title: Symptom clusters in patients with cancer in the hospice/palliative care setting.
abstract: We determined commonly experienced symptoms reported by adult patients with cancer admitted to urban, ethnically diverse hospice settings and identified symptom clusters.
  
  
  
  We used hierarchical cluster analysis of 150 patients (41 % male, 20-92 years [M = 59, SD = 13.3], 51 % African American, 37 % Caucasian, 12 % other). Using pen-tablet computers, participants completed the Symptom Distress Scale (SDS), a sleep quality item, and listed analgesics consumed in the previous 24 h.
  
  
  
  Four symptom clusters were identified: cluster 1 (Pain-Fatigue) consisted of pain frequency, fatigue, and pain intensity; cluster 2 (Ingestion-Elimination) consisted of appetite and bowel problems; cluster 3 (General Well-Being) consisted of insomnia, appearance, and outlook; and cluster 4 (Respiratory-Nausea-Concentration) consisting of breathing, cough, nausea frequency, nausea intensity, and concentration. There were no significant differences between Caucasians and African Americans on total SDS scores, analgesic consumption, sleep quality, or most cluster scores.
  
  
  
  This is the first symptom cluster analysis in a US sample with a sizeable proportion of minority hospice/palliative care patients with cancer. Further research to determine the stability of identified symptom clusters over time and discovery of the biological interactions of symptoms within the cluster may lead to symptom management therapies designed for the alleviation of all clustered symptoms.
authors.affiliation: Mennonite College of Nursing, Illinois State University, 210 Edwards Hall, Campus Box 5810, Normal, IL, 61790, USA. sstaple@ilstu.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Stapleton
authors.affiliation: School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA.
authors.forename: Janean
authors.initials: J
authors.lastname: Holden
authors.affiliation: Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.|City of Hope National Medical Center, 1500 Duarte Rd, Duarte, CA, 91010, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Epstein
authors.affiliation: Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, 1225 Center Drive, Room 2203, Gainesville, FL, 32610, USA.
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Wilkie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006738:Hospices / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D055815:Young Adult
keywords: Cancer; Hierarchical cluster analysis; Hospice; Palliative care; Pittsburgh sleep quality index; Symptom clusters; Symptom distress scale