Cited by 159Cancer survivorship and carePain Management and Opioid UseCancer-related cognitive impairment studies

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Symptom clusters in cancer patients

Chen, Mei-Ling, Tseng, Ho-Ching·2006·Supportive Care in Cancer

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Abstract

Goals of work Cancer patients often experience multiple symptoms, many of which have been reported to correlate with each other. The goals of this study were to understand which cancer-related symptoms cluster together and to test the conceptual meanings of the revealed symptom clusters.Patients and methods Patients with various cancer diagnoses (N=151) were recruited from a medical center in northern Taiwan. The 13-item M.D. Anderson symptom inventory was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with oblique rotation. The known-group technique was used to validate the conceptual meanings of revealed factors.Main results Patients' symptom severity ratings fit a three-factor solution that explained 55% of the variance. These three factors (symptom clusters) were named sickness symptom cluster, gastrointestinal symptom cluster, and emotional symptom cluster. Patients with pain and with advanced diseases had significantly higher mean scores in the sickness symptom cluster than patients without pain and with earlier-stage diseases. The patients' functional status was negatively correlated with mean scores in the sickness symptom cluster. Patients under chemotherapy demonstrated significantly higher mean scores in the gastrointestinal symptom cluster than patients under other treatments. Patients with anxiety or depression also had significantly higher mean scores in the emotional symptom cluster than patients without anxiety or depression.Conclusions This study identified three underlying symptom clusters and verified their conceptual meaning in cancer patients. Knowing these symptom clusters may help healthcare professionals understand plausible mechanisms for the aggregation of symptoms.

