Symptom clusters and quality of life in breast cancer survivors after cancer treatment in a tertiary hospital in Korea

Symptom clusters and sentinel symptoms in breast cancer survivors based on self-reported outcomes:A cross-sectional survey

AIM

To investigate symptom clusters and sentinel symptoms in breast cancer survivors based on self-reported outcomes, explore the impact of sentinel symptoms on patients' quality of life and psychological distress, provide a basis for implementing accurate symptom management.

DESIGN

A cross-sectional survey.

METHODS

The study was conducted from September 2021 to December 2022. We recruited 281 patients who were re-examined in an outpatient department of a tertiary hospital in Hebei Province. The European Organization for the Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire - Core30 (QLQ-C30), the EORTC Quality-of-Life Questionnaire Breast Cancer - 23 (QLQ-BR23), the Hospital Anxiety and Depression Scale (HADS) were used to conduct the survey. Symptom clusters were explored using principal component analysis, sentinel symptoms were explored using the Apriori algorithm. Correlation analysis was used to explore the relationship between sentinel symptoms and quality of life, correlation with psychological distress. This paper adhered to the STROBE guidelines.

RESULTS

Breast cancer survivors have a wide range of self-reported symptoms in the form of four symptom clusters: a fatigue symptom cluster, a gastrointestinal symptom cluster, a sickness symptom cluster and a surgical trauma-related symptom cluster. Three sentinel symptoms were explored: pain, alopecia and limited function of the upper limbs. Except for sexual function, all of the sentinel symptoms were negatively correlated with patients' quality of life and positively correlated with psychological distress (p < .05).

CONCLUSIONS

Breast cancer survivors have a variety of symptoms in the form of four symptom clusters. Pain, alopecia and limited function of the upper limbs are the sentinel symptoms, which affect patients' quality of life and psychological distress.

Neuropathic Pain Affects Quality of Life in Breast Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy

BACKGROUND

Despite the significant impact of chemotherapy-induced peripheral neuropathy on the quality of life for breast cancer survivors, there is a notable lack of comprehensive research. Therefore, a crucial need exists for further systematic investigation and inquiry into this matter.

AIMS

This study examined predictors of quality of life in breast cancer survivors with chemotherapy-induced peripheral neuropathy.

DESIGN

A cross-sectional, correlational design.

SETTINGS

This study was conducted at a medical center in northern Taiwan and a teaching hospital in northeastern Taiwan.

PARTICIPANTS/SUBJECTS

One hundred and thirty adult women with breast cancer, who have undergone chemotherapy and obtained a Total Neuropathy Scale-Clinical Version score>0, were enrolled.

METHODS

Neuropathic pain, sleep disturbances, depression, and quality of life were evaluated using multiple regression analysis to identify quality of life predictors. Clinical importance was established using the minimally important difference of Functional Assessment of Cancer Therapy-Breast.

RESULTS

The study indicated that improving depression (B = -10.87, p < .001) and neuropathic pain (B = -8.33, p = .004) may enhance the quality of life of breast cancer survivors with chemotherapy-induced peripheral neuropathy. Moreover, the individual's marital status and family history of breast cancer were identified as predictive factors.

CONCLUSIONS

This study illuminates quality of life determinants for breast cancer survivors with chemotherapy-induced peripheral neuropathy, advocating comprehensive care and addressing depression and neuropathic pain for better outcomes.

Cancer coping self-efficacy, symptoms and their relationship with quality of life among cancer survivors

PURPOSE

Cancer coping self-efficacy refers to an individual's confidence in dealing with challenges from cancer-related events, and a positive association with quality of life (QoL) has been demonstrated. Considering unresolved physical and psychological symptoms at the survivorship phase, which are known to worsen QoL, the association between cancer coping self-efficacy and QoL needs to be evaluated controlling for known contributing factors of QoL. This study aimed to describe cancer survivors' cancer coping self-efficacy, symptoms and their relationship with QoL.

METHODS

A descriptive correlational study was conducted. Participants were cancer survivors who completed intended treatment except for hormone therapy (N = 240). Cancer coping self-efficacy, symptoms, and QoL were measured. To evaluate the association of cancer survivors' cancer coping self-efficacy with QoL, correlation and multiple regression analysis were conducted.

RESULTS

Cancer coping self-efficacy demonstrated a significant positive association with QoL. Symptoms had a significant negative association with QoL. Fully active cancer survivors demonstrated significantly better QoL than those with functional deterioration. Self-efficacy for using spiritual coping had a significant positive association with QoL, along with symptoms and functional status, which explained 37.5% of QoL.

CONCLUSIONS

Cancer survivors' QoL was related to spiritual coping self-efficacy, symptoms and functional status. Improving spiritual coping self-efficacy and managing symptoms reflecting survivors' functional status need to be integrated into survivorship care.

Prevalence of Psychoneurological Symptoms and Symptom Clusters in Women with Breast Cancer Undergoing Treatment: Influence on Quality of Life

OBJECTIVES

To identify subgroups of psychoneurological symptoms (PNS) and their relationship to different clinical variables in a sample of women with breast cáncer (BC) with different type of treatment, and the possible influence of these on quality of life (QoL), using a factorial principal components analysis.

DATA SOURCES

Observational, cross-sectional, non-probability study (2017-2021) at Badajoz University Hospital (Spain). A total of 239 women with BC receiving treatment were included.

RESULTS

68% of women presented fatigue, 30% depressive symptoms, 37.5% anxiety, 45% insomnia, and 36% cognitive impairment. The average score obtained for pain was 28.9. All the symptoms were related between themselves, and within the cluster of PNS. The factorial analysis showed three subgroups of symptoms, which accounted for 73% of variance: state and trait anxiety (PNS-1), cognitive impairment, pain and fatigue (PNS-2), and sleep disorders (PNS-3). The depressive symptoms were explained equally by PNS-1 and PNS-2. Additionally, two dimensions of QoL were found (functional-physical and cognitive-emotional. These dimensions correlated with the three PNS subgroups found. A relationship was found between chemotherapy treatment and PNS-3, and its negative impact on QoL.

CONCLUSIONS

A specific pattern of grouped symptoms in a psychoneurological cluster with different underlying dimensions has been identified which negatively influences QoL of survivors of BC.

IMPLICATION FOR NURSING PRACTICE

It is important to raise awareness among professionals and patients about the existence of a cluster of PNS, the patient's profile, as well as the factors that exacerbate them. This will allow them to be treated more effectively and comprehensively.

Symptom Clusters and Quality of Life in Patients With Breast Cancer Receiving Endocrine Therapy in China

OBJECTIVES

Breast cancer patients undergoing endocrine therapy experience various symptoms that have long-term effects on their quality of life. However, which symptom clusters are expressed and affect patients' quality of life remain significantly controversial. Therefore, we aimed to explore symptom clusters among breast cancer patients receiving endocrine therapy and identify the impact of these clusters on their quality of life.

DATA SOURCES

This secondary analysis of data from a cross-sectional study aimed to explore the symptom experiences and quality of life of breast cancer patients receiving endocrine therapy. The participants were invited to complete the Functional Assessment of Cancer Therapy-Breast (FACT-B) and Endocrine Subscale (ES). Principal component analysis, Spearman correlation analyses, and multiple linear regression were used to explore symptom clusters and identify their influence on quality of life.

CONCLUSION

Data from 613 participants were obtained, and 19 symptoms were included in the principal component analysis, which identified five symptom clusters: the systemic, pain and emotional, sexual, vaginal, and vasomotor symptom clusters. Adjustment for covariates revealed that the systemic and pain and emotional symptom clusters were negative predictors of quality of life. The fitted model explained approximately 38.1% of the variance.

