consecutively enrolled patients with multiple types of advanced cancers from 10 cancer institutes in China from August 2019 to December 2020. Demographic characteristics, clinicopathological data, and clinical treatment history were extracted from medical records. Symptom burden, psychological status, and SI were assessed using the MD Anderson Symptom Inventory (MDASI), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9), respectively. A multivariable logistic regression model was employed to establish the model structure.ResultsIn total, 2814 participants were included in the final analysis. Nine predictors including age, sex, number of household members, history of previous chemotherapy, history of previous surgery, MDASI score, HADS-A score, HADS-D score, and life satisfaction were retained in the final SI prediction model. The model achieved an area under the curve (AUC) of 0.85 (95% confidential interval: 0.82-0.87), with AUCs ranging from 0.75 to 0.95 across 10 hospitals and higher than 0.83 for all cancer types.ConclusionThis study built an easy-to-use, good-performance predictive model for SI. Implementation of this model could facilitate the incorporation of psychosocial support for suicide prevention into the standard care of patients with advanced cancer.

目的:了解老年进展期癌症患者自杀意念的检出率及危险因素.方法:采用横断面研究设计,使用病人健康问卷-9、MD安德森症状问卷、医院焦虑抑郁量表(HADS)对全国10个中心的住院进展期癌症患者进行调查,样本为年龄65岁及以上的691例老年患者,使用logistic回归分析从人口统计学与疾病相关因素、症状负担和心理痛苦3个层面探索自杀意念的危险因素.结果:老年进展期癌症患者自杀意念的检出率为21.7％.焦虑(HADS-A得分≥8:OR=4.48,95％CI:2.60～7.71,P＜0.001)、抑郁(HADS-D得分≥8:OR=2.50,95％CI:1.46～4.27,P＜0.01)是自杀意念的危险因素.结论:焦虑、抑郁是老年进展期癌症患者自杀意念突出的危险因素,应重视对这一人群的焦虑抑郁的筛查.

The quality of care provided to patients with cancer at the end of their lives remains unsatisfactory, especially during their last days and hours of life. This study aimed to investigate knowledge and practice behaviors of oncology nurses in relation to the care of the dying and to analyze the influencing factors. A convenience sample of 222 oncology nurses was recruited from 14 hospitals in Beijing, China, in January 2022. These nurses completed an online survey that included a demographic and work characteristics questionnaire and knowledge and practice behavior questionnaires regarding the care needs of dying cancer patients. The self-perceived knowledge and practice behavior of oncology nurses toward the care of the dying were found to be moderate. However, their understanding of airway management, restlessness, and delirium management was insufficient. In addition, their ability to effectively communicate recommendations for discontinuing unnecessary procedures, medications, treatments, and monitoring was inadequate. Nurses' previous end-of-life care education and experience of caring for dying patients influenced their knowledge. Nurses' practice settings, experience of caring for dying patients, and their knowledge were key factors in shaping their behaviors. Providing targeted continuing education for nurses in hospital settings and exploring the nursing pathway may be important ways to bridge their knowledge gap and enhance their practice behaviors toward caring for dying patients.

ObjectiveWe conducted this cross-sectional study to explore the mediating and predicting role of somatic symptom disorder (SSD) between psychological measures and quality of life (QOL) among Chinese breast cancer patients.MethodsBreast cancer patients were recruited from three clinics in Beijing. Screening tools included the Patient Health Questionnaire-15 (PHQ-15), the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder-7 scale (GAD-7), the Health Anxiety Scale (Whiteley Index-8, WI-8), the Somatic Symptom Disorder B-Criteria Scale (SSD-12), the Fear of Cancer Recurrence scale (FCR-4), the Brief Illness Perception Questionnaire (BIPQ-8), and the Functional Assessment of Cancer Therapy-Breast (FACT-B). Chi-square tests, nonparametric tests, mediating effect analysis, and linear regression analysis were used for the data analysis.ResultsAmong the 264 participants, 25.0% were screened positive for SSD. The patients with screened positive SSD had a lower performance status, and a greater number of patients with screened positive SSD received traditional Chinese medicine (TCM) (p < 0.05). Strong mediating effects of SSD were found between psychological measures and QOL among patients with breast cancer after adjusting for sociodemographic variables as covariates (p < 0.001). The range of the percentage mediating effects was 25.67% (independent variable = PHQ-9) to 34.68% (independent variable = WI-8). Screened positive SSD predicted low QOL in physical (B = −0.476, p < 0.001), social (B = −0.163, p < 0.001), emotional (B = −0.304, p < 0.001), and functional (B = −0.283, p < 0.001) well-being, as well as substantial concerns caused by breast cancer (B = −0.354, p < 0.001).ConclusionScreened positive SSD had strong mediating effects between psychological factors and quality of life among breast cancer patients. Additionally, screened positive SSD was a significant predictor of lower QOL among breast cancer patients. Effective psychosocial interventions for improving QOL should consider the prevention and treatment of SSD or integrated SSD caring dimensions for breast cancer patients.

