Should we cluster patients or symptoms? The myth of symptom clusters based on ‘depression, insomnia, pain’ and ‘depression, fatigue, pain’

Aktaş, Aynur; Hauser, Katherine; Rybicki, Lisa

doi:10.1136/bmjspcare-2015-000896

Cited by 10 publications

(7 citation statements)

References 35 publications

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“…Furthermore, cancer patients are more likely to experience several symptoms at the same time compared with healthy subjects under circadian perturbations ( Dodd et al, 2004 ; Chen and Tseng, 2006 ; Walsh and Rybicki, 2006 ; Chen and Lin, 2007 ). Statistical analysis allowed the identification of clusters of three or more symptoms often co-occurring in patients ( Miaskowski et al, 2004 ; Barsevick et al, 2006 ; Dong et al, 2014 , 2016 ; Aktas et al, 2016 ). The main clinical utility of a better understanding of the patterns of association, interaction, synergy, etiology, and pathophysiology of concomitant symptoms producing specific clinical outcomes (both in terms of prognosis and of patient-reported functional outcomes) derives from the possibility of multimodal therapeutic interventions aimed at relieving the clustered symptoms.…”

Section: Cts Disruptionmentioning

confidence: 99%

Systems Chronotherapeutics

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Innominato

Dallmann

et al. 2017

Pharmacological Reviews

262

287

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Chronotherapeutics aim at treating illnesses according to the endogenous biologic rhythms, which moderate xenobiotic metabolism and cellular drug response. The molecular clocks present in individual cells involve approximately fifteen clock genes interconnected in regulatory feedback loops. They are coordinated by the suprachiasmatic nuclei, a hypothalamic pacemaker, which also adjusts the circadian rhythms to environmental cycles. As a result, many mechanisms of diseases and drug effects are controlled by the circadian timing system. Thus, the tolerability of nearly 500 medications varies by up to fivefold according to circadian scheduling, both in experimental models and/or patients. Moreover, treatment itself disrupted, maintained, or improved the circadian timing system as a function of drug timing. Improved patient outcomes on circadian-based treatments (chronotherapy) have been demonstrated in randomized clinical trials, especially for cancer and inflammatory diseases. However, recent technological advances have highlighted large interpatient differences in circadian functions resulting in significant variability in chronotherapy response. Such findings advocate for the advancement of personalized chronotherapeutics through interdisciplinary systems approaches. Thus, the combination of mathematical, statistical, technological, experimental, and clinical expertise is now shaping the development of dedicated devices and diagnostic and delivery algorithms enabling treatment individualization. In particular, multiscale systems chronopharmacology approaches currently combine mathematical modeling based on cellular and whole-body physiology to preclinical and clinical investigations toward the design of patient-tailored chronotherapies. We review recent systems research works aiming to the individualization of disease treatment, with emphasis on both cancer management and circadian timing system–resetting strategies for improving chronic disease control and patient outcomes.

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Section: Cts Disruptionmentioning

confidence: 99%

Systems Chronotherapeutics

Ballesta

Innominato

Dallmann

et al. 2017

Pharmacological Reviews

262

287

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“…It may exacerbate fatigue and pain and can reduce functionality and increase infection risk. [ 9 44 45 ] A tendency of sleep disturbances improvement was observed in the IG. Those findings could be enhanced to patients' mood, auto perception of well-being and functionality, and in the case of this study it might was a result of relaxation techniques which allows better sleep levels.…”

Section: Discussionmentioning

confidence: 95%

Psychoeducational Nursing Intervention for Symptom Management in Cancer Patients: A Randomized Clinical Trial

Salvetti

Donato

Machado

et al. 2021

Asia-Pacific Journal of Oncology Nursing

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Objective: The objective of this study was to assess the effects of a psychoeducational intervention upon symptom control and quality of life (QoL) among cancer patients. Methods: This was an open randomized clinical trial (RCT) conducted at the Cancer Institute of the State of São Paulo. The RCT comprised 107 outpatients in chemotherapy or radiation for malignant neoplasms. Participants were randomized to control group (usual treatment) or intervention group (IG) (psychoeducational intervention) with assessments at baseline and upon completion of the intervention. Sociodemographic information, clinical data, QoL, functionality, and symptoms were assessed. This trial is registered with the Brazilian Clinical Trials Registry number RBR-9337nv. A mixed-effects model was applied to compare the effects of the intervention between the groups. Results: The most frequent symptoms were fatigue (76.6%), insomnia (47.7%), pain (42.1%), and loss of appetite (37.4%). The symptom intensity analysis suggests that insomnia was the strongest symptom, followed by fatigue, loss of appetite, and pain. The IG experienced a significant improvement in terms of loss of appetite ( P = 0.002) and a tendency toward less insomnia ( P = 0.053). Conclusions: The intervention significantly reduced appetite loss in cancer patients. Despite no effects observed in global QoL or functionality, the intervention yielded a tendency to improve insomnia, and this outcome should be investigated in future studies.

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“…Similarly, preliminary data demonstrating a correlation between inflammatory markers and cancer pain intensity is also worthy of further investigation [121]. There is a need to more clearly define symptom clusters that include pain, and to determine their potential if any in cancer pain classification [122,123].…”

Section: Expert Commentarymentioning

confidence: 99%

The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management

Lawlor

Reis-Pina

2018

Expert Review of Quality of Life in Cancer Care

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Introduction: Undertreatment of cancer pain is associated with inadequate assessment and inconsistent or non-standardized classification, resulting in failure to both appreciate its multidimensional nature and appropriately target therapeutic interventions. This review examines the classification of cancer pain with a focus on the progressive development of the Edmonton Classification System for Cancer Pain (ECS-CP); the appropriateness of its constituent features, associated outcomes and its potential future development in cancer pain classification. Areas covered: A Medline search from 1989 to November 2017, using combined terms 'cancer' or 'oncology', 'Edmonton', 'pain' or 'analgesia', and 'staging' or 'classification', identified 280 records. A total of 20 studies with empirical data relating to validation studies of the ECS-CP or evaluation of either its constituent or proposed domains were selected for inclusion in the core review. Expert commentary: The ECS-CP is a tool in evolution and a valid template for further cancer pain classification development. The assessment of ECS-CP domains requires a standardized approach. The domain ratings can inform the therapeutic strategy, and are associated with pain management outcomes, particularly stable pain control. The ECS-CP enables standardized reporting, based on patients' pain and related characteristics, and thus may improve the validity of comparisons across research study samples.

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Should we cluster patients or symptoms? The myth of symptom clusters based on ‘depression, insomnia, pain’ and ‘depression, fatigue, pain’

Cited by 10 publications

References 35 publications

Systems Chronotherapeutics

Systems Chronotherapeutics

Psychoeducational Nursing Intervention for Symptom Management in Cancer Patients: A Randomized Clinical Trial

The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management

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