IMPLICATIONS FOR NURSING PRACTICE

This study demonstrated that breast cancer patients receiving endocrine therapy experienced symptoms that tended to occur in five clusters (i.e., systemic, pain and emotional, sexual, vaginal, and vasomotor symptoms). Developing interventions for the systemic and pain and emotional symptom clusters may effectively improve patients' quality of life.

Hot flushes and sweating, sleep problems, joint and muscular discomfort, and physical and mental exhaustion in breast cancer survivors during the first 24 months of tamoxifen therapy: a prospective observational study

Purpose

This study aimed to explore symptom trajectories over 24 months for hot flushes and sweating, sleep problems, joint and muscular discomfort, and physical and mental exhaustion experienced by premenopausal women diagnosed with tamoxifen-treated breast cancer.

Methods

A total of 104 patients participated in the study. The menopausal symptoms were examined using the Menopausal Rating Scale at baseline, 3–6, 12, and 18–24 months after initiating tamoxifen. The changes over four time points were analyzed using repeated measures analysis of variance. The chi-square test was used to examine the differences between “no symptom-to-mild” and “moderate-to-extremely severe” 3–6 months after initiating tamoxifen according to the patients’ chemotherapy treatment experiences.

Results

All menopausal symptoms occurred in > 70% of patients with breast cancer and persisted until 24 months. More than 50% of patients experienced four menopausal symptoms, with at least two at a serious severity level after initiating tamoxifen. Hot flushes and sweating occurred in the highest number of patients, recording high scores. Sleep problems and physical and mental exhaustion exhibited relatively high scores, even before tamoxifen initiation. There were significant changes over four time points in all symptoms. Young patients aged < 40 years experienced more severe sleep problems, and patients who had previously received chemotherapy experienced more severe joint and muscular discomfort.

Conclusions

This study’s findings may assist in alerting healthcare providers to menopausal symptoms that develop during tamoxifen therapy and the need for early and active intervention to minimize symptom occurrence and distress.

A present from the forest: Focus group interviews on cancer survivors’ forest experiences

Objective

To explore cancer survivors' forest experiences and to understand the relevance of these experiences from their perspectives in the context of the growing interest in nature's impact on health and quality of life.

Methods

From July 29 to August 12, 2021, four focus group interviews were conducted with cancer survivors who visited forests in South Korea. The data were analyzed using qualitative content and thematic analysis.

Results

The participants were 21 female cancer survivors with a mean age of 58.4 (age range 44–69) years. The focus group interviews revealed three themes and 10 sub-themes regarding subjective perceptions and experiences related to forests. The overarching themes were as follows: (1) awakened bodily senses and fascination with the forest; (2) remedial effect; and (3) a source of inspiration. These three themes capture the impact of forest experiences on participants’ lives and the value they derived from these experiences. The participants considered these experiences a gift from forests. In particular, they experienced aesthetic enrichment and restorative effects such as boosted energy levels, reduced fatigue, and a buffer against mood swings. Finally, forests were a source of inspiration that led the participants toward personal growth.

Conclusions

By gaining a better understanding of survivors' forest experiences, we identified that forest-based interventions for supportive cancer care can align with patients’ values and preferences and serve as a secure space where they can feel cared for. This study can contribute to the development of forest-based interventions for cancer survivorship care.

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Cancer survivors experienced awakened bodily senses and fascination with the forest.

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Cancer survivors realized the remedial effects of forests.

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Forests also became sources of inspiration for cancer survivors.

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These results can contribute to the development of forest-based interventions.

The moderating role of coping flexibility in reports of somatic symptoms among early breast cancer patients

OBJECTIVE

The current study assessed breast cancer patients' somatic symptoms during the first six months post diagnosis and examined the moderating role of coping flexibility (i.e., trauma-focused and forward-focused coping strategies) on the association between reported somatic symptoms three months after breast cancer diagnosis and somatic symptoms six months after diagnosis.

METHOD AND MEASURES

An international sample of 702 women diagnosed with breast cancer from four countries (Finland, Israel, Italy, Portugal) completed self-reported questionnaires at three time points: at the time of diagnosis (M0), three months post diagnosis (M3), and six months post diagnosis (M6). The questionnaires included the coping flexibility scale and questions about demographics, medical data, and somatic symptoms.

