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Park JH, Chun M, Bae SH, Woo J, Chon E, Kim HJ. Latent profile analysis for assessing symptom clusters in women with breast cancer. J Cancer Surviv 2024:10.1007/s11764-024-01648-6. [PMID: 39066841 DOI: 10.1007/s11764-024-01648-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To identify symptom clusters among breast cancer survivors and investigate differences in health-related quality of life (HRQoL) and distress based on these discerned symptom clusters using latent profile analysis. METHODS We enrolled 655 adult breast cancer survivors aged 19 years and older, registered with the Cancer Survivor Integrated Supportive Center from May 2020 to July 2022. The study measured five symptoms-pain, fatigue, insomnia, anxiety, and depression-using a Visual Analogue Scale ranging from 0 to 10 points. Distress was measured using the National Comprehensive Cancer Network Distress Thermometer, with scores ranging from 0 to 10 points. HRQoL was determined using the EuroQol-5 Dimension questionnaire. Data analysis was conducted using the Jamovi and Mplus 8.8 software programs. RESULTS The Cluster with Few Symptoms (46.8%) was the most common, whereas the Psychological Cluster with a very high degree of depression and anxiety accounted for 20.0%, and the Moderate symptom cluster with symptoms of 3 or more points accounted for 14.4%. Distress scores were relatively high in the Psychological Cluster and the Pain-Fatigue-Insomnia Cluster, and were lowest in the Cluster with Few Symptoms (F = 103.92, p < 0.001). HRQoL scores were highest in the Cluster with Few Symptoms and lowest in the Pain-Fatigue-Insomnia Cluster (F = 177.62, p < 0.001). CONCLUSIONS Approximately half of breast cancer survivors who had completed the major treatment experienced persistent high symptoms such as depression and anxiety or pain, fatigue, and insomnia. IMPLICATIONS FOR CANCER SURVIVORS These findings provide foundational data for developing tailored intervention strategies and programs based on symptom experiences.
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Affiliation(s)
- Jin-Hee Park
- College of Nursing, Research institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Mison Chun
- Department of Radiation Oncology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Sun Hyoung Bae
- College of Nursing, Research institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Jeonghee Woo
- Cancer Center Management Team, Gyeonggi Regional Cancer Center, Suwon, Republic of Korea
| | - Eunae Chon
- Cancer Survivor Center, Gyeonggi Regional Cancer Center, Suwon, Republic of Korea
| | - Hee Jun Kim
- College of Nursing, Ajou University, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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Fathian M, Akbari F. Breast cancer symptom profile longitudinal changes: data mining study. BMJ Support Palliat Care 2024:spcare-2023-004566. [PMID: 38918047 DOI: 10.1136/spcare-2023-004566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES Identifying stable co-occurring symptoms in breast cancer (BC) patients during chemotherapy can improve symptom management and the treatment process. This study examines symptom cluster stability in Iranian BC patients receiving chemotherapy and evaluates stability across three-time points within each cluster. METHODS This study collected data from three-time points: initial chemotherapy commencement, 2½ months postdiagnosis, and 5 months postdiagnosis. The research used exploratory factor analysis (EFA) in combination with hierarchical cluster analysis (HCA) and K means clustering to address research questions. RESULTS In the initial clustering step, EFA identified five clusters with high consistency across three-time points. The first cluster showed depression, anxiety and irritability, while the second cluster was characterised by sexual interest and pain. The third cluster was associated with diarrhoea and vomiting. In the second step, we obtained the HCA item output and two clusters of K means clustering that recorded depression and anxiety symptoms over time. Vomiting, dry mouth, sexual interest, worrying and numbness were observed during the first and second points, but the frequency has decreased since then. CONCLUSIONS Cancer's psychological and physiological symptoms, including depression, anxiety, digestive and hormonal issues, remain stable throughout the disease. Palliative care centres can improve patients' quality of life and treatment process by addressing persistent symptoms.
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Albusoul RM, Hasanien AA, Abdel Razeq NM, Al-Maharma DY. Symptom Clusters and Their Impact on Spiritual Well-Being Among Women with Breast Cancer. Int J Womens Health 2024; 16:961-970. [PMID: 38827927 PMCID: PMC11144402 DOI: 10.2147/ijwh.s463840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose To explore symptom experience and symptom clusters among Jordanian women with breast cancer and investigate whether these clusters predict patients' spiritual well-being. Patients and Methods A sample of 142 Jordanian women with breast cancer were asked to complete the Memorial Symptom Assessment Scale (MSAS), Functional Assessment of Chronic Illness Therapy- Spiritual Well-being (FACIT-Sp) scale, and socio-demographic questionnaire. Exploratory factor analysis was used to group symptoms into clusters, and multiple linear regression was used to explore the symptom clusters that predict spiritual well-being. Results The most prevalent symptoms among women with breast cancer were fatigue, anxiety, tension, and pain. All these symptoms have a prevalence greater than 50%. Three clusters were found: treatment-related symptom cluster consisting of eight symptoms, gastrointestinal symptom cluster consisting of seven symptoms, and psychological symptom cluster consisting of five symptoms. The psychological symptom cluster was the only cluster predicting the women's spiritual well-being (t (141) = -3.049; p < 0.01). Conclusion Women with breast cancer experience several concurrent symptoms and symptom clusters. Screening for psychological symptom clusters and their treatment improves patients' spiritual well-being. The majority of women with breast cancer did not receive any complementary therapies and hardly any spiritual or psychological support, which should be provided in the future to support their spiritual well-being.
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Affiliation(s)
- Randa M Albusoul
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Amer A Hasanien
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Nadin M Abdel Razeq
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Dua’ Y Al-Maharma
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
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Min SH, Chee W, Im EO. Changes in Symptom Clusters Among Asian American Breast Cancer Survivors in Technology-Based Coaching Intervention. Cancer Nurs 2024:00002820-990000000-00207. [PMID: 38232228 PMCID: PMC11252245 DOI: 10.1097/ncc.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Limited research studies have focused on examining the impact of technology-based interventions in changing symptom clusters among Asian American breast cancer survivors. OBJECTIVE The aim of this study was to understand the longitudinal impact of a technology-based program on the symptom cluster experience of Asian American breast cancer survivors. METHODS This is a secondary data analysis that used exploratory factor analysis at each time point (baseline, post-1 month, post-3 months) for the control and intervention groups (N = 199). RESULTS The number of symptom clusters remained the same, and the same symptoms remained in similar clusters across the 2 groups. The control group experienced psychological cluster, fatigue cluster, and neck/skin cluster at baseline; psychological cluster, fatigue/dizzy cluster, and neck/skin cluster at post-1 month; and psychological cluster, fatigue/dizzy cluster, and somatic cluster at post-3 months. The intervention group experienced psychological cluster, neck cluster, and appetite/itching cluster at baseline; somatic/anticholinergic cluster, psychological/sexual cluster, and appetite cluster at post-1 month; and psychological cluster, neck cluster, and itching cluster at post-3 months. The psychological and neck clusters shared similar core symptoms of feeling nervous, dry mouth, and cough between the control and intervention groups. CONCLUSION The different symptom cluster experiences may be due to the technology-based intervention where the intervention group receives individual/group coaching/support that may have changed symptom clusters over time. Yet, the true efficacy of the intervention on symptom clusters warrants further investigation. IMPLICATIONS FOR PRACTICE Clinicians should understand the changes in symptom clusters as well as the presence of core symptoms and take a targeted symptom cluster approach in clinical settings.