Objectives . The integration of patient-reported health status has been increasingly emphasised for delivering high-quality care to advanced cancer patients. This research is designed to track health status changes over time in Chinese advanced cancer patients to explore the risk factors affecting their health status. Methods . Advanced cancer patients were recruited from Peking University Cancer Hospital. An electronic patient-reported outcome (ePRO) system with validated measurements was used to collect the data. ANOVA, the chi-square test, the nonparametric Kruskal–Wallis H test, and generalized estimating equation (GEE) analysis were used for the data analysis. Results . One hundred and three patients completed a baseline survey ( T  = 0) and two follow-up surveys ( T 1 = 14 days, T 2 = 28 days). Chi-square test results indicate a significant decrease in the percentage of patients reporting moderate or severe difficulty experienced by patients in terms of mobility, pain/discomfort, and anxiety/depression. However, there is a significant increase in the percentage of patients reporting moderate or severe difficulty in self-care and usual activities. Scores on the visual analogue scale in the EQ-5D-5L instrument (EQ-VAS) are associated with patients’ income, and the degree of moderate or severe anxiety/depression is found to be associated with employment status. The GEE results show that pain, loss of appetite, poor walking status effected by symptoms, depression, and anxiety has worsened the health status. Conclusions . The health status of Chinese advanced cancer patients under ePRO follow-up in China significantly improves in the physical and psychological dimensions, accompanied by a decrease in usual activities and self-care. Routine screening and rational supportive care are recommended in oncology for cancer care. Based on the rational application of ePRO, longitudinal studies exploring the potential mechanisms of health status changing would provide more beneficial guidance for improving the quality of life in patients with advanced cancer.

Background Patients with cancer experience multiple symptoms related to cancer, cancer treatment, and the procedures involved in cancer care; however, many patients with pain, depression, and fatigue, especially those outside the hospital, receive inadequate treatment for their symptoms. Using an electronic patient-reported outcome (ePRO) platform to conduct symptom management follow-up in outpatients with advanced cancer could be a novel and potentially effective approach. However, empirical evidence describing in detail the preparation and implementation courses in a real setting is needed. Objective The purpose of this paper was to describe the implementation process and evaluation of an ePRO platform that facilitates symptom management for patients with cancer, share our experiences and the problems we encountered during the process of implementation, and share the solutions we identified for those problems. Moreover, we tested the feasibility, safety, and efficacy of the ePRO platform. Methods This was a real-world, ongoing, longitudinal, single-center, prospective study with a total of 7 follow-ups conducted within 4 weeks after the first visit to the symptom management clinic (on days 1, 3, 7, 10, 14, 21, and 28). Participants were encouraged to complete scales for physical symptoms (pain, fatigue, and shortness of breath), cognitive symptoms (memory problems and impaired concentration), and affective symptoms (especially depression and anxiety) during follow-up. The design and function of the ePRO-doctor client and ePRO-patient client, the patient-reported outcome (PRO) scales used in the study, and the strategies to promote symptom tracking have been described. Moreover, the training and evaluation for research assistants have been presented. The efficacy of the ePRO platform was assessed with a comparison of the baseline and 4-week outcomes on the MD Anderson Symptom Inventory. Results Using the ePRO platform for symptom management follow-ups in advanced cancer patients was associated with a high completion rate (72.7%-86.4%) and a low drop-off rate (23.6%). The ePRO platform sent 293 alert notifications to both patients and doctors, which promoted patient security. The short and sharp PRO tool selection, user-friendly interface, automatic reminder notifications and alerts, and multiple dimensional training were essential components for the preparation and implementation of the ePRO system. The results showed significant improvements in the mean scores of pain, fatigue, and numbness from baseline to day 28 (P=.02, P=.02, and P<.001, respectively). Conclusions The use of an ePRO platform for symptom management follow-ups in advanced cancer patients is time-saving, energy-saving, and effective. PRO tool selection, platform design, and training of research assistants are important aspects for implementation. Future research should validate the ePRO platform in a larger randomized controlled study.

