Differences in Symptom Clusters Identified Using Ratings of Symptom Occurrence vs. Severity in Lung Cancer Patients Receiving Chemotherapy

Abstract

Context An important question in symptom clusters research is whether the number and types of symptom clusters vary based on the specific dimension of the symptom experience used to create the clusters. Objectives Given that lung cancer patients undergoing chemotherapy (CTX) report an average of 14 co-occurring symptoms and studies of symptom clusters in these patients are limited, the purpose of this study, in lung cancer patients undergoing CTX (n=145), was to identify whether the number and types of symptom clusters differed based on whether symptom occurrence rates or symptom severity ratings were used to create the clusters. Methods A modified version of the Memorial Symptom Assessment Scale was used to assess for the occurrence and severity of 38 symptoms, one week after the administration of CTX. Exploratory factor analysis was used to extract the symptom clusters. Results Both the number and types of symptom clusters were relatively similar using symptom occurrence rates or symptom severity ratings. Five symptom clusters were identified using both symptom occurrence rates and severity ratings (i.e., sickness behavior, lung cancer-specific, psychological, nutritional, epithelial). Across these two dimensions, the specific symptoms within each of the symptom clusters were relatively similar. Conclusions Identification of symptom clusters in patients with lung cancer may assist with the development of more targeted symptom management interventions. Future studies are warranted to determine if symptom clusters change over a cycle of CTX in patients with lung cancer.

Symptom Clusters in Patients With Gastrointestinal Cancers Using Different Dimensions of the Symptom Experience

“…The most common and severe symptom was lack of energy and the most distressing symptom was ''I don't look like myself.'' Consistent with previous reports in patients with breast 19,34,35 and lung 36 cancer, for all three symptom dimensions, the same four symptom clusters (i.e., psychological, CTXrelated, GI, weight change) were identified and the symptoms within each cluster were relatively similar. The remainder of this discussion will place these findings within the context of the extant literature.…”

“…Although a psychological symptom cluster was reported in previous studies of patients with breast, 19,35,37 lung, 36,38 and heterogeneous cancer diagnoses, 16,39e44 it was found in only three of the six studies of symptom clusters in patients with GI cancers. 11,13,14 Across the four symptom cluster studies in GI cancers (i.e., our study and the other three 11,13,14 ), anxiety and depression were the two consistent symptoms.…”

“…Although a GI symptom cluster was identified across all three symptom dimensions in our study, abdominal cramps was the only consistent symptom. In numerous studies of patients with breast, 19,35,37,53 lung, 36,38 and heterogeneous cancer diagnoses, 55 a GI symptom cluster was identified and nausea and vomiting were the most common symptoms in these studies. However, a GI symptom cluster was identified in only three studies of patients with GI cancers.…”

Symptom clusters in childhood cancer survivors in Korea: A latent class analysis

“…This could miscategorise participants who may have a higher occurrence rate but lower severity rates, and the symptom burden could be overestimated. However, the authors found similarities in both the number and types of symptom clusters in patient with breast, lung and paediatric cancer undergoing active treatment (Baggott, Cooper, Marina, Matthay, & Miaskowski, 2012; Ward Sullivan et al., 2017; Wong et al., 2017). Until now, there has been no gold standard recommendation for LCA in symptom analysis.…”

Construct Validity of the Spanish Versions of the Memorial Symptom Assessment Scale Short Form and Condensed Form: Rasch Analysis of Responses in Oncology Outpatients

“…New analyses with different samples and statistical approaches would be necessary before making such an important decision. In addition, it would be interesting to examine where symptoms recently added by some authors would be located in the continuum of the construct 31 (e.g., increased appetite, weight gain, abdominal cramps, and hot flashes).…”