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Affiliation(s)
- Se Hee Min
- Author Affiliations: School of Nursing, Columbia University (Dr Min), New York, New York; and The University of Texas at Austin School of Nursing (Drs Chee and Im), Austin, Texas
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Luo R, Chen H, Liu Y, Sun H, Tang S, Chen Y. Symptom clusters among breast cancer patients in relation to chemotherapy cycles: a longitudinal study. Support Care Cancer 2023; 31:573. [PMID: 37698687 DOI: 10.1007/s00520-023-08038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/03/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE The aim of this study was to identify symptom clusters in breast cancer patients undergoing adjuvant chemotherapy. METHODS A prospective longitudinal study was conducted. And a sample of 620 breast cancer patients receiving adjuvant chemotherapy was recruited using convenience sampling from May 20, 2020, to March 31, 2021. Data were collected eight times: the first chemotherapy cycle (T1) to the eighth cycle of chemotherapy (T8). Exploratory factor analysis was used to explore the composition of symptom clusters. RESULTS Symptoms with an incidence of less than 20% were deleted and the remaining symptoms were included in the factor analysis. Three common factors were extracted in T1, including gastrointestinal symptom cluster, emotional and psychological symptom cluster, and menopausal symptom cluster. Five common factors were extracted from T2 to T7, including gastrointestinal symptom cluster, emotional and psychological symptom cluster, neurological symptom cluster, menopausal symptom cluster, and self-image disorder symptom cluster. Four common factors were extracted at T8, including gastrointestinal symptom cluster, emotional and psychological symptom cluster, neurological symptom cluster, and menopausal symptom cluster. CONCLUSION Breast cancer patients undergoing adjuvant chemotherapy experience multiple symptoms and different symptom clusters in different chemotherapy cycles. It is a benefit for health care providers to better understand and care for breast cancer patients. It will also help such women to manage concurrent symptoms ahead to promote their quality of life.
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Affiliation(s)
- Ruzhen Luo
- Xiangya Nursing School, Central South University, 172 Tong Zi Po Road, Changsha, 410013, Hunan, China
| | - Hongbo Chen
- School of Nursing, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China.
| | - Hongyu Sun
- School of Nursing, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China.
| | - Siyuan Tang
- Xiangya Nursing School, Central South University, 172 Tong Zi Po Road, Changsha, 410013, Hunan, China.
| | - Yuhong Chen
- The First Department of Mammary Gland, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
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Grayson S, Sereika S, Conley Y, Bender C, Carr K, Wesmiller S. Psychoneurological symptom cluster trajectories in individuals treated for early-stage breast cancer. Support Care Cancer 2023; 31:563. [PMID: 37676346 DOI: 10.1007/s00520-023-08018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND/PURPOSE The psychoneurological (PN) symptom cluster has been defined in the literature as anxiety, depression, fatigue, sleep disturbance, and pain. PN symptoms are influenced by cancer and its treatment as well as biological and psychosocial factors. The purpose of this analysis was to describe temporal patterns of the PN symptom cluster severity in breast cancer survivors over the year following initial surgical intervention and investigate the time-dependent effect of treatment modality on symptom severity. METHODS In a prospective longitudinal study, symptom data were collected from individuals with early-stage breast cancer 48 h after initial surgery and at monthly intervals for the subsequent 12 months using the PROMIS®-29 subscales for anxiety, depression, fatigue, sleep disturbance, and pain. Applying group-based trajectory modeling, we classified participants into subgroups with similar temporal patterns of PN symptom cluster severity and included treatment modality as a time-dependent covariate. RESULTS Across 353 participants (mean age 60.10 ± 11.9 years, 88.95% white, 66.57% undergoing segmental mastectomies), four distinct trajectory subgroups (mild [47.6%; n = 168], moderate [28.3%; n = 100], severe [15.9%; n = 56], and most severe increasing [8.2%; n = 29]) were revealed for PN symptom cluster severity. Chemotherapy was associated with greater severity in all symptom severity subgroups, while radiation was associated with greater symptom severity in the mild and most severe increasing subgroups. CONCLUSIONS AND IMPLICATIONS A subgroup of individuals with early-stage breast cancer experienced persistent severe PN symptoms. Future research should focus on psychosocial, biological, and disease-related characteristics of individuals in the most severe symptom group to inform preventative treatments and effective interventions.
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Affiliation(s)
- Susan Grayson
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Susan Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Bender
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katrina Carr
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan Wesmiller
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Ozkaraman A, Kazak A, Dudaklı N, Ozen H. Evaluation of the Effect of Self-Efficacy on Symptoms in Gastrointestinal Cancer Patients. J Palliat Care 2023; 38:207-214. [PMID: 36128832 DOI: 10.1177/08258597221125286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The incidence of gastrointestinal cancer is increasing day by day and is among the highest 10 cancer types in the world. This study was conducted to evaluate the effects of self-efficacy of patients with gastrointestinal system cancer on symptom clusters. Methods: This cross-sectional study was conducted with 105 patients treated for gastrointestinal system cancer in a hospital located in the south of Turkey. In the study, patients over 18 years of age without hearing or speech impairment were included. To determine symptom clusters, Latent Profile Analysis and comparison of self-efficacy scale items by symptom clusters were performed with Chi-square, ANOVA, and Kruskal Wallis test. Results: The mean age of the patients was 58.83 ± 13.1 years; of the patients, 37.1% had colon ca, 21.9% had rectum ca. The patients had higher mean scores of fatigue, pain, feeling distressed, feeling sad, dry mouth, sleep disturbance, loss of appetite and nausea in the last week. The patients had higher mean scores of fatigue, pain, feeling distressed, feeling sad, dry mouth, sleep disturbance, loss of appetite and nausea in the last week. Three symptom clusters were determined by latent profile analysis; high, moderate, mild. It was determined that the level of self-efficacy was high in the symptom cluster which is low symptom severity and number of symptoms (p < .05). Conclusion: The number and the severity of symptoms are lower in patients with high self-efficacy perceptions.
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Affiliation(s)
- Ayşe Ozkaraman
- Department of Nursing, Faculty of Health Sciences, 53004Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Aysun Kazak
- Department of Medical Services and Techniques First and Emergency Aid Program, Vocational School of Health Services, 52983Mersin University, Mersin, Turkey
| | - Nuran Dudaklı
- Mersin City Training and Research Hospital, Psychiatry Clinic, Mersin, Turkey
| | - Hülya Ozen
- Department of Medical Informatics, Gulhane Faculty of Medicine, 574983University of Health Sciences, Ankara, Turkey
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Al Qadire M, Aljezawi M, Al Omari O, Alatoum AM, Khalaf A. Identifying Symptom Clusters in Cancer Patients Receiving Chemotherapy using Symptom Occurrence and Distress Dimensions. Clin Nurs Res 2023; 32:185-196. [PMID: 35658723 DOI: 10.1177/10547738221100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The current study explored symptom clusters in a heterogenous sample that includes all age groups, and all types of cancer being treated with chemotherapy. A cross-sectional survey design was used. The sample comprise 393 cancer patients with a mean age of 52.1 years (SD 13.9). The most prevalent symptoms were tiredness (78.9%), lack of energy (71.8%), and irritability (66.9%) and the most distressing symptom was lack of appetite. Four clusters of the symptom experience: chemotherapy-related, psychological, fatigue and pain, and gastrointestinal symptoms, regardless of the dimension used, were identified. The content and number of symptoms within each cluster using the distress dimension were slightly different from the occurrence dimension. The findings call for an early comprehensive assessment and treatment of symptoms for patients undergoing chemotherapy. Also, healthcare providers especially nurses need to thoroughly assess and manage these symptoms to ease patients' experience, enhance their compliance and improve their quality of life.
