Stability of Symptom Clusters in Patients With Lung Cancer Receiving Chemotherapy

Abstract

Context: Patients with lung cancer who undergo chemotherapy (CTX) experience multiple concurrent symptoms. An evaluation of how these symptoms cluster together and how these symptom clusters change over time may provide insights into how to treat these multiple cooccurring symptoms. Objectives: The purposes of this study, in a sample of lung cancer patients (n=145) who were receiving chemotherapy (CTX) were to evaluate for differences in the number and types of symptom clusters at three time points (i.e., before CTX, the week after CTX, and two weeks after CTX) using ratings of symptom occurrence and severity and to evaluate for changes in these symptom clusters over time. Methods: At each of the three assessments, a modified version of the Memorial Symptom Assessment Scale was used to assess the occurrence and severity of the 38 symptoms. Exploratory factor analyses were used to extract the symptom clusters. Results: Across the two symptom dimensions (i.e., occurrence and severity) and the three assessments, six distinct symptom clusters were identified. However, only three of these clusters were relatively stable across both dimensions and across time (i.e., lung cancer specific, psychological, nutritional). Two additional clusters varied by time but not by symptom dimension (i.e., epithelial/gastrointestinal, epithelial). A sickness behavior cluster was identified at each assessment with the exception of the week before CTX using the severity dimension. Conclusion: These findings provide insights into the most common symptom clusters in patients undergoing CTX for lung cancer. The most common symptoms within each cluster appear to be relatively stable across the two dimensions, as well as across time.

Symptom Clusters’ Content, Stability and Correlation with the Quality of Life in a Heterogeneous Group of Cancer Patients: A Large-Scale Longitudinal Study

“…Only the content of our treatment side-effects cluster differed; it consisted of 10 symptoms, which tended to be split into two or more clusters in previous studies. For example, they might be divided into chemotherapy and radiation therapy toxicity clusters, or named after body system toxicities (e.g., GI, respiratory or urinary system related symptom clusters) (Albusoul et al, 2017;Russell et al, 2019;Thomas et al, 2014). Overall, our results support the fact that each symptom cluster has a core symptom that seem to be a constant component of the cluster, and thus we propose that it may provoke other symptoms.…”

“…At the baseline time-point, five clusters were identified: psychological, treatment side-effects, nausea and vomiting, pain, and fatigue clusters (see Table 3). Previous studies reported that the most commonly identified clusters were as follows: anxiety and depression (psychological), nausea and vomiting, pain, and fatigue and tiredness clusters (Albusoul et al, 2017;Barsevick, 2016;Nho et al, 2017;Russell et al, 2019;Ward Sullivan et al, 2018).…”

Distinct diarrhea profiles during outpatient chemotherapy

“…Our findings regarding the significantly higher co-occurrence rates for eleven common GI symptoms in the high compared to the none class adds to the growing body of literature on the identification of a GI symptom cluster in patients with breast [35], lung [28], GI [11], and gynecological [12] cancers. In addition, across all four CID classes, greater than 40% of the patients reported the occurrence of dry mouth, nausea, and change in the way food tastes prior to their second or third cycle of CTX.…”

Correlation Analysis of Mood State and Symptom Clusters in Patients With Stage-Ⅳ Lung Cancer During Immunotherapy

“…The symptom clusters change with time and the patients' experience also changes. However, three symptom clusters remain relatively stable: lung cancer-speci c, psychological, and nutritional symptom groups [21]. It is suggested that medical staff should pay close attention to the psychological changes in patients with lung cancer at various treatment stages.…”