The effect of symptom clusters on functional status and quality of life in women with breast cancer

Abstract

Purpose The purposes of this study of women with breast cancer receiving chemotherapy with/without radiation therapy were to determine whether: 1) subgroups of oncology outpatients can be identified based on a specific symptom cluster (i.e., pain, fatigue, sleep disturbances, depression); 2) these subgroups differ on outcomes (i.e., functional status, quality of life; 3) subgroup membership changes over time. Methods A secondary data analysis using data collected from 112 women at initial chemotherapy. Symptom and outcome measures were completed at three time points: baseline (i.e., the week before cycle two - T1); end of cancer treatment (T2), end of the study (approximately one year after the start of chemotherapy - T3). Cluster analysis identified patient subgroups based on symptom severity scores. Results At T1 and T2, four patient subgroups were identified: ALL LOW (one or no symptom greater than the cut score), MILD (two symptoms), MODERATE (three or four symptoms), and ALL HIGH (four symptoms). At T3, three subgroups were identified: MILD, MODERATE and ALL HIGH. Subgroups with high severity levels of all four symptoms had poorer functional status and QOL at each time point than other subgroups (p<.001). Group membership changed over time. Conclusions Subgroups of patients with different symptom experiences were identified. For some patients severity of all four symptoms persisted months after cancer treatment. Initial and ongoing assessment to identify those patients in the ALL HIGH patient subgroup is important so that appropriate interventions to improve functional status and quality of life can be offered.

Symptom Clusters and Work Limitations in Employed Breast Cancer Survivors

“…Kim, et al, 2008;Ridner, 2005), researchers have also identified symptom clusters in patients with lung cancer (Fox & Lyon, 2006) and gliomas (Fox, Lyon, & Farace, 2007). Across studies of breast cancer patients, similar symptom clusters have emerged: researchers have identified clusters of fatigue, cognitive impairment, and mood disturbance (Bender, et al, 2005); fatigue, cognitive impairment, depressed mood, insomnia, and pain (H. Kim, et al, 2008); fatigue, depressed mood, and pain (Thornton, et al, 2010); and fatigue, pain, depression, and insomnia (Dodd, et al, 2010).…”

“…Although breast cancer has been the cancer type most commonly studied for symptom clusters (Bender, et al, 2005;Dodd, et al, 2010;H. Kim, et al, 2008;Ridner, 2005), researchers have also identified symptom clusters in patients with lung cancer (Fox & Lyon, 2006) and gliomas (Fox, Lyon, & Farace, 2007).…”

“…work), clinicians may be better positioned to identify individuals who are most likely to benefit from intervention targeted at reducing specific clusters of symptoms and ultimately improving functional outcomes. To the limited extent that previous studies have related symptom clusters with outcomes, they have examined the relationship between symptom clusters and quality of life (Dodd, et al, 2010;Fox & Lyon, 2006;Fox, et al, 2007) and physical performance status (Dodd, et al, 2010;Dodd, Miaskowski, et al, 2001), finding that greater symptom burden is associated with poorer quality of life and reduced physical function.…”

“…Most studies of symptom clusters have used factor analysis or cluster analysis to group together symptoms that frequently co-occur rather than individuals who display similar patterns of symptoms (Dodd, et al, 2010). Although grouping individuals based on their pattern of symptoms is a less common approach, it has been used in a small number of studies (Dodd, et al, 2010;Miaskowski, et al, 2006;Shi, et al, 2011;Trask & Griffith, 2004).…”

“…In the last decade, an emerging body of research has turned attention to the study of symptom clusters (Barsevick, 2007;Barsevick, Whitmer, Nail, Beck, & Dudley, 2006;Bender, Ergun, Rosenzweig, Cohen, & Sereika, 2005;Chen & Lin, 2007;Dodd, Cho, Cooper, & Miaskowski, 2010;Fan, Filipczak, & Chow, 2007;H. Kim, Barsevick, Tulman, & McDermott, 2008;Miaskowski & Aouizerat, 2007;Molassiotis, Wengstrom, & Kearney, 2010;Ridner, 2005;Thornton, Andersen, & Blakely, 2010;Xiao, 2010).…”