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George, M. A., Lustberg, M. B., & Orchard, T. (2020) · Breast Cancer Research and Treatment · doi:10.1007/s10549-020-05808-x · Cited by 57
Identifying psychological morbidity among people with cancer using the Hospital Anxiety and Depression Scale: time to revisit first principles?
Carey, M. L., Noble, N., Sanson‐Fisher, R., & Mackenzie, L. (2011) · Psycho-Oncology · doi:10.1002/pon.2057 · Cited by 52
Identification of Latent Classes in Patients Who Are Receiving Biotherapy Based on Symptom Experience and Its Effect on Functional Status and Quality of Life
Dodd, M. J., Cho, M. H., Cooper, B. A., Petersen, J., Bank, K. A., Lee, K. A., & Miaskowski, C. A. (2010) · Oncology nursing forum · doi:10.1188/11.onf.33-42 · Cited by 50
“Numerous studies have used the conceptual approach of grouping of symptoms to create symptom clusters (Chen & Tseng, 2006; Chow et al., 2008; Cleeland et al., 2000; Gift, Jablonski, Stommel, & Given, 2004; Gift, Stommel, Jablonski, & Given, 2003; Gleason et al., 2007; Kim et al., 2009; Kim,…”
Method
Identifying symptom clusters in paediatric cancer patients using the Memorial Symptom Assessment Scale
Atay, S., Conk, Z., & Bahar, Z. (2012) · European Journal of Cancer Care · doi:10.1111/j.1365-2354.2012.01324.x · Cited by 48
Symptom clusters in patients with nasopharyngeal carcinoma during radiotherapy
Xiao, W., Chan, C. W. H., Fan, Y., Leung, D. Y. P., Xia, W., He, Y., & Tang, L. (2017) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2017.02.004 · Cited by 48
Symptom Clusters and Functional Status of Women with Breast Cancer
Suwisith, N., Hanucharurnkul, S., Dodd, M. J., Vorapongsathorn, T., Pongthavorakamol, K., & Asavametha, N. (2008) · Pacific Rim International Journal of Nursing Research · Cited by 46
Symptoms, clusters and quality of life prior to surgery for breast cancer
Denieffe, S., Cowman, S., & Gooney, M. (2013) · Journal of Clinical Nursing · doi:10.1111/jocn.12430 · Cited by 46
“Samples were often heterogeneous for cancer type with a very small proportion being patients with breast cancer (Chen & Tseng 2006, Chen & Lin 2007).”
The psychometric properties of cancer multisymptom assessment instruments: a clinical review
Aktaş, A., Walsh, D., & Kirkova, J. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-015-2732-7 · Cited by 45
Breast Cancer and Symptom Clusters During Radiotherapy
Matthews, E. E., Schmiege, S. J., Cook, P. F., & Sousa, K. H. (2011) · Cancer Nursing · doi:10.1097/ncc.0b013e3182277222 · Cited by 45
“The first approach is to cluster variables in large data sets using exploratory factor analytic models or hierarchical cluster analysis.(8,9) Although the clusters in large data sets may not be clinically predetermined, they can arise from a common pathophysiological pathway.”
Method
Prevalence of Symptoms and Quality of Life Among Jordanian Cancer Patients
Qadire, M. I. A., & Alkhalaileh, M. A. (2014) · Clinical Nursing Research · doi:10.1177/1054773814564212 · Cited by 45
Facing the large variety of life-limiting conditions in children
Hoell, J. I., Weber, H. L., Warfsmann, J., Trocan, L., Gagnon, G., Danneberg, M., Balzer, S., Keller, T., Janßen, G., & Kuhlen, M. (2019) · European Journal of Pediatrics · doi:10.1007/s00431-019-03467-9 · Cited by 44
“By identifying and treating such SC, it is hoped to overcome the shortcoming of treating single symptoms for improving the quality of life [4, 5, 30].”
Background
Chemotherapy‐Induced Neuropathic Pain and Its Relation to Cluster Symptoms in Breast Cancer Patients Treated with Paclitaxel
Golan‐Vered, Y., & Pud, D. (2012) · Pain Practice · doi:10.1111/j.1533-2500.2012.00554.x · Cited by 42
Differences in symptom clusters identified using symptom occurrence rates versus severity ratings in patients with breast cancer undergoing chemotherapy
Sullivan, C. W., Leutwyler, H. C., Dunn, L. B., Cooper, B. A., Paul, S. M., Conley, Y. P., Levine, J. D., & Miaskowski, C. A. (2017) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2017.04.001 · Cited by 42
“…were done using samples of patients who were heterogeneous, in terms of their cancer diagnoses and/or cancer treatments (Chen and Lin, 2007; Chen and Tseng, 2006; Karabulut et al., 2010; Molassiotis et al., 2010; Skerman et al., 2012; Yamagishi et al., 2009), research is needed on symptom…”
Method
Symptom clusters and related factors in oesophageal cancer patients 3 months after surgery
Guo, M., Wang, C., Yin, X., Nie, L., & Wang, G. (2019) · Journal of Clinical Nursing · doi:10.1111/jocn.14935 · Cited by 42
Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy
Han, C. J., Reding, K. W., Cooper, B. A., Paul, S. M., Conley, Y. P., Hammer, M. J., Kober, K. M., Levine, J. D., & Miaskowski, C. A. (2019) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2019.07.029 · Cited by 42
Identification of Cancer-Related Symptom Clusters: An Empirical Comparison of Exploratory Factor Analysis Methods
Skerman, H. M., Yates, P. M., & Battistutta, D. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.07.009 · Cited by 40
The identification of multiple symptom clusters and their effects on functional performance in cancer patients
Oh, H., Seo, Y., Jeong, H., & Seo, W. (2012) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2011.04057.x · Cited by 40
“A similar concept of ‘sickness behaviour’ has also been proposed to explain the common etiologies of symptoms within clusters by Chen and Tseng (2006).”
ReCAP: Identifying Severe Adverse Event Clusters Using the National Cancer Institute’s Common Terminology Criteria for Adverse Events
Zhong, X., Lim, E. A., Hershman, D. L., Moinpour, C. M., Unger, J. M., & Lee, S. M. (2016) · Journal of Oncology Practice · doi:10.1200/jop.2015.006106 · Cited by 40
“Furthermore, if these symptom clusters arise from a common mechanism and are amenable to a common intervention, clinicians can then manage and treat multiple symptoms within the same cluster, which may lead to improvements in quality of life, adherence to treatment, and therapeutic benefit.(9-11) In recent years, symp…”
