title: Symptom Clusters Change Over Time in Women Receiving Adjuvant Chemotherapy for Breast Cancer.
abstract: Patients with breast cancer receiving chemotherapy (CTX) experience multiple concurrent symptoms, but little is known about how symptoms change during and after treatment. Knowledge of the identity and trajectory of symptom clusters (SCs) would enhance measurement and management.
  
  
  
  We aimed to identify SCs and their change over time from baseline to completion of breast cancer CTX.
  
  
  
  SCs were identified and assessed for change in 219 women from Nebraska at four times: baseline, during cycles #3 and #4 of CTX, and one month after finishing CTX. Ten symptoms were measured: two using the Hospital Anxiety and Depression Scale and eight using the Symptom Experience Scale. Exploratory factor analysis was conducted at each time point, then changes in SCs were evaluated at different times.
  
  
  
  Two SCs were identified before and after initiating CTX: gastrointestinal and treatment-related. The number and type of symptoms in each cluster differed over time. Clusters were dynamic during CTX with changes in the number and type of symptoms. Only one treatment-related SC, which consisted of fatigue, pain, and sleep disturbance, was identified after CTX completion.
  
  
  
  SCs during CTX appear to be dynamic, changing over time from before until after CTX completion. Repeated assessments of SCs reveal symptoms that are present and when patients are most burdened and in need of additional support.
authors.affiliation: The University of Jordan, School of Nursing, Amman, Jordan. Electronic address: r.albusoul@ju.edu.jo.
authors.forename: Randa M
authors.initials: RM
authors.lastname: Albusoul
authors.affiliation: University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Berger
authors.affiliation: University of California San Francisco, School of Nursing, San Francisco, California, USA.
authors.forename: Caryl L
authors.initials: CL
authors.lastname: Gay
authors.affiliation: University of California San Francisco, School of Nursing, San Francisco, California, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Janson
authors.affiliation: T32 Nursing Research Training in Symptom Management, University of California San Francisco, School of Nursing, San Francisco, California, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology*; D000072716:Cancer Pain / Q000175:diagnosis / Q000453:epidemiology*; D015984:Causality; D017281:Cost of Illness; D003520:Cyclophosphamide / Q000627:therapeutic use; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009329:Nebraska / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome; D016387:Women's Health / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents; D003520:Cyclophosphamide
keywords: Breast cancer; chemotherapy; longitudinal study; oncology; symptom clusters; symptom experience