通过查阅大量中外文献,结合临床工作,从国内心理社会肿瘤学专业人员的视角,描述国内外心理社会肿瘤学的临床实践,包括痛苦筛查、癌症症状的精神科管理、心理干预的实施以及心理社会肿瘤学多学科团队建设的最新进展,指出国内心理社会肿瘤学在上述临床实践中存在的挑战和不足,并从探索适合我国国情的痛苦筛查管理的模式与流程,心理干预方法本土化和在国内建立心理社会肿瘤学多学科团队等方面对学科进一步规范发展以及如何更好地融入肿瘤临床实践提出了新的思考.

Introduction Major depressive disorder (MDD) is associated with an increased risk of suicide and suicide attempt among cancer patients. However, we do not know how many cancer patients without MDD have suicidal ideation (SI). Objectives This study aimed to investigate the prevalence, characteristics and correlated factors of SI among advanced cancer patients without MDD. Methods This is a multi-center, cross-sectional study based on an electronic patient-reported outcome systems in patients who were diagnosed with advanced lung, liver, gastric, esophageal, colorectal or breast cancer, the top six prevalent cancers in China. A total of 2930 advanced cancer patients were recruited from 10 regional representative cancer centers across China from August 2019 to December 2020. Patients completed the Patient Health Questionnaire-9 regarding if they had thoughts of being better off dead or of hurting themselves in some way in the previous 2 weeks. Patients also completed the symptom inventory and quality of life assessment. Generalized estimating equation model was performed to explore the correlated factors associated with SI among the patients without MDD. Results The overall prevalence of SI among advanced cancer patients without MDD was 13.1%. The prevalence was higher in older patients. After adjusted for existing conditions, patients with vomiting symptom (p < 0.001), poorer life quality (p < 0.001), and middle education level (p = 0.031) were correlated factors of SI. Conclusions The suicidal ideation is common in advanced cancer patients without MDD. Patients with vomiting, poor quality of life, and middle education level should be screened and monitored for suicidal ideation even without MDD. Clinical Trial Information ChiCTR1900024957.

Objective:Recent research has documented psychological distress in advanced breast cancer (ABC) patients, but few studies have examined how death anxiety is affected by the symptom burden. Therefore, this study aims to explore the association among symptom burden, death anxiety and psychological distress (depression and anxiety) in ABC patients.Methods:This cross-sectional study used the Death and Dying Anxiety Scale (DADDS), 9-item Patient Health Questionnaire (PHQ-9), General Anxiety Disorder-7 (GAD-7) and MD Anderson Symptom Inventory (MDASI) to assess death anxiety, depression, anxiety, and symptom burden, respectively. Bias-corrected bootstrapping methods were used to estimate indirect effects and 95% confidence intervals.Results:Two hundred ABC patients completed the questionnaires. All of the respondents were females, with a mean age of 50±10 years. Initial correlation analyses revealed significant associations of death anxiety with depression (r=0.57, P<0.001), anxiety (r=0.60, P<0.001) and symptom burden (r=0.43, P<0.001). Moreover, depression (r=0.53, P<0.001) and anxiety (r=0.45, P<0.001) were significantly correlated with symptom burden. An analysis using Hayes' PROCESS macro revealed the partial effecting role of death anxiety in the relationship between depression and symptom burden, and between anxiety and symptom burden (contributions to the total effect of 0.247 and 0.469, respectively).Conclusions:This study provides insight into the relationship between death anxiety and symptom burden. The results suggest that interventions addressing death anxiety may be more effective for alleviating the depression and anxiety experienced by ABC patients with a symptom burden.

