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Original research
Symptom clusters in oncology outpatients: stability and consistency across a cycle of chemotherapy
  1. Carolyn S Harris1,
  2. Kord Kober2,
  3. Bruce Cooper2,
  4. Yvette P Conley1,
  5. Marilyn J Hammer3,
  6. Anand A Dhruva4,
  7. Frances Cartwright5,
  8. Steven Paul2,
  9. Jon Levine4 and
  10. Christine Miaskowski6
  1. 1 School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
  2. 2 School of Nursing, University of California, San Francisco, CA, USA
  3. 3 Dana Farber Cancer Institute, Boston, MA, USA
  4. 4 School of Medicine, University of California, San Francisco, CA, USA
  5. 5 Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
  6. 6 School of Nursing and School of Medicine, University of California, San Francisco, CA, USA
  1. Correspondence to Dr Christine Miaskowski, University of California San Francisco, San Francisco, CA 94143, USA; chris.miaskowski{at}nursing.ucsf.edu

Abstract

Objectives Improved understanding of the stability and consistency of symptom clusters across time, symptom dimensions and cancer diagnoses will lead to refinements in symptom assessments and management, and provide direction for mechanistic studies. Study purposes were to describe the occurrence, severity and distress of 38 symptoms; evaluate the stability and consistency of symptom clusters across a cycle of chemotherapy, three symptom dimensions and four distinct cancer types; and identify common and distinct symptom clusters.

Methods Oncology outpatients (n=1329) completed the Memorial Symptom Assessment Scale prior to their next cycle of chemotherapy (T1), 1 week after chemotherapy (T2) and 2 weeks after chemotherapy (T3). Symptom clusters were identified using exploratory factor analysis using unweighted least squares. GEOMIN rotated factor loadings with absolute values ≥0.40 were considered meaningful. Clusters were stable if they were identified across each time point and/or dimension. Clusters were consistent if the same two or three symptoms with the highest factor loadings were identified across each time point and/or dimension.

Results Patients reported 13.9 (±7.2) symptoms at T1, 14.0 (±7.0) at T2 and 12.2 (±6.8) at T3. Psychological, weight gain, gastrointestinal and respiratory clusters were stable across time and dimensions. Only the psychological, weight gain and respiratory clusters were consistent across time and dimensions.

Conclusion Given the stability of the psychological, weight gain and gastrointestinal clusters across cancer diagnoses, symptoms within these clusters need to be routinely assessed. However, respiratory and hormonal clusters are unique to specific cancer types and the symptoms within these clusters are variable.

  • cancer
  • symptoms and symptom management

Data availability statement

Data are available upon request.

https://doi.org/10.1136/spcare-2022-003785

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    Data availability statement

    Data are available upon request.

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    Footnotes

    • Contributors CM contributed to the data acquisition. CSH, KK and CM contributed to the study conception and design; analysis of data; and drafted and critically revised the manuscript. BC and SP both contributed to the data analysis and critically revised the manuscript. YPC, MJH, AAD, FC and JL each contributed to the interpretation of the data, and critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy. CM is responsible for the overall content as the guarantor.

    • Funding The study was supported by a grant from the National Cancer Institute (CA134900). CM is an American Cancer Society Clinical Research Professor. CSH is supported by grants from the American Cancer Society and the National Institute of Nursing Research of the National Institutes of Health (NR016920).

    • Disclaimer The contents of this study are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.