Symptom clusters in patients with cancer in the hospice/palliative care setting

Stapleton, Stephen J.; Holden, Janean E.; Epstein, Joel B.; Wilkie, Diana J.

doi:10.1007/s00520-016-3210-6

Cited by 26 publications

(21 citation statements)

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“…Similar to previous studies, nausea and vomiting combined to form an independent and robust cluster [ 8 , 13 , 15 ]. Although Cronbach’s coefficient was only 0.625, this value was acceptable considering the underlying commonality; however, whether loss of appetite was involved remains debatable.…”

Section: Discussionmentioning

confidence: 72%

Symptom clusters and related factors in bladder cancer patients three months after radical cystectomy

et al. 2017

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BackgroundTo identify symptom distress and clusters in patients 3 months after radical cystectomy and to explore their potential predictors.MethodsA cross-sectional design was used to investigate 99 bladder cancer patients 3 months after radical cystectomy. Data were collected by demographic and disease characteristic questionnaires, the symptom experience scale of the M.D. Anderson symptom inventory, two additional symptoms specific to radical cystectomy, and the functional assessment of cancer therapy questionnaire. A factor analysis, stepwise regression, and correlation analysis were applied.ResultsThree symptom clusters were identified: fatigue-malaise, gastrointestinal, and psycho-urinary. Age, complication severity, albumin post-surgery (negative), orthotropic neobladder reconstruction, adjuvant chemotherapy and American Society of Anesthesiologists (ASA) scores were significant predictors of fatigue-malaise. Adjuvant chemotherapy, orthotropic neobladder reconstruction, female gender, ASA scores and albumin (negative) were significant predictors of gastrointestinal symptoms. Being unmarried, having a higher educational level and complication severity were significant predictors of psycho-urinary symptoms. The correlations between clusters and for each cluster with quality of life were significant, with the highest correlation observed between the psycho-urinary cluster and quality of life.ConclusionsBladder cancer patients experience concurrent symptoms that appear to cluster and are significantly correlated with quality of life. Moreover, symptom clusters may be predicted by certain demographic and clinical characteristics.

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Section: Discussionmentioning

confidence: 72%

Symptom clusters and related factors in bladder cancer patients three months after radical cystectomy

et al. 2017

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“…Prior analyses have largely been conducted in patients either during cancer treatment, 31,32 shortly after therapy completion, 33,34 or during palliative/hospice care. 35 Only Kim et al 36 evaluated patients who were either 2 to 5 years (n = 66) or . 5 years (n = 56) postcancer diagnosis, although some were still undergoing treatment.…”

Section: Jcoorgmentioning

confidence: 99%

Cumulative Burden of Morbidity Among Testicular Cancer Survivors After Standard Cisplatin-Based Chemotherapy: A Multi-Institutional Study

Kerns¹,

Fung²,

Monahan³

et al. 2018

JCO

103

106

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Purpose In this multicenter study, we evaluated the cumulative burden of morbidity (CBM) among > 1,200 testicular cancer survivors and applied factor analysis to determine the co-occurrence of adverse health outcomes (AHOs). Patients and Methods Participants were ≤ 55 years of age at diagnosis, finished first-line chemotherapy ≥ 1 year previously, completed a comprehensive questionnaire, and underwent physical examination. Treatment data were abstracted from medical records. A CBM score encompassed the number and severity of AHOs, with ordinal logistic regression used to assess associations with exposures. Nonlinear factor analysis and the nonparametric dimensionality evaluation to enumerate contributing traits procedure determined which AHOs co-occurred. Results Among 1,214 participants, approximately 20% had a high (15%) or very high/severe (4.1%) CBM score, whereas approximately 80% scored medium (30%) or low/very low (47%). Increased risks of higher scores were associated with four cycles of either ifosfamide, etoposide, and cisplatin (odds ratio [OR], 1.96; 95% CI, 1.04 to 3.71) or bleomycin, etoposide, and cisplatin (OR, 1.44; 95% CI, 1.04 to 1.98), older attained age (OR, 1.18; 95% CI, 1.10 to 1.26), current disability leave (OR, 3.53; 95% CI, 1.57 to 7.95), less than a college education (OR, 1.44; 95% CI, 1.11 to 1.87), and current or former smoking (OR, 1.28; 95% CI, 1.02 to 1.63). CBM score did not differ after either chemotherapy regimen ( P = .36). Asian race (OR, 0.41; 95% CI, 0.23 to 0.72) and vigorous exercise (OR, 0.68; 95% CI, 0.52 to 0.89) were protective. Variable clustering analyses identified six significant AHO clusters (χ P < .001): hearing loss/damage, tinnitus (OR, 16.3); hyperlipidemia, hypertension, diabetes (OR, 9.8); neuropathy, pain, Raynaud phenomenon (OR, 5.5); cardiovascular and related conditions (OR, 5.0); thyroid disease, erectile dysfunction (OR, 4.2); and depression/anxiety, hypogonadism (OR, 2.8). Conclusion Factors associated with higher CBM may identify testicular cancer survivors in need of closer monitoring. If confirmed, identified AHO clusters could guide the development of survivorship care strategies.

