Symptom cluster patterns during the first year after diagnosis with cancer.
BACKGROUND
Research about clusters of symptoms in oncology is an emerging field of study. However, there is still conceptual confusion about clusters of symptoms and little agreement across studies.


OBJECTIVE
The aim of the present study was to explore clusters of symptoms over time in a large heterogeneous group of patients with cancer and thereby contribute to the conceptual and methodological debate in this research area.


METHODS
A longitudinal design was used to assess symptoms in cancer patients over four time points during the first year after diagnosis using the Memorial Symptom Assessment Scale. The study recruited 143 patients from five U.K. cancer centers and provided 504 symptom assessments at the beginning of treatment and 3, 6, and 12 months later.


RESULTS
Six symptom clusters were identified at the first assessment, which were maintained across the assessment points with slight variations. These included gastrointestinal, hand/foot, body image, respiratory, nutritional, and emotional symptom clusters. The behavior of the clusters over time highlighted the complexities of symptom cluster assessment and the dynamic relationships between symptoms. Frequency, severity, and distress from symptoms were significantly higher (up to 75% higher) in patients who experienced a cluster of symptoms than in the overall sample, suggesting that symptom assessments in unselected patients underestimate the symptom burden in subgroups of patients.


CONCLUSIONS
We propose attention to symptom clusters that are stable across time and include core or defining symptoms within the cluster, and we further discuss the usefulness and applicability of conceptual and methodological criteria used in this study for future symptom cluster research.
School of Nursing, University of Manchester, Manchester M13 9PL, United Kingdom. alex.molassiotis@manchester.ac.uk
Alex
A
Molassiotis
Yvonne
Y
Wengström
Nora
N
Kearney
D000203:Activities of Daily Living; D000328:Adult; D000342:Affective Symptoms / Q000150:complications; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D004417:Dyspnea / Q000150:complications; D005260:Female; D006304:Health Status; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000150:complications; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis; D010146:Pain / Q000150:complications; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D015431:Weight Loss