title: Symptoms, clusters and quality of life prior to surgery for breast cancer.
abstract: OBJECTIVE
  To examine the pretreatment symptoms and symptom clusters that women awaiting breast cancer surgery are experiencing and the impact of these symptoms on their quality of life.
  
  
  BACKGROUND
  Most women diagnosed with breast cancer will have surgery as a first-line treatment. The presence of presurgery symptoms may be significant in contributing to distress and impaired quality of life. While it seems that women with breast cancer may experience the symptoms of fatigue, pain, depression and sleep disturbance as a cluster, this has not yet been confirmed by empirical research in the presurgery time period.
  
  
  METHODS
  A multiple-point prospective longitudinal cohort panel design is used.
  
  
  METHODS
  Presurgery symptoms and quality of life were assessed using the Hospital Anxiety and Depression Scale, Insomnia Severity Index, Functional Assessment of Cancer Therapy-Fatigue, Brief Pain Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(3).
  
  
  RESULTS
  Participants (n = 94, age range 30-92) experienced symptoms prior to surgery, with pain being a more prevalent symptom (35%) than fatigue (32%), sleep disturbances (25·5%) or depression (11%). global quality of life was significantly impacted on by fatigue and showed a moderate correlation with emotional functioning and a weak correlation with physical and social functioning. Hierarchical cluster analysis identified the presence of five clusters with symptoms present in differing intensities in each cluster.
  
  
  CONCLUSIONS
  In this cohort of women, healthy other than having a diagnosis of breast cancer, symptoms were impacting on quality of life. It is evident that clusters of symptoms are present presurgery that must be assessed and managed.
  
  
  CONCLUSIONS
  Healthcare delivery systems must ensure that early symptoms are addressed effectively in the presurgery period to improve quality of life and reduce adverse outcomes postsurgery.
authors: Department of Nursing, Waterford Institute of Technology, Waterford, Ireland.
authors: Suzanne
authors: S
authors: Denieffe
authors: Seamus
authors: S
authors: Cowman
authors: Martina
authors: M
authors: Gooney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000451:nursing / Q000523:psychology*; D016000:Cluster Analysis; D015331:Cohort Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D057234:Preoperative Period; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000451:nursing / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: breast cancer; depression; fatigue; hierarchical cluster analysis; pain; quality of life; sleep; surgery; symptom clusters; symptoms