Influence of transcatheter arterial embolization on symptom distress and fatigue in liver cancer patients

Table 1 General characteristics of liver cancer patients

Characteristics	Values
Gender (male/female)	75/25
Age (yr)	64.3 ± 4.5
Education level (primary or below/high school or vocational/university or above)	19/37/44
Occupation (yes/no)	71/29
Marital status (single/married)	19/81
Presence of family support (no/yes)	8/92
No. of embolization procedures (1/2/3/4 or more)	19/19/18/44
Tumor size (cm)	4.9 ± 1.8
Embolization agent volume (mL)	7.6 ± 2.5
Performance status (PST) (0/1/2)	63/32/5
Biochemical results on day 1 post-TAE
AST (U/L)	288.5 ± 24.1
ALT (U/L)	206.8 ± 19.7
Total bilirubin (μmol/L)	26.7 ± 4.2
Cortisol (nmol/L)	491.8 ± 98.1
Biochemical results on day 3 post-TAE
AST (U/L)	126.4 ± 10.8
ALT (U/L)	162.3 ± 19.5
Total bilirubin (μmol/L)	26.6 ± 3.4
Cortisol (nmol/L)	487.9 ± 54.3

Physical functional status refers to the Eastern Cooperative Oncology Group (ECOG) Performance Status Scale. 0: Fully active, able to carry on all pre-disease performance without restriction; 1: Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework or office work; 2: Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TAE: Transcatheter arterial embolization.

Table 2 Scores on symptom distress subscales at postoperative day 3 following transcatheter arterial embolization

Subscale	T1	T2	T3	F	P value	Post hoc Bonferroni comparisons
Pain	3.1 ± 0.5	2.3 ± 0.5	1.7 ± 0.6	47.21	0.001	T1 > T2 > T3
Fatigue	2.8 ± 0.9	2.3 ± 0.3	1.8 ± 0.4	22.72	0.004	T1 > T2 > T3
Fever	2.6 ± 0.5	2.8 ± 0.7	1.9 ± 0.2	7.55	0.032	T2, T1 > T3
Insomnia	2.3 ± 0.6	1.8 ± 0.4	1.5 ± 0.3	15.88	0.009	T1 > T2 > T3
Abdominal distension	2.4 ± 1.1	2.1 ± 0.9	1.5 ± 0.7	19.45	0.006	T1 > T2 > T3
Anorexia	2.2 ± 0.3	1.7 ± 0.4	1.5 ± 0.4	12.64	0.012	T1 > T2 > T3
Nausea	1.9 ± 0.4	1.4 ± 0.5	1.1 ± 0.3	23.00	0.004	T1 > T2 > T3
Vomiting	1.6 ± 0.4	1.2 ± 0.2	1.1 ± 0.4	14 97	0.009	T1 > T2 > T3
Bowel movement	1.8 ± 0.9	1.4 ± 0.4	1.2 ± 0.3	8.58	0.027	T1 > T2 > T3
Dry mouth	1.8 ± 0.5	1.5 ± 0.6	1.4 ± 0.2	7.29	0.035	T1 > T2 > T3
Chills	1.9 ± 1.2	1.6 ± 0.3	1.3 ± 0.2	7.05	0.041	T1 > T2 > T3
Chest tightness	1.6 ± 0.2	1.3 ± 0.4	1.1 ± 0.5	6.26	0.043	T1 > T2 > T3
Gastric burning sensation	1.9 ± 0.6	1.5 ± 0.4	1.3 ± 0.4	16.61	0.008	T1 > T2 > T3
Urination	1.3 ± 0.7	1.2 ± 0.5	1.1 ± 0.2	2.58	0.598
Dyspnea	1.3 ± 0.5	1.2 ± 0.4	1.2 ± 0.5	1.82	0.611
Cough	1.3 ± 0.2	1.2 ± 0.5	1.1 ± 0.4	1.63	0.724
Oral esophageal pain	1.1 ± 0.3	1.0 ± 0.2	1.1 ± 0.3	0.40	0.921
Restlessness	1.5 ± 0.8	1.3 ± 0.6	1.3 ± 0.6	2.10	0.372
Concentration	1.4 ± 0.6	1.2 ± 0.4	1.3 ± 0.2	0.86	0.728
Appearance	1.3 ± 0.5	1.1 ± 0.5	1.2 ± 0.6	1.12	0.827
Bleeding	1.1 ± 0.4	1.1 ± 0.3	1.3 ± 0.1	1.48	0.782
Numbness	1.2 ± 0.5	1.2 ± 0.4	1.1 ± 0.3	0.89	0.709

T1, T2, and T3 represent different time points following transcatheter arterial embolization for liver cancer. F denotes the results of the analysis of variance, P indicates the level of statistical significance, and Bonferroni signifies the post-hoc comparison method.

