title: Impact of Symptom Clusters on Quality of Life Outcomes in Patients from Japan with Advanced Nonsmall Cell Lung Cancers.
abstract: OBJECTIVE
  Identify symptom clusters based on symptoms experienced by patients with advanced nonsmall cell lung cancers (NSCLCs), and examine the relationship between the symptom clusters and impairment in everyday life and quality of life (QOL).
  
  
  METHODS
  Using the M.D. Anderson Symptom Inventory, 9 symptom items and the QOL Questionnaire (QLQ-C-30) evaluation apparatus from the European Organization for Research and Treatment of Cancer, we evaluated symptom severity, interference in daily life, and QOL. Factor analysis and multiple regression analysis techniques were used.
  
  
  RESULTS
  Sixty patients with advanced NSCLCs seen in pulmonary medicine departments were included in the study. The average age of patients was 64.33 (standard deviation = 11.40). Thirty-six were male and 24 were female. Three symptom clusters were identified as fatigue/anorexia cluster (dry mouth, altered the sense of taste, drowsiness, fatigue/tiredness, and lack of appetite), pain cluster (anxiety, sadness, and pain), numbness cluster (numbness, leg weakness, and distress). The pain cluster had the strongest influence (adjustedR2= 0.355) on daily life (emotions) while the numbness cluster most strongly affected walking. The fatigue/anorexia cluster explained 22.7% of role function variance. This symptom clustering may be unique among patients with advanced NSCLCs.
  
  
  CONCLUSIONS
  Each of these clusters affected QOL and everyday life with varying degrees of influence. In clinical screening assessments, focusing on symptom clusters could provide tailored management strategies for patients with advanced NSCLCs. These care strategies may improve outcomes specifically for advanced NSCLCs patients.
authors.affiliation: Department of Nursing, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
authors.forename: Tamami
authors.initials: T
authors.lastname: Hamada
authors.affiliation: Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Komatsu
authors.affiliation: Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pennsylvania, USA.
authors.forename: Margaret Quinn
authors.initials: MQ
authors.lastname: Rosenzweig
authors.affiliation: Division of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Chohnabayashi
authors.affiliation: Division of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nishimura
authors.affiliation: Department of Medicine, School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Oizumi
authors.affiliation: Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pennsylvania, USA.
authors.forename: Dianxu
authors.initials: D
authors.lastname: Ren
keywords: Advanced nonsmall cell lung cancer; cross-sectional; factor analysis; impairment of everyday life; quality of life; symptom clusters