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Symptom clusters in patients with cancer in the hospice/palliative care setting

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Abstract

Purpose

We determined commonly experienced symptoms reported by adult patients with cancer admitted to urban, ethnically diverse hospice settings and identified symptom clusters.

Methods

We used hierarchical cluster analysis of 150 patients (41 % male, 20–92 years [M = 59, SD = 13.3], 51 % African American, 37 % Caucasian, 12 % other). Using pen-tablet computers, participants completed the Symptom Distress Scale (SDS), a sleep quality item, and listed analgesics consumed in the previous 24 h.

Results

Four symptom clusters were identified: cluster 1 (Pain-Fatigue) consisted of pain frequency, fatigue, and pain intensity; cluster 2 (Ingestion-Elimination) consisted of appetite and bowel problems; cluster 3 (General Well-Being) consisted of insomnia, appearance, and outlook; and cluster 4 (Respiratory-Nausea-Concentration) consisting of breathing, cough, nausea frequency, nausea intensity, and concentration. There were no significant differences between Caucasians and African Americans on total SDS scores, analgesic consumption, sleep quality, or most cluster scores.

Conclusion

This is the first symptom cluster analysis in a US sample with a sizeable proportion of minority hospice/palliative care patients with cancer. Further research to determine the stability of identified symptom clusters over time and discovery of the biological interactions of symptoms within the cluster may lead to symptom management therapies designed for the alleviation of all clustered symptoms.

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Acknowledgments

Grant Number 1F31NR010048 from the National Institutes of Health, National Institute of Nursing Research, supported this publication. Grant Number R01 NR009092 from the National Institutes of Health, National Institute of Nursing Research, supported data collection and P30 NR010680 supported manuscript preparation. Its contents are solely the responsibility of the authors and do not represent the official views of the National Institute of Nursing Research. The final peer-reviewed manuscript is subject to the National Institutes of Health Public Access Policy.

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Authors and Affiliations

  1. Mennonite College of Nursing, Illinois State University, 210 Edwards Hall, Campus Box 5810, Normal, IL, 61790, USA

    Stephen J. Stapleton

  2. School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA

    Janean Holden

  3. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Joel Epstein

  4. City of Hope National Medical Center, 1500 Duarte Rd, Duarte, CA, 91010, USA

    Joel Epstein

  5. Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, 1225 Center Drive, Room 2203, Gainesville, FL, 32610, USA

    Diana J. Wilkie

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  1. Stephen J. Stapleton
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  2. Janean Holden
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  4. Diana J. Wilkie
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Correspondence to Stephen J. Stapleton.

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Stapleton, S.J., Holden, J., Epstein, J. et al. Symptom clusters in patients with cancer in the hospice/palliative care setting. Support Care Cancer 24, 3863–3871 (2016). https://doi.org/10.1007/s00520-016-3210-6

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  • DOI: https://doi.org/10.1007/s00520-016-3210-6

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