Update on interventions focused on symptom clusters:  what has been tried and what have we learned?
OBJECTIVE
Although clinicians and researchers acknowledge symptom clusters, the focus has been on relieving a single symptom. This review summarizes the recent literature on interventions that focus on relief of symptom clusters in patients with cancer.


RESULTS
Twelve intervention studies meeting inclusion criteria were published in 2011-2012. The timeframe was expanded to 2009-2012 and 24 studies met the criteria: 18 in early stage and 6 in advanced-stage cancer patients. Several cognitive behavioral therapy, complementary therapy, and exercise interventions demonstrated positive outcomes in relieving a variety of symptom clusters in several cancer types. Most psychoeducational interventions using traditional formats or those combined with automated clinician alerts demonstrated effectiveness in reducing a variety of clusters. Clusters that included fatigue and anxiety or depression were reduced by exercise in early stage patients and by methylphenidate in advanced-stage patients. Current NIH R01 funded studies verified the trends in the types of interventions being tested.


CONCLUSIONS
Few interventions have been tested and found to be effective in relieving the specific symptom clusters in early and advanced-stage cancer patients. Future research needs to expand our understanding of the mechanisms that initiate co-occurring symptoms. Mechanism-targeted interventions need to be identified and tested in homogeneous samples with specific symptom clusters. Interventions need to be replicated before guidelines can be established.
College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska 68198-5330, USA. aberger@unmc.edu
Ann M
AM
Berger
Sriram
S
Yennu
Rita
R
Million
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001007:Anxiety / Q000209:etiology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000639:trends; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000639:trends; D000529:Complementary Therapies / Q000523:psychology / Q000639:trends; D003863:Depression / Q000209:etiology / Q000628:therapy; D005081:Exercise Therapy / Q000523:psychology / Q000639:trends; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D010166:Palliative Care / Q000379:methods* / Q000639:trends; D013577:Syndrome
D000970:Antineoplastic Agents