Symptom Cluster Patterns During the First Year After Diagnosis with Cancer
Accepted 10 October 2009. published online 12 March 2010.
Abstract
Context
Research about clusters of symptoms in oncology is an emerging field of study. However, there is still conceptual confusion about clusters of symptoms and little agreement across studies.
Objectives
The aim of the present study was to explore clusters of symptoms over time in a large heterogeneous group of patients with cancer and thereby contribute to the conceptual and methodological debate in this research area.
Methods
A longitudinal design was used to assess symptoms in cancer patients over four time points during the first year after diagnosis using the Memorial Symptom Assessment Scale. The study recruited 143 patients from five U.K. cancer centers and provided 504 symptom assessments at the beginning of treatment and 3, 6, and 12 months later.
Results
Six symptom clusters were identified at the first assessment, which were maintained across the assessment points with slight variations. These included gastrointestinal, hand/foot, body image, respiratory, nutritional, and emotional symptom clusters. The behavior of the clusters over time highlighted the complexities of symptom cluster assessment and the dynamic relationships between symptoms. Frequency, severity, and distress from symptoms were significantly higher (up to 75% higher) in patients who experienced a cluster of symptoms than in the overall sample, suggesting that symptom assessments in unselected patients underestimate the symptom burden in subgroups of patients.
Conclusion
We propose attention to symptom clusters that are stable across time and include core or defining symptoms within the cluster, and we further discuss the usefulness and applicability of conceptual and methodological criteria used in this study for future symptom cluster research.
aSchool of Nursing, University of Manchester, Manchester, United Kingdom
bCancer Care Research Centre, University of Stirling, Stirling, United Kingdom
cDivision of Nursing, Karolinska Institutet, Stockholm, Sweden
Address correspondence to: Professor Alex Molassiotis, RN, PhD, School of Nursing, University of Manchester, Jean McFarlane Building, University Place, Manchester M13 9PL, United Kingdom.
The projects from which data were drawn were funded by the Christie Hospital Charitable Trust and The Scottish Government Health Department.
ABSTRACT