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Affiliation(s)
- Mohammad Al Qadire
- Sultan Qaboos University, Muscat, Sultanate of Oman.,Al Al-Bayt University, Mafraq, Jordan
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Suskin JA, Paul S, Stuckey AR, Conley YP, Miaskowski C, Dunn LB. Risk factors for worse anxiety trajectories among patients undergoing cancer chemotherapy. Support Care Cancer 2023; 31:32. [DOI: 10.1007/s00520-022-07481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
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Suskin JA, Paul S, Stuckey AR, Conley YP, Hammer MJ, Miaskowski C, Dunn LB. Anxiety trajectories: An observational study of women undergoing chemotherapy for breast or gynecological cancer. Eur J Oncol Nurs 2022; 61:102227. [DOI: 10.1016/j.ejon.2022.102227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/09/2022] [Indexed: 11/17/2022]
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An Investigation of Symptom Clusters and Sentinel Symptoms During the First 2 Cycles of Postoperative Chemotherapy in Patients With Lung Cancer. Cancer Nurs 2022; 45:488-496. [PMID: 35089876 DOI: 10.1097/ncc.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lung cancer has the highest incidence and mortality of all cancers in China. Patients after a lobectomy experience serious physical and psychological symptoms during chemotherapy. Studies are lacking about symptom clusters (SCs) and sentinel symptoms during the postoperative chemotherapy period in lung cancer patients. OBJECTIVE The aim of this study was to explore SCs and sentinel symptoms during cycles 1 and 2 of postoperative chemotherapy in patients with lung cancer. METHODS Using a longitudinal study design, patients in treatment for lung cancer were measured at 2 separate points following a lobectomy: chemotherapy cycle 1 and chemotherapy cycle 2. The MD Anderson Symptom Inventory lung cancer-specific module and First Appearance of Symptoms Time Sheet were completed. RESULTS A total of 180 postoperative patients with lung cancer participated in the study. Four SCs were identified at chemotherapy cycle 1: gastrointestinal SC, respiratory tract SC, psychological SC, and somatic SC. The sentinel symptoms were nausea, cough, sadness, and fatigue. At chemotherapy cycle 2, similar SCs were identified, with the exception of merging the psychological SC and somatic SC, resulting in 3 clusters: gastrointestinal SC, respiratory tract SC, and psychological-somatic SC. The sentinel symptoms were nausea, cough, and fatigue. CONCLUSIONS Symptom clusters and sentinel symptoms were stable during the first 2 cycles of postoperative chemotherapy in patients with lung cancer. IMPLICATIONS FOR PRACTICE The understanding of SCs and sentinel symptoms could be beneficial to assess and manage both in postoperative patients with lung cancer during chemotherapy. Nurses should pay close attention to sentinel symptoms and develop effective interventions.
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Haryani, Hsu YY, Wang ST. Symptom clusters change over time among patients with gynecological cancer receiving chemotherapy. Eur J Oncol Nurs 2022; 60:102193. [PMID: 36030751 DOI: 10.1016/j.ejon.2022.102193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE This study aimed to explore symptom clusters at different time points among patients with gynecological cancer undergoing chemotherapy. METHODS A longitudinal design was used to explore the patterns of symptom clusters four times: during prechemotherapy (T0), first (T1), second (T2), and third (T3) cycles of chemotherapy. The Memorial Symptom Assessment Scale was used to assess the dimension of symptoms. The study was conducted in Indonesia. Exploratory factor analysis was used to analyze the structures of symptom clusters across time. RESULTS A total of 120 subjects provided baseline data, and 82 were retained at T3. Before chemotherapy, the most prevalent symptoms were pain and difficulty in sleeping. However, after starting chemotherapy, the patients suffered from chemotherapy-related side effects, including nausea, change in taste, lack of appetite, hair loss, fatigue, and feeling of "I don't look like myself." Six symptom clusters were identified in patients with gynecological cancer across four time points during chemotherapy: pain-related, nutritional, emotional, hormonal-related, fatigue-related, and body-image symptom clusters. Nutrition and emotion symptom clusters occurred consistently from T0 to T3, fatigue-related clusters appeared after chemotherapy at T1 and T2, and body-image symptom clusters emerged at late T2 and T3. CONCLUSION The structures of symptom clusters in this study were dynamic and various. The nutrition and emotional-related symptoms constituted a cluster during chemotherapy. Oncology nurses should provide physical and psychosocial interventions to relieve these symptoms in patients with gynecological cancer undergoing chemotherapy.
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Affiliation(s)
- Haryani
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Yu-Yun Hsu
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan.
| | - Shan-Tair Wang
- Professor & Deputy Superintendent Ditmanson Medical Foundation, Chiayi Christian Hospital
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The effect of spiritual well-being on symptom experience in patients with cancer. Support Care Cancer 2022; 30:6767-6774. [PMID: 35525850 DOI: 10.1007/s00520-022-07104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To explore the effect of spiritual well-being on the symptom experience of patients with cancer. METHODS This is a cross-sectional survey that enrolled 459 patients with cancer from three large hospitals in Jordan in 2018. Participants completed questionnaires related to demographic data, spiritual well-being, and symptom experience. Additional information was obtained from the medical record review. We then conducted multiple regression to evaluate if spiritual well-being predicts the patients' reported symptom distress. RESULTS Patients reported thirty-six symptoms. Of which 15 have a prevalence of more than 30%. Fatigue was the most prevalent symptom (n = 282, 61.4%), followed by pain (n = 243, 52.9%) and anxiety (n = 230, 50.1%). Spiritual well-being predicted 7.1% of the total variance in patients' symptom distress (F, 19.650; p < 0.0001). Additional predictors were gender, education level, having a problem covering the treatment cost, family cancer history, and whether taking a complementary treatment or not. CONCLUSIONS Patients with cancer experience multiple symptoms related to the disease and its treatment. Improving patients' spiritual well-being through an increased sense of meaning and peace can improve cancer symptom experience by decreasing symptom distress. In general, hospitals in Jordan focus on direct symptom management and do not look after patients' spiritual needs. Raising awareness about the importance of patients' spiritual well-being and providing appropriate spiritual assessment and interventions to patients with spiritual distress can improve patients' symptom experience.
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He X, Ng M, Choi K, Li L, Zhao W, Zhang M, So W. Synergistic Interactions Among Fatigue, Sleep Disturbance, and Depression in Women With Breast Cancer: A Cross-Sectional Study. Oncol Nurs Forum 2022; 49:243-254. [PMID: 35446832 DOI: 10.1188/22.onf.243-254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the symptom cluster of fatigue, sleep disturbance, and depression among female patients with breast cancer receiving chemotherapy, and to evaluate its impact on quality of life (QOL) and symptom severity. SAMPLE & SETTING 372 patients receiving adjuvant chemotherapy recruited from two tertiary hospitals in China. METHODS & VARIABLES Symptom severity and QOL were evaluated using the Brief Fatigue Inventory, Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, and Functional Assessment of Cancer Therapy-Breast on the eighth day after receiving chemotherapy. RESULTS All symptoms positively correlated with each other. Although the symptom cluster was significantly associated with decreased QOL, individualized symptom severity worsened as the number of symptoms increased. IMPLICATIONS FOR NURSING The prevalence of and interactions among fatigue, sleep disturbance, and depression negatively affect symptom severity and patients' QOL. Conducting early assessment followed by effective cluster-based interventions is needed to manage this symptom cluster.
