title: [Identification and validation of symptom clusters in patients with hepatocellular carcinoma].
abstract: 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.
authors.affiliation: Department of Clinical Nursing Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Myung Sook
authors.initials: MS
authors.lastname: Cho
authors.forename: In Gak
authors.initials: IG
authors.lastname: Kwon
authors.forename: Hee Sun
authors.initials: HS
authors.lastname: Kim
authors.forename: Kyunghee
authors.initials: K
authors.lastname: Kim
authors.forename: Eunjung
authors.initials: E
authors.lastname: Ryu
mesh_terms: 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