Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec;58(6):989-1001.e10.
doi: 10.1016/j.jpainsymman.2019.07.029. Epub 2019 Aug 9.

Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy

Claire J Han  1 , Kerryn Reding  1 , Bruce A Cooper  2 , Steven M Paul  2 , Yvette P Conley  3 , Marilyn Hammer  4 , Kord M Kober  2 , Jon D Levine  5 , Christine Miaskowski  6
Affiliations

Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy

Claire J Han et al. J Pain Symptom Manage. 2019 Dec.

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.

Keywords: Symptoms; chemotherapy; distress; gastrointestinal cancer; occurrence; severity; symptom clusters.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors have no conflicts of interest to declare.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Nagel GC, Schmidt S, Strauss BM, Katenkamp D. Quality of life in breast cancer patients: a cluster analytic approach. Empirically derived subgroups of the EORTC-QLQ BR 23--a clinically oriented assessment. Breast Cancer Res Treat 2001;68:75–87. - PubMed
    1. Tantoy IY, Cataldo JK, Aouizerat BE, Dhruva A, Miaskowski C. A review of the literature on multiple co-occurring symptoms in patients with colorectal cancer who received chemotherapy alone or chemotherapy with targeted therapies. Cancer Nurs 2016;39:437–445. - PMC - PubMed
    1. Glimelius B, Hoffman K, Graf W, et al. Cost-effectiveness of palliative chemotherapy in advanced gastrointestinal cancer. Ann Oncol 1995;6:267–274. - PubMed
    1. Tantoy IY, Dhruva A, Cataldo J, et al. Differences in symptom occurrence, severity, and distress ratings between patients with gastrointestinal cancers who received chemotherapy alone or chemotherapy with targeted therapy. J Gastroint Oncol 2017;8:109–126. - PMC - PubMed
    1. Miaskowski C, Barsevick A, Berger A, et al. Advancing symptom science through symptom cluster research: expert panel proceedings and recommendations. J Natl Cancer Inst 2017;109. - PMC - PubMed

Publication types

Substances