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Affiliation(s)
| | | | | | - Lulu Li
- Fifth Affiliated Hospital of Sun Yat-Sen University
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Harris CS, Kober KM, Conley YP, Dhruva AA, Hammer M, Miaskowski CA. Symptom clusters in patients receiving chemotherapy: A systematic review. BMJ Support Palliat Care 2022; 12:10-21. [PMID: 34921000 PMCID: PMC8857036 DOI: 10.1136/bmjspcare-2021-003325] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Since 2001, symptom cluster research has grown considerably. However, because multiple methodological considerations remain, ongoing synthesis of the literature is needed to identify gaps in this area of symptom science. This systematic review evaluated the progress in symptom clusters research in adults receiving primary or adjuvant chemotherapy since 2016. METHODS Eligible studies were published in English between 1 January 2017 and 17 May 2021; evaluated for and identified symptom clusters 'de novo;' and included only adults being treated with primary or adjuvant chemotherapy. Studies were excluded if patients had advanced cancer or were receiving palliative chemotherapy; symptoms were measured after treatment; symptom clusters were pre-specified or a patient-centred analytic approach was used. For each study, symptom instrument(s); statistical methods and symptom dimension(s) used to create the clusters; whether symptoms were allowed to load on more than one factor; method used to assess for stability of symptom clusters and associations with secondary outcomes and biomarkers were extracted. RESULTS Twenty-three studies were included. Memorial Symptom Assessment Scale was the most common instrument and exploratory factor analysis was the most common statistical method used to identify symptom clusters. Psychological, gastrointestinal, and nutritional clusters were the most commonly identified clusters. Only the psychological cluster remained relatively stable over time. Only five studies evaluated for secondary outcomes. DISCUSSION While symptom cluster research has evolved, clear criteria to evaluate the stability of symptom clusters and standardised nomenclature for naming clusters are needed. Additional research is needed to evaluate the biological mechanism(s) for symptom clusters. PROSPERO REGISTRATION NUMBER CRD42021240216.
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Affiliation(s)
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anand A. Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Christine A. Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA,School of Medicine, University of California, San Francisco, CA, USA
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D’Silva F, Javeth A, Singh P. Cancer-Related Fatigue – Clinical Evaluation Scales and Interventions: A Systematic Review. Indian J Palliat Care 2022; 28:88-98. [PMID: 35673374 PMCID: PMC9165454 DOI: 10.25259/ijpc_455_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cancer-related fatigue (CRF) is one of the most frequent and prevalent symptoms expressed by cancer patients and cancer survivors. It is a multifactorial phenomenon that causes a direct detrimental impact on quality of life. Objectives: This systematic review aims to identify different clinical evaluation scales and interventions available for fatigue associated with cancer. Materials and Methods: A methodology of the systematic literature review was carried out. Two separate databases PubMed and Google Scholar searches were performed using different MeSH terms. Results: A total of 2611 research articles were screened and identified 10 unidimensional scales (four with one item scales and six with numerous item scales) and 13 multidimensional scales which are available for the screening and clinical evaluation of fatigue. Reviews have also revealed non-pharmacological interventions such as exercise, complementary therapies, nutritional and psychoeducational interventions, sleep therapy, energy therapy, bright white light, restorative therapies upcoming anthroposophical medicine, and various pharmacological agents effective in managing CRF. Conclusion: Clinical evaluation of fatigue and its management is crucial for improving the quality of life. Yet, more rigorous research studies with higher statistical power need to be conducted on these interventions to generate adequate evidences for managing the CRF.
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Affiliation(s)
- Fatima D’Silva
- Department of Medical Surgical Nursing, Nitte Usha Institute of Nursing Sciences, NITTE (Deemed to Be University), Mangalore, Karnataka, India,
| | - Athar Javeth
- Department of Medical Surgical Nursing, College of Nursing, Patna, Bihar, India,
| | - Pritanjali Singh
- Department of Radiation Oncology, All India Institute of Medical Science, Patna, Bihar, India,
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17
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Hajj A, Hachem R, Khoury R, Hallit S, ElJEBBAWI B, Nasr F, El Karak F, Chahine G, Kattan J, Rabbaa Khabbaz L. Clinical and genetic factors associated with anxiety and depression in breast cancer patients: a cross-sectional study. BMC Cancer 2021; 21:872. [PMID: 34330229 PMCID: PMC8323303 DOI: 10.1186/s12885-021-08615-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/15/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the progress in assessment and treatment of breast cancer, being diagnosed with it or receiving chemotherapy treatment is still conceived as a traumatic experience. Women develop negative thoughts about life and death with detrimental effects on their daily physical functioning/activities, emotional state and overall quality of life. The aim of our study was to evaluate the level of anxiety and depression among breast cancer patients receiving chemotherapy and explore the correlation between these psychological disorders, clinical, sociodemographic and genetic factors. METHODS A cross-sectional study was conducted among breast cancer patients undergoing intravenous chemotherapy at the oncology outpatient unit of Hôtel-Dieu de France hospital (November 2017-June 2019; Ethical approval number: CEHDF1016). All patients gave their written informed consent and completed several validated scales, including the Hospital Anxiety and Depression scale (HADS) for the assessment of anxiety and depression. Sleep quality, insomnia, cognitive function, fatigue and pain were also evaluated. Genotyping for certain gene polymorphisms (CLOCK, PER2, CRY2, OPRM1, ABCB1, COMT, DRD2) was performed using the Lightcycler® (Roche). RESULTS A total of 112 women was included. The prevalence of depression was 43.4%, and 56.2% of the patients reported anxiety (based on the HADS classification). Multivariable analysis showed that higher cognitive scores and taking fosaprepitant were significantly associated with lower depression and anxiety scores. Moreover, being married compared to single was also associated with lower depression scores, whereas higher PSQI scores (worse sleep quality) and having the PER2 AA variant genotype compared to GG were significantly associated with higher depression scores. Finally, reporting a more severe insomnia and having the COMT Met/Met genotype were significantly associated with a higher anxiety score. CONCLUSIONS Our study demonstrated a strong relationship between depression scores and cognitive impairment, sleep quality, marital status, fosaprepitant intake, and PER2 polymorphism, while anxiety scores were correlated to cognitive impairment, insomnia severity, fosaprepitant intake, and COMT polymorphism. The association with PER polymorphism was not previously reported. Identification of genetic and clinical risk factors for anxiety and depression would help clinicians implement an individualized management therapy aiming at preventing and alleviating the burden of these symptoms in breast cancer patients, hence improving their overall quality of life.
