Symptom clusters in oncology outpatients: stability and consistency across a cycle of chemotherapy

Author:

Harris Carolyn SORCID,Kober Kord,Cooper Bruce,Conley Yvette P,Hammer Marilyn J,Dhruva Anand A,Cartwright Frances,Paul Steven,Levine Jon,Miaskowski ChristineORCID

Abstract

ObjectivesImproved 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.MethodsOncology 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.ResultsPatients 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.ConclusionGiven 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.

Funder

American Cancer Society

National Cancer Institute

National Institutes of Health

National Institute of Nursing Research of the National Institutes of Health

Publisher

BMJ

Subject

Medical–Surgical Nursing,Oncology (nursing),General Medicine,Medicine (miscellaneous)

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