Symptom Clusters in Cancer Patients with Brain Metastases

Chow, Edward; Fan, Grace; Hadi, Stephanie; Wong, Jennifer; Kirou-Mauro, Andrea; Filipczak, Linda A.

doi:10.1016/j.clon.2007.09.007

Cited by 83 publications

(77 citation statements)

References 16 publications

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“…Most previous studies utilized the 13-item MD Anderson Symptom Inventory (MDASI), and in these reports, nausea and dyspnea tended to coexist with other symptoms that are not captured by the ESAS [8,13,23,30,40,41]. However, the three remaining symptoms in this cluster-fatigue, drowsiness, and poor appetite-did show a general tendency to cluster together in studies that used the ESAS, MDASI, or other symptom scales [8,12,23,39]. This trend suggests that these three symptoms might share a common etiology or that one symptom may produce a downstream effect on another.…”

Section: Discussionmentioning

confidence: 86%

“…In one analysis of breast cancer patients by Bender et al, anxiety and depression formed a consistent symptom cluster that was prevalent in all stages of breast cancer [3]. Likewise, two studies conducted by Chow et al, involving patients with bone [11] and brain metastases [12], respectively, found that anxiety and depression occurred together before and after palliative radiotherapy. Similar cluster patterns involving various affective symptoms, such as emotional distress, sadness, anxiety, and depression, were noted in three additional studies [8,23,39], including patients with different cancers at various disease stages.…”

Section: Discussionmentioning

confidence: 94%

“…In contrast to prior studies that have primarily focused on early stage cancers [8,33], inpatients [35,39], or a single cancer type [3,19,20] or metastatic site [11,12], we specifically explored symptom clusters in a large cohort of outpatients with a variety of advanced cancers. Outpatients represent a substantial proportion of the individuals in need of palliative care services near the end of life [27].…”

Section: Discussionmentioning

confidence: 98%

“…The term "symptom clusters" has been defined as two or more interrelated symptoms that are present together, independent of other symptom clusters, and may or may not suggest a common etiology or underlying mechanism [14,17,26]. Investigations of symptom clusters have primarily concentrated on inpatients [35,39], early stage cancers [8,33], a single cancer type [3,19,20], or a specific metastatic site [11,12] and have usually involved only a small sample of patients. Only a few studies have specifically examined symptom clusters in patients with advanced disease [35,39].…”

Section: Introductionmentioning

confidence: 99%

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Symptom clusters in patients with advanced cancers

Cheung

Zimmermann

2009

Support Care Cancer

144

114

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Symptom clusters in patients with advanced cancers

Cheung

Zimmermann

2009

Support Care Cancer

144

114

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“…Symptom clusters are a dynamic construct and remain unpredictable across varied treatments, conditions, and time periods. This symptom cluster phenomenon is not limited to the present research, but has also been observed in earlier studies with symptom clusters 16,17 . Using the Edmonton Symptom Assessment Scale on patients with bone 16 and brain metastases 17 , these two studies were able to extract symptom clusters at baseline that rearranged at subsequent followup weeks.…”

Section: Discussionmentioning

confidence: 49%

Validation of Symptom Clusters in Patients with Metastatic Bone Pain

et al. 2008

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PurposeSymptom clusters (SCs) are a dynamic construct. They consist of at least 2 or 3 interrelated symptoms that may be a significant predictor of patient morbidity. In a previous study, we identified 2 SCs in patients with bone metastases:• An activity-related interference cluster • A psychology-related interference cluster These SCs may be clinically important in the pain and symptom management of patients with metastatic bone pain. It is therefore important to validate the reported SCs to determine if they hold true across similar patient populations. Patients and MethodsFrom February to September 2007, our study accrued 52 patients with bone metastases [29 men (56%), 23 women (44%); median age: 68.5 years (range: 39-87 years)] who were referred for palliative radiotherapy (RT). Prostate (31%), breast (29%), and lung (19%) were the most common primary cancer sites. Treatment arms ranged from single to multiple fractions, with most patients receiving a single 8-Gy fraction (77%) or 20 Gy in 5 fractions (21%). The most prevalent sites for RT were spine (42%), hips (17%), and pelvis (14%). Worst pain at the site of RT and functional interference scores were assessed using the Brief Pain Inventory (BPI), a multidimensional pain instrument that uses 11-point numeric rating scales. Patients provided their symptom severity scores on the BPI at baseline and at 4, 8, and 12 weeks post RT. At all time points, a principal component analysis with varimax rotation was performed on 8 items (worst pain and 7 functional interference items) to determine relationships between symptoms before and after RT for bone pain. ResultsTwo SCs were identified. Cluster 1 included worst pain and interference with general activity, normal work, and walking ability; cluster 2 consisted of interference with mood, sleep, enjoyment of life, and relations with others. Our statistical analysis produced varied results for the 2 clusters found in our previous investigation. These differences may be an indicator for the instability of SCs or may be a result of the fewer number of patients accrued in the present validation study. ConclusionsThe SCs in our two studies were not identical for patients receiving palliative RT for symptomatic bone metastases. Another SC validation study should be conducted with a larger sample before a conclusion is drawn about the existence of an unstable phenomenon in SC research. KEY WORDSBone metastases, metastatic bone pain, palliative radiotherapy, symptom cluster, symptom cluster instability

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A modified Edmonton Symptom Assessment Scale for symptom clusters in radiation oncology patients

et al. 2017

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Patient‐reported outcomes regarding symptom burden may provide valuable information in addition to physician assessment. Systematic collection of patient‐reported outcomes may be an important metric to identify unmet needs and improve quality of patient care. To understand common symptoms of patients seen in radiation oncology clinic, we examined the prospectively collected modified Edmonton Symptom Assessment Scale (ESAS‐r) data to explore symptom clusters. Our clinic established use of a modified Edmonton Symptom Assessment Scale in August 2015. All outpatients presenting for radiation oncology services completed the form at each clinic visit. Symptom clusters are defined by two or more symptoms that are interrelated and occur simultaneously with a high degree of predictability. A sample of 916 de‐identified surveys was assessed statistically using principal component analysis (PCA) with varimax rotation to determine independent clustering between the symptoms queried. We found four major clusters of symptoms: Tiredness (tired, drowsiness; PC1), Loss of Appetite (nausea, lack of appetite; PC2), Low Well‐Being (overall & spiritual well‐being; PC3), and Depression (depression, anxiety; PC4). These accounted for 46%, 9.2%, 7.6%, and 7% of total variance, respectively. Internal consistency using Cronbach's alpha was 0.87, 0.7, 0.82, and 0.87, respectively. The most frequent write‐in item was itchiness, present in 24% of the 148 patients responding. Assessment of patients seen in a large radiation oncology clinic revealed several symptom clusters. {Tiredness and drowsiness} represents a major symptom cluster. Itchiness may be underrecognized.

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Symptom Clusters in Cancer Patients with Brain Metastases

Cited by 83 publications

References 16 publications

Symptom clusters in patients with advanced cancers

Symptom clusters in patients with advanced cancers

Validation of Symptom Clusters in Patients with Metastatic Bone Pain

A modified Edmonton Symptom Assessment Scale for symptom clusters in radiation oncology patients

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