title: Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference?
abstract: BACKGROUND
  In clinical practice, some symptoms and problems frequently occur in combination, which may have consequences for symptom management.
  
  
  OBJECTIVE
  Facing a growing number of non-cancer patients in palliative care, this study aimed to differentiate symptom clusters in the non-cancer population from those in cancer patients.
  
  
  METHODS
  Inpatient data from the German Hospice and Palliative Care Evaluation between 2007 and 2011 were used for a cluster analysis of a 16-item symptom and problem checklist. An agglomerative hierarchical method was chosen. Coefficients from distance matrix ranging between 0 and 1 were calculated to indicate the interrelationship of clustered symptoms.
  
  
  RESULTS
  The analysis identified five clusters in cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.125); 3) wound care and disorientation/confusion (d = 0.229); 4) organization of care and overburdening of family (d = 0.202); and 5) weakness, tiredness, need for assistance with activities of daily living, and loss of appetite (d = 0.207). Five comparable clusters were identified in non-cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.166); 3) organization of care and overburdening of family (d = 0.187); 4) weakness and need for assistance with activities of daily living (d = 0.139); and 5) tiredness and loss of appetite (d = 0.182).
  
  
  CONCLUSIONS
  As symptom clusters do not significantly differ between cancer and non-cancer patients, specific frequent symptoms in non-cancer patients should be assessed. Identification of symptom clusters may help to target therapies and focus the use of medications to improve patients' quality of life.
authors.affiliation: Department of Palliative Medicine, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. Electronic address: stephanie.stiel@uk-erlangen.de.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stiel
authors.affiliation: Department of Palliative Medicine, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Dominik M K
authors.initials: DM
authors.lastname: Matthies
authors.affiliation: Cognitive Systems Group, Faculty Information Systems and Applied Computer Science, University of Bamberg, Bamberg, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Seuß
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA.
authors.forename: Declan
authors.initials: D
authors.lastname: Walsh
authors.affiliation: Clinical Analysis, Research and Application (CLARA), Kleinmachnow, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lindena
authors.affiliation: Department of Palliative Medicine, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center, CCC Erlangen - EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ostgathe
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D005260:Female; D005858:Germany; D006801:Humans; D007297:Inpatients; D008297:Male; D009369:Neoplasms / Q000503:physiopathology* / Q000628:therapy*; D010166:Palliative Care
keywords: Cluster analysis; cancer; non-cancer; palliative care; problems; symptoms