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“…Today only few socio-demographic or disease-related factors of prognostic impact are known, [10] and the prognostic impact of symptoms or specific constellations of physical and psychosocial problems is still unclear. Some previous studies aimed to define symptom clusters (SCs) that might help to understand the patients' situation during palliative care more comprehensively [11][12][13][14][15]. A review analysis pointed out that these studies were indeed able to work out similar clusters grouping into four typical issues (anxiety/ depression, nausea/vomiting, nausea/appetite loss, and fatigue/dyspnea/drowsiness/pain), but their impact and influencing factors remain inconsistently defined [16].…”

Section: Introductionmentioning

confidence: 99%

Systematic symptom and problem assessment at admission to the palliative care ward – perspectives and prognostic impacts

et al. 2020

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Background: Symptom assessment is essential in palliative care, but holds challenges concerning implementation and relevance. This study aims to evaluate patients' main symptoms and problems at admission to a specialist inpatient palliative care (SIPC) ward using physician proxy-and patient self-assessment, and aims to identify their prognostic impact as well as the agreement between both assessments. Methods: Within 12 h after admission, palliative care specialists completed the Symptom and Problem Checklist of the German Hospice and Palliative Care Evaluation (HOPE-SP-CL). Patients either used the new version of the minimal documentation system for patients in palliative care (MIDOS) or the Integrated Palliative Care Outcome Scale (IPOS) plus the Distress Thermometer (DT). Results: Between 01.01.2016-30.09.2018, 1206 patients were included (HOPE-SP-CL 98%; MIDOS 21%, IPOS 34%, DT 27%) whereof 59% died on the ward. Proxy-assessment showed a mean HOPE-SP-CL Total Score of 24.6 ± 5.9 of 45. Most frequent symptoms/problems of at least moderate intensity were weakness (95%), needs of assistance with activities of daily living (88%), overburdening of family caregivers (83%), and tiredness (75%). Factor analysis identified four symptom clusters (SCs): (1) Deteriorated Physical Condition/Decompensation of Home Care, (2) Emotional Problems, (3) Gastrointestinal Symptoms and (4) Other Symptoms. Self-assessment showed a mean MIDOS Total Score of 11.3 ± 5.3 of 30, a mean IPOS Total Score of 32.0 ± 9.0 of 68, and a mean distress of 6.6 ± 2.5 of 10. Agreement of self-and proxy-assessment was moderate for pain (ƙ = 0.438) and dyspnea (ƙ = 0.503), fair for other physical (ƙ = 0.297 to 0.394) and poor for psychological symptoms (ƙ = 0.101 to 0.202). Multivariate regression analyses for single symptoms and SCs revealed that predictors for dying on the SIPC ward included impaired ECOG performance status, moderate/severe dyspnea, appetite loss, tiredness, disorientation/confusion, and the SC Deteriorated Physical Condition/Decompensation of Home Care.

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Symptom clusters in patients with cancer in the hospice/palliative care setting

Cited by 26 publications

References 50 publications

Symptom clusters and related factors in bladder cancer patients three months after radical cystectomy

Symptom clusters and related factors in bladder cancer patients three months after radical cystectomy

Cumulative Burden of Morbidity Among Testicular Cancer Survivors After Standard Cisplatin-Based Chemotherapy: A Multi-Institutional Study

Systematic symptom and problem assessment at admission to the palliative care ward – perspectives and prognostic impacts

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