RESULTS

The highest level of somatic symptoms was reported after three months post diagnosis (M3), as compared to M0 and M6. Both trauma-focused and forward-focused coping strategies moderated the relationship between somatic symptoms at M3 and somatic symptoms at M6.

CONCLUSION

The findings highlight the importance of assessing somatic symptoms soon after breast cancer diagnosis and throughout the early phase of treatment. Coping flexibility can buffer the stability of the somatic symptoms during this initial phase.

Varying severities of symptoms underline the relevance of personalized follow-up care in breast cancer survivors: latent class cluster analyses in a cross-sectional cohort

PURPOSE

Insights into the severity of co-existing symptoms can help in identifying breast cancer survivors in need of symptom management. We aimed to identify subgroups of breast cancer survivors based on patterns of symptom severity, and characteristics associated with these subgroups.

METHODS

We selected surgically treated stage I-III breast cancer survivors 1-5 years post-diagnosis from the Netherlands Cancer Registry (N = 876). We assessed experienced severity of fatigue, nausea, pain, dyspnea, insomnia, appetite, constipation, diarrhea, and emotional and cognitive symptoms through the EORTC-QLQ-C30 Quality of Life Questionnaire on a scale of 0-100. We determined subgroups of survivors using latent class cluster analyses (LCA) based on severity of co-existing symptoms and compared their mean severity to the age-matched female reference population to interpret clinical relevance. We assessed subgroup characteristics by multinomial logistic regression analyses.

RESULTS

From 404 respondents (46%), three subgroups of survivors with distinct symptom severity were identified: low severity (n = 116, 28.7%), intermediate severity (n = 224, 55.4%), and high severity (n = 59, 14.6%). The low subgroup reported lower symptom severity than the general population; the intermediate subgroup reported a similar symptom severity, although scores for fatigue, insomnia, and cognitive symptoms were worse (small-medium clinical relevance). The high subgroup had worse symptom severity (medium-large clinical relevance). Compared to the intermediate subgroup, one (RRR: 2.75; CI: 1.22-6.19; p = 0.015) or more (RRR: 9.19; CI: 3.70-22.8; p =  < 0.001) comorbidities were significantly associated with the high subgroup. We found no associated treatment characteristics.

CONCLUSION

We identified distinct subgroups of breast cancer survivors based on symptom severity, underlining the relevance of further exploring personalized follow-up strategies.

Symptom clusters and quality of life in ambulatory patients with multiple myeloma

PURPOSE

The aim of this study was to investigate symptom clusters and associated clinical factors in ambulatory multiple myeloma patients undergoing medication therapy. We also aimed to determine the correlations between symptom clusters and patient quality of life.

METHODS

A total of 174 multiple myeloma patients hospitalized in the haematology day unit were included in this study. A cross-sectional survey was conducted to examine symptoms and quality of life. Symptoms were assessed by the Chinese version of the Condensed Memorial Symptom Assessment Scale. Quality of life was measured with the Functional Assessment of Cancer Therapy-General. Principal component analysis was used to identify symptom clusters. Independent-samples t tests and chi-square tests were used for comparisons between groups. Spearman's rank correlation analysis was used to identify correlations.

RESULTS

We identified three symptom clusters in multiple myeloma patients: psychological; pain, dry mouth, and difficulty sleeping; and fatigue symptom cluster. For each symptom cluster, the patients could be categorized into a severe-symptom group or a mild-symptom group based on the distress of symptoms. The patients in each group exhibited differential demographic and clinical features. Symptom cluster distress was adversely correlated with patients' quality of life.

CONCLUSIONS

Ambulatory multiple myeloma patients undergoing anticancer medication therapy experience multiple symptoms, which can be categorized into three symptom clusters. For each symptom cluster, level of distress was associated with patients' demographic and clinical characteristics. The presence and level of distress of these symptom clusters have adverse impacts on patients' quality of life.

