Symptom Clusters in Patients With Advanced Cancer: A Systematic Review of Observational Studies

Dong, Skye; Butow, Phyllis; Costa, Daniel; Lovell, Melanie; Agar, Meera

doi:10.1016/j.jpainsymman.2013.10.027

Cited by 158 publications

(133 citation statements)

References 69 publications

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

Section: Introductionmentioning

confidence: 99%

“…Several reviews have highlighted the predictive ability of SCs in compromising patient outcomes like quality of life (QOL) and functional status, often in a multiplicative rather than additive manner (4)(5)(6)(7). Although identification of SCs can result in effective symptom management interventions, there is no accepted 'best practice' approach for identifying SCs (4). The large number of statistical methods that have been used to discover cluster composition, with little guidance regarding justification of choice of method ( (8, 9) are two exceptions), is a major barrier to the conceptual validity and clinical utility of statisticallyderived SCs (8,10).…”

Section: Introductionmentioning

confidence: 99%

“…Dong et al (4) reported that some studies had empirically examined predictors and outcomes of SCs, but that this was done in a piecemeal fashion and without guidance from an over-arching framework. Examples of relevant frameworks are Wilson and Cleary's (17) model and the theory of unpleasant symptoms (18), both of which posit that physiological factors cause symptoms, which in turn influence functional status.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Symptom Clusters in Advanced Cancer Patients: An Empirical Comparison of Statistical Methods and the Impact on Quality of Life

Dong

Costa

Butow

et al. 2016

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

Purpose: To investigate the consistency of symptom cluster composition in advanced cancer patients using different statistical methodologies for all patients across five primary cancer sites, and to examine which clusters predict functional status, a global assessment of health and global quality of life.Methods: Principal components analysis and exploratory factor analysis (with different rotation and factor selection methods) and hierarchical cluster analysis (with different linkage and similarity measures) were used on a dataset of 1562 advanced cancer patients who completed the EORTC QLQ-C30.Results: Four clusters consistently formed for many of the methods and cancer sites: tenseworry-irritable-depressed (emotional cluster); fatigue-pain; nausea-vomiting; and concentrationmemory (cognitive cluster). The emotional cluster was a stronger predictor of overall quality of life than the other clusters. Fatigue-pain was a stronger predictor of overall health than the other clusters. The cognitive cluster and fatigue-pain predicted physical functioning, role functioning, and social functioning. Conclusions:The four identified symptom clusters were consistent across statistical methods and cancer types, although there were some noteworthy differences. Statistical derivation of symptom clusters is in need of greater methodological guidance. A psychosocial pathway in the management of symptom clusters may improve quality of life. Biological mechanisms underpinning symptom clusters need to be delineated by future research. A framework for evidence-based screening, assessment, treatment, and follow-up of symptom clusters in advanced cancer is essential.Statistical methods for symptom clusters in advanced cancer

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Symptom Clusters in Advanced Cancer Patients: An Empirical Comparison of Statistical Methods and the Impact on Quality of Life

Dong

Costa

Butow

et al. 2016

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

show abstract

“…Using self-assessment tools [11,12] Wong-Baker Faces Scale To ascertain the existence of other comorbidities and / or additive behaviors [11,12] To verify the performance of previous or current oncological treatments [11,12] To perform a comprehensive analysis of the etiology of oncologic pain with analytical and imaginary findings Individualization of nursing care [8,14,[17][18][19] Inclusion of the significant person in the therapeutic plan [8,12,14,17] Psycho-emotional support [19] Counseling / education for health self-management / health literacy [6,11,12,17,19] Phone follow-up Effective assisted cough training [1,8] Positioning to reduce respiratory work [1,8] Application of facial cold to stimulate the trigeminal nerve [1,21] Consider the need to adopt healthy lifestyles [8] Psycho-emotional support [1,8,20] Management of anxiety of the person / caregiver / family, with exploration of the meaning of dyspnea for the person, illness and life expectancy [1,8,20] Relaxing and visualization exercises [1,8,20,21] Consider adjustment of nutritional and water habits [8] Education for self-management of the therapeutic regimen [8] Referral to other health services / professionals: pai...…”

Section: Assessment Of Oncologycal Painmentioning

confidence: 99%

“…In an advanced stage of the oncological disease dyspnea is one of the symptoms that assumes particular relevance often arises associated with pain (about 45%) represented a cluster symptoms inducer of greater anxiety and fatigue. That is responsible for the demand for health care so it is fundamental a serious investment in their control [8]. The objective of this systematic review of the literature is to identify non-pharmacological strategies in the control of pain and dyspnea of the patients with oncological disease in acute care.…”