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Affiliation(s)
- Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon. .,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculté de pharmacie, Saint-Joseph University, Beirut, Lebanon.
| | - Roula Hachem
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculté de pharmacie, Saint-Joseph University, Beirut, Lebanon
| | - Rita Khoury
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculté de pharmacie, Saint-Joseph University, Beirut, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB (Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Bashar ElJEBBAWI
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculté de pharmacie, Saint-Joseph University, Beirut, Lebanon
| | - Fady Nasr
- Department of Hemato-Oncology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Fadi El Karak
- Department of Hemato-Oncology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Georges Chahine
- Department of Hemato-Oncology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Joseph Kattan
- Department of Hemato-Oncology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Lydia Rabbaa Khabbaz
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculté de pharmacie, Saint-Joseph University, Beirut, Lebanon
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18
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Factors associated with sleep disturbances in women undergoing treatment for early-stage breast cancer. Support Care Cancer 2021; 30:157-166. [PMID: 34244851 PMCID: PMC8270775 DOI: 10.1007/s00520-021-06373-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/19/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to examine factors associated with sleep disturbance in women receiving adjuvant therapy for breast cancer. METHODS This study employed a cross-sectional design using data collected at 3 months post-surgery from an ongoing longitudinal parent study. Participant data were divided into adjuvant treatment groups (chemotherapy, radiation, and aromatase inhibitors) and no adjuvant treatment groups. Symptoms were measured using patient self-report measures. Analysis of variance was used to assess between adjuvant treatment group differences in sleep disturbance. Regression analysis was performed to assess the relationship between sleep disturbance and other symptoms within adjuvant treatment groups. RESULTS The sample included 156 women diagnosed with early-stage breast cancer. There were significant differences in levels of reported sleep disturbance between treatment groups (p = 0.049), with significantly higher levels of sleep disturbances in those receiving radiation compared to those receiving no adjuvant treatment (p = 0.038) and in those receiving chemotherapy and those receiving no adjuvant treatment (p = 0.027). Increased sleep disturbance was found to be a significant predictor for increased pain severity, nausea severity, anxiety, depressive symptoms, fatigue, decreased physical function, and decreased ability to participate in social roles and activities. Co-occurring symptoms with sleep disturbance differed between adjuvant treatment groups. Sleep disturbance was also associated with younger age (p = 0.008). CONCLUSIONS Patients undergoing chemotherapy or radiation for breast cancer report higher levels of sleep disturbance than those not receiving adjuvant therapy. Sleep disturbance is associated with other symptoms experienced by patients with cancer and thus requires continual assessment and future research into effective interventions.
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19
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Min SH, Docherty SL, Im EO, Yang Q. Identification of Symptom Clusters Among Midlife Menopausal Women with Metabolic Syndrome. West J Nurs Res 2021; 44:838-853. [PMID: 34039103 DOI: 10.1177/01939459211018824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to identify and compare symptom clusters in midlife menopausal women with and without metabolic syndrome based on symptom occurrence and severity dimension through secondary data analysis of the Study of Women's Health Across the Nation. Exploratory factor analysis was used to group symptoms that are highly correlated with each other and verified by confirmatory factor analysis. Midlife menopausal women with metabolic syndrome (n = 424) experienced mental health, vasomotor, and somatic cluster across both symptom dimensions. In contrast, midlife menopausal women without metabolic syndrome (n = 1022) experienced mental health/sleep/urinary, vasomotor, and somatic cluster for symptom occurrence dimension and mental health/sleep, vasomotor/genital, and somatic cluster for symptom severity dimension. This is the first study to identify symptom clusters in midlife menopausal women with metabolic syndrome, who are at risk for experiencing complex symptoms associated with menopause transition and metabolic syndrome, and to compare symptom clusters to those without metabolic syndrome.
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Affiliation(s)
- Se Hee Min
- School of Nursing, Duke University, Durham, NC, USA
| | | | - Eun-Ok Im
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Qing Yang
- School of Nursing, Duke University, Durham, NC, USA
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20
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Tabudlo JB. A Proposed Theory of Symptom Cluster Management. BELITUNG NURSING JOURNAL 2021; 7:78-87. [PMID: 37469941 PMCID: PMC10353591 DOI: 10.33546/bnj.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 07/21/2023] Open
Abstract
Background Symptom cluster management is in its early stages in many chronic and debilitating illnesses. The development of a proposed theory should be an initial step in advancing this area of interest. Objective This article presents the development of a Proposed Theory of Symptom Cluster Management. Methods The concept analysis, statement synthesis, and theory synthesis by Walker and Avant were used in the development of this proposed theory. A search from July to September 2020 for published empirical and theoretical articles was conducted in scientific databases, expanded on the web, and secondary references from identified articles. Results The Proposed Theory of Symptom Cluster Management is both a descriptive and explanatory theory. The defining characteristics of symptom cluster management include the basic and effectiveness components. Antecedents for symptom cluster management include socio-demographic characteristics, symptom cluster characteristics, individual clinical characteristics, individual illness factors, and situational factors or symptom experience. The consequences are clustered as personal-related, health-related, social-related outcomes, and existential outcomes. Measurement tools for the antecedents and outcomes in symptom cluster management and the analytical and statistical strategies were considered. Relational statements were also identified. Theoretical assertions were advanced. Conclusion The Proposed Theory of Symptom Cluster Management may provide a holistic approach because it integrates both the symptom cluster and management strategies. The concepts, statements including the complete representation of the proposed theory identified in this article, may provide cues to policymakers and clinical researchers towards the development of tailored interventions and programs.
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Affiliation(s)
- Jerick B. Tabudlo
- University of the Philippines Manila, College of Nursing, Philippines
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21
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So WKW, Law BMH, Ng MSN, He X, Chan DNS, Chan CWH, McCarthy AL. Symptom clusters experienced by breast cancer patients at various treatment stages: A systematic review. Cancer Med 2021; 10:2531-2565. [PMID: 33749151 PMCID: PMC8026944 DOI: 10.1002/cam4.3794] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Breast cancer patients often experience symptoms that adversely affect their quality of life. It is understood that many of these symptoms tend to cluster together: while they might have different manifestations and occur during different phases of the disease trajectory, the symptoms often have a common aetiology that is a potential target for intervention. Understanding the symptom clusters associated with breast cancer might usefully inform the development of effective care plans for affected patients. The aim of this paper is to provide an updated systematic review of the known symptom clusters among breast cancer patients during and/or after cancer treatment. A search was conducted using five databases for studies reporting symptom clusters among breast cancer patients. The search yielded 32 studies for inclusion. The findings suggest that fatigue-sleep disturbance and psychological symptom cluster (including anxiety, depression, nervousness, irritability, sadness, worry) are the most commonly-reported symptom clusters among breast cancer patients. Further, the composition of symptom clusters tends to change across various stages of cancer treatment. While this review identified some commonalities, the different methodologies used to identify symptom clusters resulted in inconsistencies in symptom cluster identification. It would be useful if future studies could separately examine the symptom clusters that occur in breast cancer patients undergoing a particular treatment type, and use standardised instruments across studies to assess symptoms. The review concludes that further studies could usefully determine the biological pathways associated with various symptom clusters, which would inform the development of effective and efficient symptom management strategies.
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Affiliation(s)
- Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bernard M H Law
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marques S N Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaole He
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dorothy N S Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alexandra L McCarthy
- School of Nursing, Midwifery and Social Work, University of Queensland and Mater Health Services, Brisbane, Queensland, Australia
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22
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Wiggenraad F, Bolam KA, Mijwel S, van der Wall E, Wengström Y, Altena R. Long-Term Favorable Effects of Physical Exercise on Burdensome Symptoms in the OptiTrain Breast Cancer Randomized Controlled Trial. Integr Cancer Ther 2021; 19:1534735420905003. [PMID: 32090630 PMCID: PMC7040931 DOI: 10.1177/1534735420905003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: We evaluate longitudinal changes in symptom clusters and core burdensome symptoms in breast cancer patients who participated in the OptiTrain trial. Methods: 240 women were randomized to 16 weeks of supervised exercise (RT-HIIT or AT-HIIT) or usual care (UC) during adjuvant chemotherapy. Symptom clusters were composed using the Memorial Symptom Assessment Scale (MSAS), assessed at baseline, 16 weeks and 12 months later. Three symptom clusters were formed. Results: Three symptom clusters were identified: "emotional," "treatment-related toxicity," and "physical," with core burdensome symptoms present over time. At 16 weeks, the reported burdens of "feeling sad" (RT-HIIT vs UC: effect size [ES] = -0.69; AT-HIIT vs UC: ES = -0.56) and "feeling irritable" (ES = -0.41 RT-HIIT; ES = -0.31 AT-HIIT) were significantly lower in both intervention groups compared with UC. At 12 months, the AT-HIIT group continued to have significantly lower scores for the core burdensome symptoms "feeling sad" (ES = -0.44), "feeling irritable" (ES = -0.44), and "changes in the way food tastes" (ES = -0.53) compared with UC. No between-group differences were found for physical symptoms. Conclusion: We identified 3 symptom clusters in breast cancer patients during and after adjuvant chemotherapy, composed of "emotional," "treatment-related toxicity," and "physical" symptoms. After treatment completion up to 12 months post-baseline, patients in the physical exercise groups reported lower symptom burden scores for emotional symptoms, compared with UC. Our findings indicate a preserved and long-term beneficial effect of physical exercise on self-reported emotional well-being in chemotherapy-treated breast cancer patients.
