A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment

Abstract

PurposeThe aim was to prospectively map symptom clusters in patients with stage I–IIIa breast cancer during standard chemotherapy treatment in a randomised study.MethodsParticipants 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.ResultsThe 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%).ConclusionIn 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.

Symptom clusters experienced by breast cancer patients at various treatment stages: A systematic review

“…Finally, at least two of the following psychological symptoms, namely sadness, worry, anxiety and depression (the Psychological Cluster), were shown in eight studies to co‐occur in patients prior to receiving treatment 20,28,30,32–35,38 . Interestingly, (fatigue and/or sleep disturbance), were also shown to exhibit an association with some of the symptoms in this cluster, namely anxiety and depression, 30,33,34 suggesting that the symptoms in both clusters may mutually influence their occurrence.…”

“…Of these 32 studies, 13 were cross‐sectional, 13–25 11 were longitudinal, 26–36 while the remaining eight involved a randomised clinical trial design 37–44 . Among these included studies, 16 involved the secondary analysis of the data of existing studies, 14,17,18,20,27,31,33–39,42–44 of which six were observational studies involving secondary analysis of data from randomised clinical trials 37–39,42–44 . Eleven of the included studies (34%) presented longitudinal changes in the composition of symptom clusters experienced by patients before, during and/or after cancer treatment 27,28,30,32–35,37–39,44 .…”

Reduced symptom burden with the support of an interactive app during neoadjuvant chemotherapy for breast cancer – A randomized controlled trial

“…It is well documented that both the illness itself and the chemotherapy are accompanied by disturbing physical and psychological symptoms [ 7 , 8 ]. Experienced symptoms can vary due to types and combinations of chemotherapies, dosages, and length of treatments as well as individual factors such as age, comorbidity, lack of social support and coping strategies [ [9] , [10] , [11] ].…”

Impact of chemotherapy on symptoms and symptom clusters in postmenopausal women with breast cancer prior to aromatase inhibitor therapy

“…According to Miaskowski (2016), 'a priori' and 'de novo' are the two common approaches to conceptualise symptom clusters. 'A priori' studies of women with breast cancer identify different subgroups of women based on predetermined symptoms (Ho, Rohan, Parent, Tager, & McKinley, 2015;Sanford et al, 2014), whereas 'de novo' studies administer several symptom assessments and identified different clusters of symptoms that develop during the treatment course (Browall et al, 2017;Roiland & Heidrich, 2011). Most symptom cluster studies have evaluated symptom clusters during the short time treatment period (i.e.…”