Section: Introductionmentioning

confidence: 99%

Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions

Fonseca¹

2017

MOJYPT

View full text Add to dashboard Cite

Objective: To identify non-pharmacological strategies in the control of pain and dyspnea in patient with oncological disease in acute care. (2011, 2014) and Cancer Care Ontario (2010) resulting in a total of 15 articles. Results:The gold standard to an adequate symptom control is a systematized assessment. Non-pharmacological measures psycho-emotional support, hypnosis, counseling, training, instruction, therapeutic adherence, music therapy, massage, relaxation techniques, telephone support, functional and respiratory reeducation increase health gains. Conclusion:The control of oncologic pain and dyspnea require a comprehensive and multimodal approach.Keywords: Oncologic pain; Dyspnea; Nursing interventions; Acute care IntroductionGlobally more than 14 million new cases of cancer will occur each year and the number of people with this disease expected to triple by 2030 as a result of survival [1,2]. Survivors continue to experience significant limitations compared to those without a history of cancer [3]. The presence of symptoms persists permanently resulting from the direct adverse effects of cancer, treatment, exacerbation and onset of new ones associated with recurrence or second tumor [4,5].Pain, dyspnea, fatigue, emotional distress arises simultaneously and is interdependent. In this way the term cluster symptoms comes to light when two or more symptoms are interrelated since they can share the same etiology and produce a cumulative effect on the person's functioning [6]. Richards et al. [7] found that patients with a high prevalence of pain were more likely to be treated with high-dose pain relief than those who did not. The incidence of pain at the onset of the disease pathway is estimated at 50% and is increased to approximately 75% at advanced stages which means that the survivor does not experience it only as an immediate treatment outcome [6]. In an advanced stage of the oncological disease dyspnea is one of the symptoms that assumes particular relevance often arises associated with pain (about 45%) represented a cluster symptoms inducer of greater anxiety and fatigue. That is responsible for the demand for health care so it is fundamental a serious investment in their control [8]. The objective of this systematic review of the literature is to identify non-pharmacological strategies in the control of pain and dyspnea of the patients with oncological disease in acute care. Research StrategyWas formulated a question in PI[C]O format: What are the non-pharmacological strategies (Intervention) for the control of pain and dyspnea (Outcomes) in the patients with oncology (Population) in acute care (Setting)? The electronic database used was based on EBSCO (MEDLINE with Full TEXT, CINAHL, Plus with Full Text, British Nursing Index) and descriptors were searched in the following order (guideline or evidence based practice or randomized controlled trial) and (symptoms control or dyspnea or tachypnea or Cheyne stokes respiration or respiratory symptoms or chronic pain or cancer pain or (oncology nu...

show abstract

Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer

Epstein,

Liou,

Romero

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportancePain is challenging for patients with advanced cancer. While recent guidelines recommend acupuncture and massage for cancer pain, their comparative effectiveness is unknown.ObjectiveTo compare the effects of acupuncture and massage on musculoskeletal pain among patients with advanced cancer.Design, Setting, and ParticipantsA multicenter pragmatic randomized clinical trial was conducted at US cancer care centers consisting of a northeastern comprehensive cancer center and a southeastern cancer institute from September 19, 2019, through February 23, 2022. The principal investigator and study statisticians were blinded to treatment assignments. The duration of follow-up was 26 weeks. Intention-to-treat analyses were performed (linear mixed models). Participants included patients with advanced cancer with moderate to severe pain and clinician-estimated life expectancy of 6 months or more. Patient recruitment strategy was multipronged (eg, patient database queries, mailings, referrals, community outreach). Eligible patients had English or Spanish as their first language, were older than 18 years, and had a Karnofsky score greater than or equal to 60 (range, 0-100; higher scores indicating less functional impairment).InterventionsWeekly acupuncture or massage for 10 weeks with monthly booster sessions up to 26 weeks.Main Outcomes and MeasuresThe primary end point was the change in worst pain intensity score from baseline to 26 weeks. The secondary outcomes included fatigue, insomnia, and quality of life. The Brief Pain Inventory (range, 0-10; higher numbers indicate worse pain intensity or interference) was used to measure the primary outcome. The secondary outcomes included fatigue, insomnia, and quality of life.ResultsA total of 298 participants were enrolled (mean [SD] age, 58.7 [14.1] years, 200 [67.1%] were women, 33 [11.1%] Black, 220 [74.1%] White, 46 [15.4%] Hispanic, and 78.5% with solid tumors). The mean (SD) baseline worst pain score was 6.9 (1.5). During 26 weeks, acupuncture reduced the worst pain score, with a mean change of −2.53 (95% CI, −2.92 to −2.15) points, and massage reduced the Brief Pain Inventory worst pain score, with a mean change of −3.01 (95% CI, −3.38 to −2.63) points; the between-group difference was not significant (−0.48; 95% CI, −0.98 to 0.03; P = .07). Both treatments also improved fatigue, insomnia, and quality of life without significant between-group differences. Adverse events were mild and included bruising (6.5% of patients receiving acupuncture) and transient soreness (15.1% patients receiving massage).Conclusions and RelevanceIn this randomized clinical trial among patients with advanced cancer, both acupuncture and massage were associated with pain reduction and improved fatigue, insomnia, and quality of life over 26 weeks; however, there was no significant different between the treatments. More research is needed to evaluate how best to integrate these approaches into pain treatment to optimize symptom management for the growing population of people living with advanced cancer.Trial RegistrationClinicalTrials.gov Identifier: NCT04095234

show abstract

Symptom Clusters in Patients With Advanced Cancer: A Systematic Review of Observational Studies

Cited by 158 publications

References 69 publications

Symptom Clusters in Advanced Cancer Patients: An Empirical Comparison of Statistical Methods and the Impact on Quality of Life

Symptom Clusters in Advanced Cancer Patients: An Empirical Comparison of Statistical Methods and the Impact on Quality of Life

Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Interventions

Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer

Contact Info

Product

Resources

About