title: A cluster of symptoms over time in patients with lung cancer.
abstract: BACKGROUND
  Patients with lung cancer present late in the disease and have multiple symptoms. Previous research has shown the symptom cluster of fatigue, weakness, weight loss, appetite loss, nausea, vomiting, and altered taste to be present at time of lung cancer diagnosis.
  
  
  OBJECTIVE
  The study determined whether the symptom cluster identified at the time of diagnosis remained 3 and 6 months later, and whether there was a difference in the mean number of symptoms and the mean level of symptom severity over time. The relation of the severity rating for individual symptoms at the time of diagnosis and at 3 and 6 months after diagnosis was examined. Predictors for the number of symptoms and whether the symptom cluster was predictive of death were determined.
  
  
  METHODS
  Secondary analysis of an existing data set for 112 patients with newly diagnosed lung cancer assessed at diagnosis and at 3 and 6 months was performed and determined whether they were alive or dead 19 months after diagnosis.
  
  
  RESULTS
  The cluster of seven symptoms had internal consistency that remained at 3 and 6 months. The mean symptom severity and the number of symptoms at diagnosis were correlated with later ratings, but decreased in severity over time. A similar decrease in severity rating was seen for the individual symptoms in the cluster. The stage of cancer at diagnosis was the most predictive of the number of cluster symptoms reported. Death 6 to 19 months after diagnosis was predicted by age, stage of cancer at diagnosis, and symptom severity at 6 months.
  
  
  CONCLUSIONS
  The symptom cluster remains over the course of lung cancer and is an independent predictor of the patient's death. Symptom severity, the number of symptoms reported, and the severity of the individual symptoms decreased over time. The stage of cancer at diagnosis is the best predictor of symptoms later in the disease.
authors.affiliation: College of Nursing, Michigan State University, East Lansing 48824-1317, USA.
authors.forename: Audrey G
authors.initials: AG
authors.lastname: Gift
authors.forename: Manfred
authors.initials: M
authors.lastname: Stommel
authors.forename: Anita
authors.initials: A
authors.lastname: Jablonski
authors.forename: William
authors.initials: W
authors.lastname: Given
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003643:Death; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D009367:Neoplasm Staging; D013997:Time Factors; D014839:Vomiting / Q000209:etiology; D015431:Weight Loss