title: A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment.
abstract: The aim was to prospectively map symptom clusters in patients with stage I-IIIa breast cancer during standard chemotherapy treatment in a randomised study.
  
  
  
  Participants completed the Memorial Symptom Assessment Scale (MSAS) at baseline, day 12 after the first and third cycle of FEC 75 or FEC 100, and day 12 after the last cycle of Taxotere. Cut-off values for symptom scores, a mean value based on each individual reporting a symptom including occurrence, frequency, severity and distress for inclusion in analysis, were determined.
  
  
  
  The symptom burden cluster analysis was conducted in two steps and included symptoms with high frequency and high levels of distress. The factor analysis revealed three symptom clusters; physical, gastro (phys/gastro) and emotional, with core symptoms that remained stable over time. The most prevalent symptoms for the total sample during all cycles were as follows: lack of energy (range between 48 and 90%), feeling sad (48-79%), difficulty sleeping (54-78%), difficulty concentrating (53-74%), worrying (54-74%) and pain (29-67%).
  
  
  
  In summary, we have prospectively established that symptom clusters remain stable over time with a basis of core symptoms. This knowledge will aid in the development of effective core symptom-focused interventions to minimise symptom burden for patients treated with chemotherapy for breast cancer.
authors.affiliation: Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden. maria.brovall@his.se.|School of Health and Education, University of Skövde, Skövde, Sweden. maria.brovall@his.se.
authors.forename: Maria
authors.identifier: 0000-0003-0976-531X
authors.initials: M
authors.lastname: Browall
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Brandberg
authors.affiliation: Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
authors.forename: Salmir
authors.initials: S
authors.lastname: Nasic
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Rydberg
authors.affiliation: Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Bergh
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rydén
authors.affiliation: Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Hanjing
authors.initials: H
authors.lastname: Xie
authors.affiliation: School of Health and Education, University of Skövde, Skövde, Sweden.
authors.forename: Irene
authors.initials: I
authors.lastname: Eriksson
authors.affiliation: Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.|Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Wengström
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D016000:Cluster Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D013577:Syndrome
chemical_list: D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil
keywords: Breast cancer; Chemotherapy; Patient reported outcome measures; Symptom; Symptom cluster