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Affiliation(s)
| | | | | | | | - Yvonne Wengström
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Renske Altena
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
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23
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Rha SY, Lee J. Stable Symptom Clusters and Evolving Symptom Networks in Relation to Chemotherapy Cycles. J Pain Symptom Manage 2021; 61:544-554. [PMID: 32828931 DOI: 10.1016/j.jpainsymman.2020.08.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/02/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT The existence of stable symptom clusters with variations or changes in cluster membership and the merging of symptom clusters over time urge us to investigate how symptom relationships change over time. OBJECTIVES To identify stable symptom clusters and understand networks among symptoms using longitudinal data. METHODS Secondary data analysis was conducted using data from a nonblinded randomized clinical trial, which evaluated the effect and feasibility of the developed cancer symptom management system. For the present study, data from all participants of the original trial were analyzed (N = 249). The severity of 20 symptoms was measured before the start of chemotherapy (CTx) and during the initial four cycles of CTx. Symptom clusters were identified using principal component and hierarchical cluster analyses, and network analysis was used to explore the relationships among symptoms. RESULTS Three common symptom clusters were identified. The first cluster consisted of anxiety, depression, sleep disturbance, pain, and dyspnea. Fatigue, difficulty concentrating, and drowsiness formed a second stable cluster throughout the CTx cycles. The third cluster comprised loss of appetite, taste change, nausea, and vomiting. In terms of the symptom networks, close relationships were recognized, irrespective of symptom severity level, between anxiety and depression, fatigue and drowsiness, and loss of appetite and taste change. Fatigue was the most central symptom with the highest strength. Edge thickening after starting CTx demonstrated evolving symptom networks in relation to CTx cycles. CONCLUSION Stable symptom clusters and evolving networks were identified. The most central symptom was fatigue; however, the paucity of studies that investigated symptom networks and central symptoms calls for further investigations on these phenomena. Identification of central symptoms and underlying mechanisms will guide efficient symptom management. Future studies will need to focus on developing comprehensive interventions for managing symptom clusters or targeting central symptoms.
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Affiliation(s)
- Sun Young Rha
- College of Medicine & Yonsei Cancer Center, Yonsei University, Seoul, Korea
| | - Jiyeon Lee
- College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea.
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24
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Psychoneurological symptom cluster in breast cancer: the role of inflammation and diet. Breast Cancer Res Treat 2020; 184:1-9. [DOI: 10.1007/s10549-020-05808-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/15/2020] [Indexed: 12/20/2022]
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25
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Sheikh-Wu SF, Downs CA, Anglade D. Interventions for Managing a Symptom Cluster of Pain, Fatigue, and Sleep Disturbances During Cancer Survivorship: A Systematic Review. Oncol Nurs Forum 2020; 47:E107-E119. [PMID: 32555558 DOI: 10.1188/20.onf.e107-e119] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION More than 40% of cancer survivors experience a symptom cluster of pain, fatigue, and sleep disturbances, which can greatly reduce quality of life. LITERATURE SEARCH A literature search was performed using CINAHL®, Google ScholarTM, PubMed®, PsycINFO®, and Web of Science. Articles included randomized controlled trials of interventions aimed at managing a symptom cluster of pain, fatigue, and sleep disturbances. DATA EVALUATION 11 studies were assessed for quality, risk of bias, cancer type, sample size, intervention type, duration, and setting. For an intervention to be considered effective, the reduction of symptom severity or distress had to be statistically significant. SYNTHESIS Data from the 11 studies were summarized. Four interventions were found to be effective in managing the symptom cluster, but evidence on long-term effectiveness was insufficient. IMPLICATIONS FOR NURSING Oncology nurses can assess the patterns and characteristics of simultaneous symptoms experienced by cancer survivors and administer interventions to relieve symptom burden and improve quality of life.
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26
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Al Qadire M, Shamieh O, Abdullah S, Albadainah F. Symptom Clusters' Content, Stability and Correlation with the Quality of Life in a Heterogeneous Group of Cancer Patients: A Large-Scale Longitudinal Study. Clin Nurs Res 2020; 29:561-570. [PMID: 32525398 DOI: 10.1177/1054773820933449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cancer-related symptoms can negatively affect the quality of life, hinder or delay treatment, and increase suffering. This study aimed to explore symptom clusters among Jordanian cancer patients. A longitudinal survey design was used. The sample consisted of 1280 cancer patients treated in three selected hospitals. Two-thirds of the participants were female (63.5%) with a mean age of 52.7 SD 13.8 years and 40.3% had breast cancer. Five clusters were identified, the first was the psychological cluster of eight symptoms; the second was the treatment side-effects cluster consisting of ten symptoms; the third was the nausea and vomiting cluster comprising four symptoms; the fourth was the pain cluster comprising four symptoms; and last was the fatigue cluster, with three symptoms. Cancer patients through the journey of cancer treatment have several symptoms that tend to occur in five clusters which are negatively correlated with their quality of life.
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27
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Berger AM, Kumar G, LeVan TD, Meza JL. Symptom Clusters and Quality of Life over 1 Year in Breast Cancer Patients Receiving Adjuvant Chemotherapy. Asia Pac J Oncol Nurs 2020; 7:134-140. [PMID: 32478130 PMCID: PMC7233556 DOI: 10.4103/apjon.apjon_57_19] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/16/2019] [Indexed: 12/23/2022] Open
Abstract
Objective: Evidence is scant regarding symptom clusters and quality of life (QOL) over 1 year in women who receive adjuvant breast cancer chemotherapy (CTX). Our purpose was to identify the prevalence and severity of individual symptoms, symptom clusters, and QOL in women receiving adjuvant breast cancer CTX from baseline over 1 year. Methods: Symptoms were identified in a sample (n = 219) at three times: baseline (prior to the first adjuvant CTX treatment), 1 month after the last CTX (approximately 6 months after baseline), and 1 year after baseline. The Hospital Anxiety and Depression Scale and Symptom Experience Scale measured symptoms. The Medical Outcomes Study, Short-Form Survey, measured QOL. Exploratory factor analysis identified symptom clusters at each time and core symptoms in clusters over time. Results: The prevalence and severity of 10 symptoms decreased over time (P < 0.05). Fatigue, sleep disturbance, and pain were most prevalent; all were of mild severity. Two symptom clusters were identified at baseline and one met internal consistency reliability criteria at the later times. Core symptoms were identified. Both the physical and mental component scores of QOL improved over time (P < 0.01), but physical was below the general population norms 1 year after baseline. Conclusions: The symptom experience was dynamic, and symptom clusters changed over 1 year. Despite mild severity, core symptoms and clusters persisted over 1 year, and physical health was below the general population norms. Breast cancer survivors with persistent single and co-occurring symptoms need to be taught to manage the patterns of symptoms over time because they may not resolve by 1 year.
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Affiliation(s)
- Ann M Berger
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gaurav Kumar
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tricia D LeVan
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jane L Meza
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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28
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Li H, Sereika SM, Marsland AL, Conley YP, Bender CM. Symptom Clusters in Women With Breast Cancer During the First 18 Months of Adjuvant Therapy. J Pain Symptom Manage 2020; 59:233-241. [PMID: 31610271 DOI: 10.1016/j.jpainsymman.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 02/09/2023]
Abstract
CONTEXT Women with breast cancer treated with aromatase inhibitor (AI) therapy experience multiple concurrent symptoms or symptom clusters. Understanding of the symptom experience and identifying symptom clusters before and during AI therapy are important for the development of interventions to improve clinical outcomes. OBJECTIVES The aim of this study was to identify symptom clusters experienced by women with breast cancer treated with AI therapy from pre-adjuvant therapy up to 18 months of adjuvant therapy using a broad scope of symptoms assessment. METHODS Forty-seven symptoms were evaluated in postmenopausal women with breast cancer (N = 354) who received AI therapy or chemotherapy followed by AI therapy. Symptoms were assessed at four semiannual time points with the Breast Cancer Prevention Trial Symptom Checklist, Patient's Assessment of Own Functioning Inventory, Beck Depression Inventory-II, and Profile of Mood States Tension/Anxiety and Fatigue/Inertia subscales. Exploratory factor analyses were conducted at each time point to identify symptom clusters. RESULTS Four stable symptom clusters (i.e., musculoskeletal, vasomotor, urinary, sexual) and three relatively stable symptom clusters (i.e., psychological, neurocognitive, weight) were identified across the 18-month follow-up period. The gastrointestinal symptom cluster only appeared at after six months of adjuvant therapy (postchemotherapy). CONCLUSION This study helps us to better understand the most common symptom clusters over the first 18 months of adjuvant therapy among postmenopausal women with early-stage breast cancer. It is critical for health care providers to know the symptom clusters commonly experienced by women receiving AI therapy with or without chemotherapy and manage them properly over time.
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Affiliation(s)
- Hongjin Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Susan M Sereika
- Department of Health and Community Systems, Center for Research and Evaluation, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yvette P Conley
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine M Bender
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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29
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Lin L, Zhang Y, Qian HY, Xu JL, Xie CY, Dong B, Tian L. Auricular acupressure for cancer-related fatigue during lung cancer chemotherapy: a randomised trial. BMJ Support Palliat Care 2019; 11:32-39. [DOI: 10.1136/bmjspcare-2019-001937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 11/03/2022]
Abstract
PurposeTo evaluate the effect of auricular acupressure (AA) on cancer-related fatigue (CRF), sleep disturbance and anxiety in lung cancer patients undergoing chemotherapy.Materials and methodsPatients were recruited from the respiratory department of a general hospital and were randomised into three groups. A 9-week course of AA using Semen Vaccariae (SV) (Group A)/AA using magnetic beads (Group B)/routine care (Group C) was implemented. CRF scores were used as the primary outcome while the sleep and anxiety scores were the secondary outcomes. Analysis of variance and least significant difference t-test were used to determine the intergroup differences and paired-sample t-test was used for the intragroup comparison.Results100 lung cancer patients undergoing chemotherapy were included. Compared with Group C, AA could significantly alleviate CRF (F:24.63, p<0.01), especially for physical and affective fatigue and Group A was more effective for managing physical fatigue than Group B in per-protocol (PP) (−1.75 (−2.69 to –0.82), p<0.01)/Intention to Treat analysis (ITT) (−1.41 (−2.39 to –0.41), p=0.01) analysis. However, AA had no effect on cognitive fatigue. Compared with Group C, only Group A produced significant improvements in sleep quality in PP analysis (−1.17 (−2.23 to –0.10), p=0.03) while it yielded negative results in ITT analysis (−0.82 (−1.74 to 0.10), p=0.08). Compared with Group C, AA could significantly reduce anxiety in PP analysis (F:9.35, p<0.01) while there was no statistical difference between Group B and Group C (−0.95 (−2.81 to 0.90), p=0.31), Group A and Group B (−1.26 (−3.12 to 0.59), p=0.18) in ITT analysis.ConclusionAA can alleviate CRF of lung cancer patients undergoing chemotherapy, especially for physical and affective fatigue. AA using SV is more effective for physical fatigue while AA using magnetic beads works better for anxiety. However, AA cannot improve the sleep quality.Trial registration numberISRCTNregistry (ISRCTN16408424).
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Han CJ, Reding K, Cooper BA, Paul SM, Conley YP, Hammer M, Kober KM, Levine JD, Miaskowski C. Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy. J Pain Symptom Manage 2019; 58:989-1001.e10. [PMID: 31404646 PMCID: PMC6878189 DOI: 10.1016/j.jpainsymman.2019.07.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/27/2019] [Accepted: 07/30/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT Limited evidence suggests that patients with gastrointestinal (GI) cancers receiving chemotherapy (CTX) experience an average of 13 co-occurring symptoms. An alternative to counting symptoms is to evaluate for symptom clusters. OBJECTIVES In a sample of patients with GI cancers receiving CTX (n = 399), we evaluated the occurrence, severity, and distress of 38 symptoms in the week before patients' second or third cycle of CTX (Time 1 [T1]), approximately one week after CTX (Time 2 [T2]), and approximately two weeks after CTX (Time 3 [T3]); evaluated for differences in the number and types of symptom clusters at each of these three assessments using ratings of occurrence, severity, and distress; and evaluated for changes in symptom clusters over time. METHODS Modified version of the Memorial Symptom Assessment Scale collected data on 38 common symptoms. Exploratory factor analyses were used to create the symptom clusters. RESULTS Five distinct symptom clusters were identified across the three symptom dimensions and the three assessments (i.e., psychological, CTX-related, weight change, GI, and epithelial). Psychological, CTX-related, and weight change clusters were relatively stable across all three symptom dimensions and time. Across all three symptom dimensions, GI cluster was identified only at T1 and epithelial cluster was identified at T2 and T3. CONCLUSION The number and types of symptom clusters appear to be relatively stable over time and across the symptom dimensions. Ongoing assessment and management of these clusters is warranted across the entire course of CTX. The underlying mechanism for these clusters warrants investigation.
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Affiliation(s)
- Claire J Han
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Kerryn Reding
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Li H, Sereika SM, Marsland AL, Conley YP, Bender CM. Impact of chemotherapy on symptoms and symptom clusters in postmenopausal women with breast cancer prior to aromatase inhibitor therapy. J Clin Nurs 2019; 28:4560-4571. [PMID: 31469461 DOI: 10.1111/jocn.15047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/24/2019] [Accepted: 08/18/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine and compare the differences in symptoms and symptom clusters between postmenopausal women with early-stage breast cancer who did and did not receive chemotherapy prior to aromatase inhibitor (AI) therapy. BACKGROUND Women with breast cancer often experience multiple concurrent symptoms during AI therapy. The burden of symptoms prior to AI is associated with nonadherence to cancer treatment. To date, few studies have comprehensively explored the symptoms and symptom clusters occurring prior to AI therapy. DESIGN Secondary analysis of a prospective repeated-measures study. METHODS The sample comprised postmenopausal women (N = 339) with breast cancer who would receive AI therapy with or without chemotherapy. We collected information on 48 symptoms after surgery or chemotherapy but before AI therapy using different symptom assessment tools. Mann-Whitney U tests were used to compare the differences in the severity of symptoms between groups. Exploratory factor analysis (EFA) was conducted to determine symptom clusters. This study followed STROBE guidelines. RESULTS The most severe symptoms among women with breast cancer prior to AI therapy were breast sensitivity, unhappy with the appearance of my body, general aches and pain, joint pain and muscle stiffness. Women who received chemotherapy prior to AI therapy experienced significantly higher severity of 22 symptoms than women who did not receive chemotherapy. Through EFA seven distinct symptom clusters were revealed in both groups: cognitive, musculoskeletal, psychological, vasomotor, weight, sexual and urinary, with additional gastrointestinal symptom cluster been identified in women who received chemotherapy. CONCLUSIONS This study indicates the presence of symptoms among women with breast cancer prior to AI therapy, with higher severity of symptoms and greater number of symptom clusters for women who received chemotherapy. RELEVANCE TO CLINICAL PRACTICE Nurses should assess and be aware of symptoms and symptom clusters existed prior to AI therapy and manage them in advance.