Cancer-Related Fatigue – Clinical Evaluation Scales and Interventions: A Systematic Review

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.

Multiple Gastrointestinal Symptoms Are Associated With Chemotherapy-Induced Nausea in Patients With Breast Cancer

BACKGROUND

Unrelieved chemotherapy-induced nausea (CIN) is a significant problem for patients with breast cancer (BC).

OBJECTIVE

In a sample of patients with BC who were assessed before their second or third cycle of chemotherapy, study purposes were to evaluate for the occurrence, severity, frequency, and distress associated with CIN; evaluate for differences in demographic and clinical characteristics and gastrointestinal (GI) symptom occurrence rates between patients who did and did not report CIN; and determine which demographic, clinical, and symptom characteristics were associated with the occurrence of CIN.

METHODS

Patients completed demographic and clinical questionnaires and the Memorial Symptom Assessment Scale for nausea and common GI symptom assessments. Univariate analyses evaluated for differences in demographic and clinical characteristics and GI symptom occurrence between patients who did and did not report CIN. Multiple logistic regression analysis evaluated for characteristics associated with CIN.

RESULTS

Of the 532 patients with BC, 47.2% reported CIN occurrence. Characteristics associated with CIN group membership were poorer functional status, receipt of chemotherapy on a 14-day cycle, and higher occurrence rates of 5 GI symptoms (ie, dry mouth, vomiting, constipation, change in the way food tastes, and lack of appetite; all P < .001).

CONCLUSIONS

Unrelieved CIN is a common symptom in patients with BC. This study is the first to demonstrate that 5 co-occurring GI symptoms were associated with CIN occurrence.

IMPLICATIONS FOR PRACTICE

This study identified new risk factors for CIN occurrence in patients with BC. Clinicians may be able to initiate additional interventions to alleviate CIN.

The Relationship between Work-Related Outcomes and Symptoms in Early Breast Cancer Survivors Receiving Adjuvant Endocrine Therapy

Objective

Methods

Results

Conclusions

Factors associated with the quality of work life among working breast cancer survivors

Objective

In South Korea, the incidence and survival rate of breast cancer are high, and the return-to-work rate of breast cancer survivors continues to increase. However, there are various obstacles after returning to work, which can negatively affect long-term quality of life management. Therefore, the purpose of this study is to identify factors associated with the quality of work life, which is a priority factor in managing the quality of life.

Methods

Data were collected from 169 female breast cancer survivors and participants were selected from three different hospitals in the metropolitan city and snowball sampling was used in conjunction. The participants filled out questionnaires about a variety of factors that may associated with quality of work life (QWL); the data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficient, and multiple linear regression.

Results

All participants were women with an average age of 48.9 years after diagnosis of cancer, with 65.7% married. 46.2% of them were in Cancer stage 1, 65.7% had work experience over six years, and most of them were educated managerial workers, fixed duty. Multiple regression analysis indicated perceived health status, social support of superior and colleagues and spiritual well-being were positive predictors and cancer fatigue and distress were negative predictors of QWL, explaining 49.5% (adjusted R²) (F_10,158 ​= ​17,486, P ​< ​0.001).

Conclusions

For increasing the QWL of working breast cancer survivors, decreasing cancer fatigue and distress and increasing perceived health status, social support, and spiritual wellbeing can be considered. The findings can contribute for developing effective and systematic interventions that consider the identified predictors to enhance the QWL and successful returning to work and job retaining.

Symptom clusters experienced by breast cancer patients at various treatment stages: A systematic review

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.

Symptom Clusters and Quality of Life in Cervical Cancer Patients Receiving Concurrent Chemoradiotherapy: The Mediating Role of Illness Perceptions

OBJECTIVES

Although studies shows that symptom clusters and illness perceptions are negatively associated with quality of life (QoL), it is unclear how these variables of cervical cancer patients who receive concurrent chemoradiotherapy (CCRT) relate to each other. This study aimed to identify the symptom clusters in cervical cancer patients who receive CCRT and evaluate the mediating effect of illness perceptions on the relationship between symptom clusters and QoL.

