[Identification and validation of symptom clusters in patients with hepatocellular carcinoma].
OBJECTIVE
The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma.


METHODS
This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters.


RESULTS
Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression.


CONCLUSIONS
Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.
Cho
Myung Sook
MS
Department of Clinical Nursing Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kwon
In Gak
IG
Kim
Hee Sun
HS
Kim
Kyunghee
K
Ryu
Eunjung
E
D000328:Adult; D000368:Aged; D001007:Anxiety; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000523:psychology* / Q000556:secondary; D057189:Checklist; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003710:Demography; D003863:Depression; D005221:Fatigue; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index