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Affiliation(s)
- Hongjin Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan M Sereika
- Center for Research and Evaluation & Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Catherine M Bender
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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Han CJ, Reding K, Cooper BA, Paul SM, Conley YP, Hammer M, Wright F, Cartwright F, Levine JD, Miaskowski C. Symptom Clusters in Patients With Gastrointestinal Cancers Using Different Dimensions of the Symptom Experience. J Pain Symptom Manage 2019; 58:224-234. [PMID: 31077784 PMCID: PMC6679763 DOI: 10.1016/j.jpainsymman.2019.04.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 12/26/2022]
Abstract
CONTEXT Patients with gastrointestinal (GI) cancers undergoing chemotherapy (CTX) experience multiple cooccurring symptoms. OBJECTIVES The aim of this study was to describe the occurrence, severity, and distress of 38 symptoms and to identify symptom clusters based on three symptom dimensions (i.e., occurrence, severity, and distress) in patients with GI cancers receiving CTX (n = 399). We compared whether the numbers and types of symptom clusters differed based on the dimension of the symptom experience used to create the clusters. METHODS A modified version of the Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress of 38 symptoms before the initiation of the patient's next dose of CTX. Exploratory factor analysis was used to determine the symptom clusters. RESULTS These patients experienced 13.0 (±7.1) symptoms before their second or third dose of CTX. For all three symptom dimensions, four symptom clusters were identified, namely psychological distress, CTX-related, GI, and weight change. The number and types of symptom clusters were relatively similar using all three symptom dimensions. However, some variability was found in the specific symptoms within each of the clusters. CONCLUSION Our findings suggest that patients with GI cancers experience multiple cooccurring symptoms. Consistent with previous studies of patients with a variety of cancer diagnoses, psychological and GI clusters are common. Clinicians need to assess for and tailor interventions for these symptom clusters.
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Affiliation(s)
- Claire J Han
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Kerryn Reding
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Frances Cartwright
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Guo M, Wang C, Yin X, Nie L, Wang G. Symptom clusters and related factors in oesophageal cancer patients 3 months after surgery. J Clin Nurs 2019; 28:3441-3450. [PMID: 31162849 DOI: 10.1111/jocn.14935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/29/2019] [Accepted: 05/26/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Min Guo
- School of Nursing Shandong University Jinan China
| | - Cui Wang
- School of Nursing Shandong University Jinan China
| | - Xiumin Yin
- School of Nursing Shandong University Jinan China
| | - Liting Nie
- School of Nursing Shandong University Jinan China
| | - Gongchao Wang
- School of Nursing Shandong University Jinan China
- Shandong Provincial Hospital Affiliated to Shandong University Jinan China
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Stability of symptom clusters and sentinel symptoms during the first two cycles of adjuvant chemotherapy. Support Care Cancer 2018; 27:1687-1695. [DOI: 10.1007/s00520-018-4413-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 08/08/2018] [Indexed: 11/12/2022]
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Sullivan CW, Leutwyler H, Dunn LB, Cooper BA, Paul SM, Levine JD, Hammer M, Conley YP, Miaskowski CA. Stability of Symptom Clusters in Patients With Breast Cancer Receiving Chemotherapy. J Pain Symptom Manage 2018; 55:39-55. [PMID: 28838866 PMCID: PMC5734998 DOI: 10.1016/j.jpainsymman.2017.08.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 01/08/2023]
Abstract
CONTEXT Patients with breast cancer who undergo chemotherapy (CTX) experience between 10 and 32 concurrent symptoms. An evaluation of how these symptoms cluster together and how these symptom clusters change over time may provide insights into how to treat these multiple co-occurring symptoms. OBJECTIVES The purposes of this study were to determine the occurrence rates and severity ratings for 38 common symptoms, evaluate for differences in the number and types of symptom clusters, and evaluate for changes over time in these symptom clusters (i.e., before CTX, the week after CTX, and two weeks after CTX). METHODS At each of the assessments, a modified version of the Memorial Symptom Assessment Scale was used to assess the occurrence and severity of the 38 symptoms. Exploratory factor analyses were used to extract the symptom clusters. RESULTS Although across the two symptom dimensions (i.e., occurrence and severity) and the three assessments, eight distinct symptom clusters were identified, only five were relatively stable across both dimensions and across time (i.e., psychological, hormonal, nutritional, gastrointestinal, and epithelial). Two of the additional clusters varied by time but not by symptom dimension (i.e., sickness behavior and weight change). The CTX neuropathy cluster was identified only at the assessment performed in the week after CTX. CONCLUSION These findings provide insights into the most common symptom clusters in patients undergoing CTX for breast cancer. In addition, the most common symptoms within each cluster appear to be relatively stable across the two dimensions, as well as across time.
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Affiliation(s)
- Carmen W Sullivan
- School of Nursing, University of California, San Francisco, California, USA
| | - Heather Leutwyler
- School of Nursing, University of California, San Francisco, California, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Differences in symptom clusters identified using symptom occurrence rates versus severity ratings in patients with breast cancer undergoing chemotherapy. Eur J Oncol Nurs 2017; 28:122-132. [PMID: 28478849 DOI: 10.1016/j.ejon.2017.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/07/2017] [Accepted: 04/11/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE One of the unanswered questions in symptom clusters research is whether the number and types of symptom clusters vary based on the dimension of the symptom experience used to create the clusters. Given that patients with breast cancer receiving chemotherapy (CTX), report between 10 and 32 concurrent symptoms and studies of symptom clusters in these patients are limited, the purpose of this study, in breast cancer patients undergoing CTX (n = 515), was to identify whether the number and types of symptom clusters differed based on whether symptom occurrence rates or symptom severity ratings were used to create the clusters. METHODS A modified version of the Memorial Symptom Assessment Scale was used to assess for the occurrence and severity of 38 symptoms, one week after the administration of CTX. Exploratory factor analysis was used to extract the symptom clusters. RESULTS Both the number and types of symptom clusters were similar using symptom occurrence rates or symptom severity ratings. Five symptom clusters were identified using symptom occurrence rates (i.e., psychological, hormonal, nutritional, gastrointestinal, epithelial). Six symptom clusters (i.e., psychological, hormonal, nutritional, gastrointestinal, epithelial, chemotherapy neuropathy) were identified using symptom severity ratings. Across the two dimensions, the specific symptoms within each of the symptom clusters were similar. CONCLUSIONS Identification of symptom clusters in patients with breast cancer may be useful in guiding symptom management interventions. Future studies are warranted to determine if symptom clusters remain stable over a cycle of CTX in patients with breast cancer.
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