title: Symptom Clusters and Impact of Fatigue and Sleep Disturbance on Symptom Experiences of Hepatoma Patients in Taiwan.
abstract: Hepatoma is the second leading cause of cancer mortality among patients with cancer in Taiwan. Patients with cancer simultaneously experience multiple symptoms in clusters. Relevant studies have generally focused on a single hepatoma symptom.
  
  
  
  The aim of this study is to explore the prevalence of symptom clusters and the impact of fatigue and sleep on symptom experiences of patients with hepatoma.
  
  
  
  The Taiwanese version of the M.D. Anderson Symptom Inventory was administered to a sample of 100 patients. Data were analyzed using descriptive statistics, Pearson correlation, and regression, factor, and hierarchical cluster analyses.
  
  
  
  The results showed that fatigue and sleep disturbance were the most severe symptoms experienced by patients with hepatoma. Patients with hepatoma who concurrently experienced fatigue and sleep disturbance experienced more symptoms and more severe symptoms than did those who experienced either symptom or no symptom. This study identified 2 clusters: 1 cluster comprised 8 symptoms and the other cluster comprised 5 symptoms. Factor analysis revealed the following 3 factors: pain-, gastrointestinal-, and sensation-related symptoms.
  
  
  
  Patients with hepatoma who concurrently experienced fatigue and sleep disturbance experienced more symptoms and more severe symptoms than did those who experienced either symptom or no symptom. This study identified 2 clusters experienced by patients with hepatoma.
  
  
  
  Our results provide implications for further research on managing the most common co-occurring symptoms to reduce symptom clusters and improve the quality of life of hepatoma patients.
authors.affiliation: Author Affiliations: Graduate Institute of Nursing (Ms Chung) and School of Nursing (Dr Lin), College of Nursing, Taipei Medical University, Taipei, Taiwan; and Loretto Heights School of Nursing, Regis University, Denver, Colorado (Dr Wang).
authors.forename: Meng-Hua
authors.initials: MH
authors.lastname: Chung
authors.forename: Shu-Yi
authors.initials: SY
authors.lastname: Wang
authors.forename: Chia-Chin
authors.initials: CC
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005221:Fatigue / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000523:psychology*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult