title: Symptom burden clusters: a challenge for targeted symptom management. A longitudinal study examining symptom burden clusters in breast cancer.
abstract: BACKGROUND
  Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters.
  
  
  OBJECTIVE
  To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer.
  
  
  METHODS
  In this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups.
  
  
  RESULTS
  Three clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with "change in the way food tastes" as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden.
  
  
  CONCLUSIONS
  This study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients.
authors.affiliation: Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: elisabeth.kenne.sarenmalm@vgregion.se.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kenne Sarenmalm
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, USA; School of Life Sciences, University of Skövde, Skövde, Sweden; Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Browall
authors.affiliation: Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
authors.forename: Fannie
authors.initials: F
authors.lastname: Gaston-Johansson
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D017281:Cost of Illness; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011788:Quality of Life; D060685:Sense of Coherence; D011795:Surveys and Questionnaires
keywords: Breast cancer; health status; quality of life; sense of coherence; symptom burden; symptom burden clusters