Cancer-related symptom clusters, eosinophils, and survival in hepatobiliary cancer: an exploratory study.
BACKGROUND
The study of symptom clusters is gaining increased attention in the field of oncology in an attempt to improve the quality of life of patients diagnosed with cancer.


OBJECTIVE
The aims of the present study were to 1) determine the prevalence and distribution of pain, fatigue, and symptoms of depression and their covariation as a cluster in people with hepatobiliary carcinoma (HBC), 2) characterize how variation in each individual symptom and/or their covariation as a cluster are associated with changes in immunity, and 3) determine if the symptom clusters, and associated biomarkers, are related to survival in people diagnosed with HBC.


METHODS
Two hundred six participants diagnosed with HBC completed a battery of standardized questionnaires measuring cancer-related symptoms. Peripheral blood leukocytes were measured at diagnosis and at three- and six-month follow-ups. Survival was measured from the date of diagnosis to death.


RESULTS
Cancer-related symptoms were prevalent and two-step hierarchical cluster analyses yielded three symptom clusters. High levels of pain, fatigue, and depression were found to be associated with elevated eosinophil percentages (F[1,78]=3.1, P=0.05) at three- and six-month follow-up using repeated-measures analysis of variance. Using multivariate latent growth curve modeling, pain was the primary symptom associated with elevated eosinophil percentages between diagnosis and six months (z=2.24, P=0.05). Using Cox regression, vascular invasion and age were negatively associated with survival (Chi-square=21.6, P=0.03). While stratifying for vascular invasion, Kaplan-Meier survival analysis was performed, and eosinophil levels above the median for the sample were found to be related to increased survival in patients with and without vascular invasion (Breslow Chi-square=4.9, P=0.03). Symptom clusters did not mediate the relationship between eosinophils and survival.


CONCLUSIONS
Cancer-related symptoms, particularly pain and depression, were associated with increased percentages of eosinophils. The presence of symptoms may reflect tumor cell death and be indicative of response to treatment, or other processes, in patients with HBC.
Steel
Jennifer L
JL
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. steeljl@upmc.edu
Kim
Kevin H
KH
Dew
Mary Amanda
MA
Unruh
Mark L
ML
Antoni
Michael H
MH
Olek
Marion C
MC
Geller
David A
DA
Carr
Brian I
BI
Butterfield
Lisa H
LH
Gamblin
T Clark
TC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001661:Biliary Tract Neoplasms / Q000453:epidemiology* / Q000276:immunology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000276:immunology; D016000:Cluster Analysis; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D004804:Eosinophils / Q000276:immunology*; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology; D010147:Pain Measurement; D018579:Patient Selection; D015995:Prevalence; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D015996:Survival Rate
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