METHODS

A cross-sectional survey was conducted on 286 cervical cancer patients receiving CCRT from October 2019 to October 2020. M.D. Anderson Symptom Inventory, Brief Illness Perception Questionnaire, and Functional Assessment Cancer Therapy-Cervix were applied to investigate the symptom clusters, illness perceptions and QoL of the participants, respectively. Exploratory factor analysis was conducted to identify symptom clusters. The relationships among symptom clusters, illness perceptions, and QoL were analyzed with the structural equation modeling.

RESULTS

A total of four symptom clusters were identified, including psychological status symptom cluster, therapy side-effect symptom cluster, sickness symptom cluster, and gastrointestinal symptom cluster (χ² = 1,552.282, Df = 78, P < 0.001). Symptom clusters, illness perceptions, and QoL were significantly correlated. Symptom clusters had significant direct (β = -0.38, P < 0.001) and indirect effects (β = -0.21, P < 0.001) on QoL.

CONCLUSION

Illness perceptions played a significant mediating role between symptom clusters and QoL in cervical cancer patients receiving CCRT. Strategies like prompting effective symptom management for the purposes of alleviating illness perceptions may contribute to improving their QoL.

Symptom experiences in post-treatment cancer survivors: associations with acceptance and commitment therapy constructs

PURPOSE

Acceptance and Commitment Therapy (ACT) has improved symptom and quality-of-life outcomes in pilot research with post-treatment cancer survivors. To further test the ACT model, the present study examined relationships between ACT constructs and subgroups of post-treatment survivors based on the severity of common symptoms.

METHODS

Survivors who had completed primary treatment for stage I or II cancer (N = 203) participated in this one-time survey. Latent class analysis (LCA) was used to identify subgroups of survivors based on the severity of fatigue, sleep disturbance, pain, anxiety, and depressive symptoms. Multinomial logistic regressions employing Vermunt's 3-step approach were used to examine ACT constructs (e.g., mindfulness, acceptance, values progress) as correlates of survivor subgroups based on symptoms.

RESULTS

The LCA showed three survivor classes: (1) mild-to-moderate levels of all symptoms except for normal pain intensity; (2) mild anxiety, moderate fatigue, and normal levels of all other symptoms; and (3) normal levels of all symptoms. Lower mindfulness, acceptance, and values progress and higher cognitive fusion, psychological inflexibility, and values obstruction were associated with a greater likelihood of being in class 1 or 2 than in class 3.

CONCLUSION

Findings are consistent with the ACT model. Survivors with greater symptom burden reported greater withdrawal from personally meaningful activities and less acceptance of their cancer diagnosis and internal experiences (e.g., thoughts, feelings, symptoms). Findings provide strong justification for further testing of ACT to reduce symptom-related suffering in cancer survivors.

Pain, fatigue and depression symptom cluster in survivors of prostate cancer

PURPOSE

Pain, fatigue and depression are common sequelae of a cancer diagnosis. The extent to which these occur together in prostate cancer survivors is unknown. We (i) investigated prevalence of the pain-fatigue-depression symptom cluster and (ii) identified factors associated with experiencing the symptom cluster among prostate cancer survivors.

METHODS

Men in Ireland diagnosed with prostate cancer 2-18 years previously were identified from population-based cancer registries and sent postal questionnaires. Cancer-related pain and fatigue were measured using the EORTC QLQ-C30 and depression using the DASS-21. Cut-offs to define 'caseness' were pain ≥ 25, fatigue ≥ 39 and depression ≥ 10. Associations between survivor-related factors, clinical variables and specific prostate cancer physical symptoms and the symptom cluster were assessed using multivariate logistic regression.