Background
Comparison of Groups With Different Patterns of Symptom Cluster Intensity Across the Breast Cancer Treatment Trajectory
Kim, H., McDermott, P. A., & Barsevick, A. M. (2013) · Cancer Nursing · doi:10.1097/ncc.0b013e31828293e0 · Cited by 37
“A psychoneurological symptom cluster (ie, pain, fatigue, sleep disturbance, lack of appetite, and drowsiness) was also found in a heterogeneous sample of oncology patients.(5) An important new line of research is to examine intraindividual change in the symptom cluster experience over time and interindividual variatio…”
Background
Insomnia in breast cancer: Independent symptom or symptom cluster?
Gehrman, P., Garland, S. N., Matura, L. A., & Mao, J. J. J. (2016) · Palliative & Supportive Care · doi:10.1017/s1478951516000900 · Cited by 36
The Influence of Oxidative Stress on Symptom Occurrence, Severity, and Distress During Childhood Leukemia Treatment
Hockenberry, M. J., Taylor, O. A., Pasvogel, A. E., Rodgers, C. C., McCarthy, K., Gundy, P. M., Montgomery, D. W., Ribbeck, P., Scheurer, M. E., & Moore, I. M. (2014) · Oncology nursing forum · doi:10.1188/14.onf.e238-e247 · Cited by 35
“…ve s al l r ig ht s. Oncology Nursing Forum • Vol. 41, No. 4, July 2014 E239 with cancer provided insight into searching for symptom relationships, concurrence, and underlying dimensions (Chen & Tseng, 2006; Dodd, Miaskowski, & Lee, 2004; Kim et al., 2009; Kim, McGuire, Tulman, & Barsevick, 2005).”
Cancer Symptom Clusters: An Exploratory Analysis of Eight Statistical Techniques
Aktaş, A., Walsh, D., & Hu, B. (2014) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.02.006 · Cited by 34
Symptom Clusters Change Over Time in Patients With Lung Cancer During Perichemotherapy
Li, N., Wu, J., Zhou, J., Wu, C., Dong, L., Fan, W., & Zhang, J. (2020) · Cancer Nursing · doi:10.1097/ncc.0000000000000787 · Cited by 33
Response analysis for multiple symptoms revealed differences between arms of a symptom management trial
Sikorskii, A. E., Given, C. W., You, M., Jeon, S., & Given, B. A. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2008.09.007 · Cited by 32
Symptom clusters in patients with cancer in the hospice/palliative care setting
Stapleton, S. J., Holden, J. E., Epstein, J. B., & Wilkie, D. J. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3210-6 · Cited by 37
An Investigation of Symptom Clusters and Sentinel Symptoms During the First 2 Cycles of Postoperative Chemotherapy in Patients With Lung Cancer
Ma, J., Xu, H., Liu, S., & Wang, A. (2022) · Cancer Nursing · doi:10.1097/ncc.0000000000001058 · Cited by 29
“It has been widely identified in patients receiving chemotherapy, regardless of the heterogeneous population or specific patients with lung cancer.(37,38) Compared with the study by Wang and Fu,(37) this study had an increased gastrointestinal SC.”
Result
Malignant Ascites Symptom Cluster in Patients Referred for Paracentesis
Husain, A. F., Bezjak, A., & Easson, A. M. (2009) · Annals of Surgical Oncology · doi:10.1245/s10434-009-0774-0 · Cited by 29
Symptom Clusters in Fibromyalgia
Rutledge, D. N., Mouttapa, M., & Wood, P. B. (2009) · Nursing Research · doi:10.1097/nnr.0b013e3181b499d2 · Cited by 28
“These include factor analysis (Chen & Tseng, 2006; Gift et al., 2004), cluster analysis (Bender, Ergyn, Rosenzweig, Cohen, & Sereika, 2005; de Souza et al., 2008; Thieme & Turk, 2006), multiple regression (Gaston-Johansson, Fall-Dickson, Bakos, & Kennedy, 1999), and multistage linear regression…”
Method
The Nested Structure of Cancer Symptoms
Bellala, G., Ganesan, A., Krishna, R., Saxman, P., Scott, C. D., Silveira, M. J., Given, C. W., & Bhavnani, S. K. (2010) · Methods of Information in Medicine · doi:10.3414/me09-01-0083 · Cited by 27
“In contrast, Chen and Tseng [12] analyzed 151 cancer patients using the MD Anderson Symptom Inventory [19].”
Depressive symptoms during the first chemotherapy cycle predict mortality in patients with advanced non-small cell lung cancer
Chen, M., Chen, M., & Yu, C. (2010) · Supportive Care in Cancer · doi:10.1007/s00520-010-1005-8 · Cited by 26
Self-citation
Symptom clusters in patients with metastatic cancer: a literature review
Thavarajah, N., Chen, E., Zeng, L., Bedard, G., Giovanni, J. D., Lemke, M., Lauzon, N., Zhou, M., Chu, D., & Chow, E. (2012) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.12.41 · Cited by 25
The Future in Psychosocial Oncology: Screening for Emotional Distress – The Sixth Vital Sign
Thomas, B. C., & Bultz, B. D. (2008) · Future Oncology · doi:10.2217/14796694.4.6.779 · Cited by 26
Symptom clusters in outpatients with cancer using different dimensions of the symptom experience
Harris, C., Kober, K. M., Cooper, B. A., Conley, Y. P., Dhruva, A., Hammer, M. J., Paul, S. M., Levine, J. D., & Miaskowski, C. A. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-07125-z · Cited by 23
Symptom clusters and their impact on quality of life among Chinese patients with lung cancer: A cross-sectional study
Li, Y., Wang, Q., Liu, C., & Hu, X. (2023) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2023.102465 · Cited by 24
The McGill University Health Centre Cancer Pain Clinic: A Retrospective Analysis of an Interdisciplinary Approach to Cancer Pain Management
Pérez, J., Olivier, S., Rampakakis, E., Borod, M., & Shir, Y. (2016) · Pain Research and Management · doi:10.1155/2016/2157950 · Cited by 23
“The lack of significant relief of shortness of breath could be explained by a lack of correlation between shortness of breath and other cancer-related symptoms reported in previous studies [19].”
Background
Cytokine Gene Polymorphisms Associated With Symptom Clusters in Oncology Patients Undergoing Radiation Therapy
Miaskowski, C. A., Conley, Y. P., Mastick, J., Paul, S. M., Cooper, B. A., Levine, J. D., Knisely, M. R., & Kober, K. M. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.05.007 · Cited by 23
Longitudinal changes in clusters of cancer patients over an 18-month period.
Trudel‐Fitzgerald, C., Savard, J., & Ivers, H. (2013) · Health Psychology · doi:10.1037/a0033497 · Cited by 21

