title: Prospective longitudinal evaluation of a symptom cluster in breast cancer.
abstract: BACKGROUND
  Symptom cluster research expands cancer investigations beyond a focus on individual symptoms in isolation.
  
  
  OBJECTIVE
  We conducted a prospective longitudinal study of sleep, fatigue, depression, anxiety, and perceived cognitive impairment in patients with breast cancer undergoing chemotherapy.
  
  
  METHODS
  Patient-reported outcome measures were administered prior to chemotherapy, at Cycle 4 Day 1, and six months after initiating chemotherapy. Participants were divided into four groups and assigned a symptom cluster index (SCI) score based on the number/severity of symptoms reported at enrollment.
  
  
  RESULTS
  Participants (N = 80) were mostly women (97.5%) with Stage II (69.0%) breast cancer, 29-71 years of age. Scores on all measures were moderately-highly correlated across all time points. There were time effects for all symptoms, except sleep quality (nonsignificant trend), with most symptoms worsening during chemotherapy, although anxiety improved. There were no significant group × time interactions; all four SCI groups showed a similar trajectory of symptoms over time. Worse performance status and quality of life were associated with higher SCI score over time.
  
  
  CONCLUSIONS
  With the exception of anxiety, the coherence of the symptom cluster was supported by similar patterns of severity and change over time in these symptoms (trend for sleep quality). Participants with higher SCI scores prior to chemotherapy continued to experience greater symptom burden during and after chemotherapy. Early assessment and intervention addressing this symptom cluster (vs. individual symptoms) may have a greater impact on patient performance status and quality of life for patients with higher SCIs.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: ssanford@nmff.org.
authors.forename: Stacy D
authors.initials: SD
authors.lastname: Sanford
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Beaumont
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Butt
authors.affiliation: Northshore University Healthcare System, Evanston, Illinois, USA.
authors.forename: Jerry J
authors.initials: JJ
authors.lastname: Sweet
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cella
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Lynne I
authors.initials: LI
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; anxiety; cognitive impairment; depression; emotional distress; fatigue; oncology; sleep disturbance; symptom cluster