RESULTS

A total of 3348 men participated (response rate = 54%). Twenty-four percent had clinically significant pain, 19.7% had clinically significant fatigue, and 14.4% had depression; 7.3% had all three symptoms. In multivariate analysis, factors significantly associated with the symptom cluster were living in Northern Ireland, experiencing back pain at diagnosis and being affected by incontinence, loss of sexual desire, bowel problems, gynecomastia and hot flashes post-treatment. There was a strong association between the cluster and health-related quality of life.

CONCLUSIONS

The pain-fatigue-depression symptom cluster is present in 1 in 13 prostate cancer survivors. Physical after-effects of prostate cancer treatment are associated with this cluster. More attention should be paid to identifying and supporting survivors who experience multiple symptoms; this may help health-related quality of life improve among the growing population of prostate cancer survivors.

Cancer-related Fatigue in Breast Cancer Survivors: A Review

Fatigue has been the most distressing and frequent symptom in breast cancer (BC) survivors after treatment. Although fatigue can occur in other cancer survivors, women with a history of BC might share some distinctive features. The present study aimed to recapitulate the knowledge about risk factors and correlates of cancer-related fatigue (CRF) in BC survivors after oncologic therapy. An electronic data search was conducted in PubMed using the terms "fatigue," "breast," "cancer," and "survivors." Records were included if they were original articles, available in English, had used a quantitative scale, had > 100 participants, and had excluded women with BC relapse. BC survivors were required to have finished their treatments ≥ 2 months before, except for hormonal therapy. The physiopathology and other interventions were considered beyond the scope of our review. The correlates were subsequently classified into 7 main categories: (1) sociodemographic data, (2) physical variables, (3) tumor- and treatment-related variables, (4) comorbidities, (5) other symptoms, (6) psychological issues, and (7) lifestyle factors. Fatigue was consistently greater in younger, obese, and diabetic women. Women reporting fatigue often communicated symptoms such as pain, depression, insomnia, and cognitive dysfunction. Coping strategies such as catastrophizing could play an important role in the persistence of fatigue. However, tumor characteristics, previous treatments received, and physical activity were not consistently reported. CRF was a strong predictor of the quality of life of BC survivors after treatment. In conclusion, we found CRF was a frequent and serious symptom that severely affects the quality of life of BC survivors after treatment. Health practitioners require more awareness and information about CRF.

A Cross-Sectional Exploration of Cytokine-Symptom Networks in Breast Cancer Survivors Using Network Analysis

PURPOSE

The purpose of this study is to (a) visualize the symptom-cytokine networks (perceived stress, fatigue, loneliness, perceived cognitive impairment, daytime sleepiness, sleep quality, and 13 cytokines) and (b) explore centrality metrics of symptom-cytokine networks in breast cancer survivors who completed chemotherapy treatment.

METHODS

Cross-sectional analysis of data collected from 66 breast cancer survivors who were on average three years post chemotherapy completion. Perceived stress, fatigue, loneliness, perceived cognitive impairment, daytime sleepiness, and sleep quality were measured with self-report instruments, and a panel of 13 cytokines was measured from serum using multiplex assays. Symptoms and cytokines were simultaneously evaluated with correlations, network analysis, and community analysis.

RESULTS

Network analysis revealed the nodes with the greatest degree and closeness were interleukin-2, granulocyte-macrophage colony-stimulating factor, interleukin-13, and perceived cognitive impairment. Node betweenness was highest for perceived cognitive impairment and interleukin-2. Community analysis revealed two separate communities of nodes within the network (symptoms and the cytokines). Several edges connected the two communities including perceived cognitive impairment, stress, fatigue, depression, interleukin-2, granulocyte-macrophage colony-stimulating factor, interleukin-8, interleukin-13, and interleukin-10. Partial correlation analyses revealed significant negative relationships between interleukin-2 and fatigue, loneliness, stress, and perceived cognitive impairment (rs = -.27 to -.37, ps < .05) and a significant negative relationship between perceived cognitive impairment and granulocyte-macrophage colony-stimulating factor (r = -.34, p < .01).