Authors: Chen, M.-L., & Tseng, H.-C.
Affiliations: Chang Gung University (TW)
Koo Foundation Sun Yat-Sen Cancer Center (TW)
Corresponding author: Chen, Mei-Ling
ORCID: Chen, Mei-Ling
Venue: Supportive Care in Cancer
Publisher: Springer Science and Business Media LLC
Published: 2006-02-21
Volume: 14
Issue: 8
Pages: 825-830
ISSN: 0941-4355 (ISSN-L)
1433-7339
DOI: 10.1007/s00520-006-0019-8
OpenAlex: W1996624485
Cited by: 159
References: 29
Citations by year: 2025: 6 · 2024: 1 · 2023: 1 · 2022: 5 · 2021: 6 · 2020: 3 · 2019: 6 · 2018: 1 · 2017: 14 · 2016: 9 · 2015: 5 · 2014: 7 · 2013: 12 · 2012: 15
FWCI: 6.96
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Supportive Care in Cancer (publishedVersion)
PubMed (publishedVersion)
Funders: Chang Gung University
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
Keywords: cancer symptoms, symptom clusters, symptom severity, gastrointestinal symptoms, emotional symptoms, pain, chemotherapy, anxiety, depression, functional status, disease stage, MD Anderson Symptom Inventory
MeSH terms: Activities of Daily Living, Adolescent, Adult, Aged, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Neoplasms, Quality of Life, Research Design, Severity of Illness Index, Taiwan, Multivariate Analysis, Cluster Analysis, Karnofsky Performance Status

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