人们一直在思考一个问题,什么是爱?我们理解的爱就是伸出一千只手去帮助别人.带着这份对爱的理解,北京大学肿瘤医院康复科创建了"心音坊"公益项目,希望用音乐抚慰癌症患者和家属的心灵,让他们在嘈杂的就诊环境中找到一个温馨、有爱绽放的角落.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:了解年轻女性进展期乳腺癌患者的死亡焦虑现状及相关因素,为进行死亡焦虑筛查及干预提供初步参考。方法:选取年龄≤50岁的年轻女性进展期乳腺癌患者109例,使用死亡和临终痛苦量表（DADDS）、9条目病人健康问卷（PHQ-9）、广泛性焦虑自评量表（GAD-7）、生命末期生活质量问卷（QUAL-EC）、多维领悟社会支持量表（MSPSS）和慢病治疗功能评价-灵性健康量表（FACIT-Sp）进行评估,用多元logistic回归模型分析死亡焦虑的相关因素。结果:本样本死亡焦虑的检出率为37.6%,焦虑、抑郁的检出率分别为25.7%和20.2%,低社会支持者占总体样本的2.8%,QUAL-EC的四个分量表与FACIT-Sp的得分分别为（10.42±2.78）分、（19.99±3.75）分、（10.26±4.05）分、（20.79±4.42）分和（29.27±11.05）分。多元logistic回归结果显示,有焦虑和有宗教信仰是死亡焦虑的危险因素（OR=25.17、4.52）,与医护人员关系良好和更好的生命末期准备是死亡焦虑的保护因素（OR=0.83、0.75）。结论:在年轻女性进展期乳腺癌群体中,死亡焦虑是普遍存在的精神健康问题,制订干预方案时应加以考虑。</span>

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:检验简易癌症相关担心量表（BCWI）在结直肠癌术后患者中的适用性。方法:按照美国矫形外科医师学会循证医学委员会推荐的跨文化调适指南对简易癌症相关担心量表进行汉化,得到BCWI中文版（C-BCWI）。选取某肿瘤医院门诊或住院的结直肠癌术后患者303例,以医院用焦虑抑郁量表（HADS）中的焦虑亚量表（HADS-a）为关联效度指标;选取其中20例患者在2周后进行重测。结果:验证性因子分析结果显示各指标拟合良好（χ²/df=1.89,RM SEA=0.05,CFI=0.90）; C-BCWI总分与HADS-a总分呈正相关（r=0.73,P &lt;0.001）。总量表的Cronbachα系数为0.92,3个维度的α为0.77～0.91;总量表的重测信度（ICC）为0.83,3个维度的ICC为0.73～1.00。结论:简易癌症相关担心量表中文版具有良好的效度和信度,可用于评估结直肠癌术后患者的担心水平。</span>

INTRODUCTION:An electronic Patient-Reported Outcome (ePRO) platform is needed for implementing evidence-based symptom management in outpatients with advanced cancer. We describe the overall protocol and the methodology for measuring symptom burden, to provide critical parameters needed to implement symptom management on the ePRO platform.METHODS AND ANALYSIS:The study focusses on patients with advanced lung cancer, stomach cancer, oesophagus cancer, liver cancer, colorectal cancer or breast cancer. The primary outcome is the change of symptom burden. MD Anderson Symptom Inventory, and other PRO instruments (Insomnia Severity Index, Hospital Anxiety and Depression Scale, 9-item Patient Health Questionnaire and EuroQol-5 dimensions-5 levels version) were used. The secondary outcomes include feasibility of using ePRO, symptom-related quality of life, reasons for no improvement of symptoms, defining frequency of PRO assessments and cut-points, items for screening and management of comorbidity and satisfaction with ePRO platform in patients and health providers. After initial outpatient visit for baseline assessment, ePRO system will automatically send follow-up notification seven times over 4 weeks to patients. The characteristics and changing trajectory of symptoms of patients will be described. Parameters for using PROs, such as optimal time points for follow-up and cut-off point for alert will be determined. The feasibility of ePRO platform to track the changes of target symptoms in outpatients will be evaluated.ETHICS AND DISSEMINATION:The study protocol and related documents were approved by the Institutional Research Board (IRB) of Peking University Cancer Hospital on 13 February 2019 (2019YJZ07). The results of this study will be disseminated through academic workshops, peer-reviewed publications and conferences.TRIAL REGISTRATION NUMBER:ChiCTR1900023560.