CONCLUSIONS

Our analyses support that perceived cognitive impairment, stress, loneliness, depressive symptoms, and fatigue co-occur and extend the literature by suggesting that interleukin-2 may contribute to the underlying mechanistic pathway of these co-occurring symptoms. Our findings add to a growing body of literature that is shifting to study symptoms as they co-occur, or cluster, rather than individual symptoms.

The Correlation of Symptom Clusters and Functional Performance in Adult Acute Leukemia Patients Under Chemotherapy

BACKGROUND

Adult acute leukemia (AL) patients who receive chemotherapy usually experience multiple symptoms during the treatment course. The symptom clusters (SCs) as well as subsets of concurrent symptoms in AL patients have not yet been demonstrated.

OBJECTIVE

To investigate the SCs of adult AL patients who were receiving chemotherapy and to determine their correlations with functional performance.

METHODS

A total of 132 hospitalized adult AL patients were included in this study. A cross-sectional survey aimed to examine symptoms and functional performance was conducted. The patients' symptoms were assessed using the Chinese version of the Condensed Memorial Symptom Assessment Scale, and functional performance was evaluated through activities of daily living and quality of life.

RESULTS

We identified 4 SCs in adult AL patients: psychological SC, pain-fatigue-sleep SC, dry mouth-constipation SC, and nutrition-impaired SC. The psychological SC was the most common and most distressing SC. The different SCs were each differentially correlated with patient characteristics. The distress of the psychological SC, pain-fatigue-sleep SC, and nutrition-impaired SC was adversely correlated with functional performance.

CONCLUSIONS

Adult AL patients undergoing chemotherapy experience multiple symptoms that can be further categorized into 4 SCs. The distress from some SCs is negatively associated with patients' functional performance.

IMPLICATIONS FOR PRACTICE

Symptom burden remains a major problem for adult AL patients undergoing chemotherapy. Identifying SCs of AL patients should be the basis for accurate and cost-effective interventions. Personalized SC management may improve the functional performance and healthcare quality of adult AL patients.

The effect of a 12-week home-based walking program on reducing fatigue in women with breast cancer undergoing chemotherapy: A randomized controlled study

BACKGROUND

Fatigue is the most common symptom experienced by cancer patients during treatment and can last long after completing treatment. Fatigue in cancer patients who have completed treatment is well known to be reduced by exercise, but the effect of exercise on reducing fatigue in patients under treatment has been inconsistent.

OBJECTIVES

The purposes of this study were to examine short-term and long-term effects of an individually tailored, home-based brisk walking program on reducing fatigue in breast cancer patients under chemotherapy.

DESIGN, SETTING, PARTICIPANTS

For this randomized controlled trial, women were recruited from a medical center in northern Taiwan if they were diagnosed with stages I-III breast cancer and experienced insomnia, fatigue, pain, or depressive symptoms after their first cycle of chemotherapy. Consenting participants (N = 159) were randomly assigned to either an exercise (12-week home-based walking program) group (n = 81) or an attention-control group (n = 78).

METHODS

The 12-week, home-based brisk walking program started on the first day of the third chemotherapy cycle. Fatigue was measured by the Brief Fatigue Inventory. Covariates, i.e., functional performance, sleep disturbance, anxiety, depression, and exercise-related variables, were also measured. Data were collected at baseline, two times during the exercise intervention, and five times after the exercise intervention (eight times in total). The effects of time-varying and time-invariant predictors on fatigue were analyzed by multilevel modeling.

RESULTS

Fatigue levels increased over time for both groups, even after completing treatment. At the end of the 12-week exercise program, the exercise group had less fatigue than the attention-control group, and this group difference was maintained for the whole study period. At the end of exercise program, women who had spent more time exercising before diagnosis had less fatigue than those who had exercised less often. In addition, patients' fatigue levels at various time points fluctuated along with their functional performance, sleep disturbance, and depression.

CONCLUSIONS

Our tailored, home-based brisk walking program effectively reduced fatigue in breast cancer patients under chemotherapy, and this effect lasted after completing treatment.