Table 3 Fatigue scores on various subscales at postoperative day 3 following transcatheter arterial embolization

Subscale	T1	T2	T3	F	P value	Post hoc Bonferroni comparisons
Easily fatigued	2.7 ± 0.5	2.2 ± 0.4	1.7 ± 0.5	18.45	0.007	T1 > T2 > T3
Want to lie down	2.9 ± 1.0	2.3 ± 0.6	1.8 ± 0.7	21.33	0.005	T1 > T2 > T3
Feel exhausted	2.6 ± 0.8	1.9 ± 0.5	1.6 ± 0.3	21.36	0.005	T1 > T2 > T3
Feel distracted	1.7 ± 0.4	1.4 ± 0.6	1.5 ± 0.6	2.26	0.064
Feel energetic	4.6 ± 1.9	4.6 ± 1.2	4.7 ± 1.3	0.13	0.857
Feel physically tired	2.4 ± 1.1	2.1 ± 0.8	1.6 ± 0.7	12.67	0.013	T1 > T2 > T3
Feel talkative	1.2 ± 0.3	1.2 ± 0.4	1.5 ± 0.6	0.92	0.694
Interest in things	4.5 ± 1.6	4.5 ± 1.4	4.4 ± 1.0	0.39	0.921
Feel irritable	1.7 ± 0.4	1.6 ± 0.8	1.4 ± 0.5	3.39	0.043	T1 > T2 > T3
Feel forgetful	1.5 ± 0.8	1.3 ± 0.2	1.3 ± 0.3	1.15	0.624
Able to concentrate	2.0 ± 0.8	1.8 ± 0.7	1.9 ± 0.7	0.65	0.829
Feel unable to get going	2.4 ± 1.0	1.7 ± 0.3	1.5 ± 0.9	6.51	0.039	T1 > T2 > T3
Feel slower thinking	1.6 ± 1.0	1.49 ± 0.9	1.4 ± 0.90	0.75	0.721
Feel like making effort	1.9 ± 0.3	1.7 ± 0.2	1.3 ± 0.2	4.00	0.032	T1 > T2 > T3
Feel overwhelming fatigue	1.6 ± 0.7	1.4 ± 0.3	1.4 ± 0.4	2.31	0.067

T1, T2, and T3 represent different time points following transcatheter arterial embolization for liver cancer. F denotes the results of the analysis of variance, P value indicates the level of statistical significance, and Bonferroni signifies the post-hoc comparison method.

Table 4 Generalized estimating equation multivariate regression analysis of factors influencing fatigue in patients following transcatheter arterial embolization

Variables	Regression coefficient	SE	Wald χ2	P value
Gender (male vs female)	0.36	1.38	0.07	0.793
Marital status (married vs single)	-3.05	1.46	4.35	0.037
Marital status (married vs single)	-0.93	1.60	0.34	0.558
Family accompaniment (yes vs no)	5.62	1.64	11.69	0.001
Educational level
Junior high school or below vs high school/vocational	0.97	2.02	0.23	0.631
Junior high school or below vs college or above	0.52	2.03	0.07	0.796
Days after embolization
Day 2 vs day 1	-1.01	0.79	1.64	0.200
Day 3 vs day 1	-1.05	0.93	1.28	0.258
PST
1 vs 0	-2.54	1.17	4.70	0.030
2 vs 0	2.69	5.13	0.27	0.601
Continuous variables
Age	-0.20	0.07	7.29	0.007
Tumor size	0.18	0.21	0.79	0.373
Number of TAE procedures	0.16	0.19	0.74	0.390
TAE dose	-0.09	0.17	0.31	0.576
AST on post-TAE day 1	-0.003	0.005	0.46	0.498
ALT on post-TAE day 1	0.003	0.015	0.41	0.523
Total bilirubin on post-TAE day 1	-0.70	1.12	0.39	0.532
Cortisol on post-TAE day 1	0.01	0.07	0.02	0.880
Total symptom distress score	0.53	0.06	79.89	0.001

TAE: Transcatheter arterial embolization; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PST: Physical functional status.