Top

Supportive Care in Cancer

Published in:

01-09-2016 | Original Article

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

Authors: Stephen J. Stapleton, Janean Holden, Joel Epstein, Diana J. Wilkie

Published in: Supportive Care in Cancer | Issue 9/2016

Abstract

Purpose

We determined commonly experienced symptoms reported by adult patients with cancer admitted to urban, ethnically diverse hospice settings and identified symptom clusters.

Methods

We used hierarchical cluster analysis of 150 patients (41 % male, 20–92 years [M = 59, SD = 13.3], 51 % African American, 37 % Caucasian, 12 % other). Using pen-tablet computers, participants completed the Symptom Distress Scale (SDS), a sleep quality item, and listed analgesics consumed in the previous 24 h.

Results

Four symptom clusters were identified: cluster 1 (Pain-Fatigue) consisted of pain frequency, fatigue, and pain intensity; cluster 2 (Ingestion-Elimination) consisted of appetite and bowel problems; cluster 3 (General Well-Being) consisted of insomnia, appearance, and outlook; and cluster 4 (Respiratory-Nausea-Concentration) consisting of breathing, cough, nausea frequency, nausea intensity, and concentration. There were no significant differences between Caucasians and African Americans on total SDS scores, analgesic consumption, sleep quality, or most cluster scores.

Conclusion

This is the first symptom cluster analysis in a US sample with a sizeable proportion of minority hospice/palliative care patients with cancer. Further research to determine the stability of identified symptom clusters over time and discovery of the biological interactions of symptoms within the cluster may lead to symptom management therapies designed for the alleviation of all clustered symptoms.

Dodd M, Miaskowski C, Lee K (2004) Occurrence of symptom clusters. J Natl Cancer Inst Monogr 32:76–78CrossRefPubMed

Ng K, von Gunten CF (1998) Symptoms and attitudes of 100 consecutive patients admitted to an acute hospice/palliative care unit. J Pain Symptom Manag 16(5):307–316CrossRef

McMillan S, Small B (2002) Symptom distress and quality of life in patients with cancer newly admitted to hospice home care. Oncol Nurs Forum 29(10):1421–1428CrossRefPubMed

Potter VT, Wiseman CE, Dunn SM, Boyle FM (2003) Patient barriers to optimal cancer pain control. Psycho-Oncology 12(2):153–160CrossRefPubMed

Hearson B, Sawatzky J (2008) Sleep disturbance in patients with advanced cancer. Int J Palliat Nurs 14(1):30–37CrossRefPubMed

Walsh D, Rybicki L (2006) Symptom clustering in advanced cancer. Support Care Cancer 14(8):831–836CrossRefPubMed

Miaskowski C, Cooper B, Paul S, Dodd M, Lee K, Aouizerat B, et al. (2006) Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: a cluster analysis. Oncol Nurs Forum 33(5):E79–E89CrossRefPubMed

Ferrell B, Levy M, Paice J (2008) Managing pain from advanced cancer in the palliative care setting. Clin J Oncol Nurs 12(4):575–581CrossRefPubMed

Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E (2001) Equianalgesic dose ratios for opioids. A critical review and proposals for long-term dosing. J Pain Symptom Manag 22(2):672–687CrossRef

10.

Beck S (2004) Symptom clusters: impediments and suggestions for solutions. J Natl Cancer Inst Monogr 32:137–138CrossRefPubMed

11.

Paice J (2004) Assessment of symptom clusters in people with cancer. J Natl Cancer Inst Monogr 32:98–102CrossRefPubMed

12.

Kim H, McGuire D, Tulman L, Barsevick A (2005) Symptom clusters: concept analysis and clinical implications for cancer nursing. Cancer Nurs 28(4):270–282CrossRefPubMed

13.

Dong ST, Butow PN, Costa DSJ, Lovell MR, Agar M (2014) Symptom clusters in patients with advanced cancer: a systematic review of observational studies. J Pain Symptom Manag 48(3):411–450CrossRef

14.

Anderson F, Downing GM, Hill J, Casorso L, Lerch N (1996) Palliative performance scale (PPS): a new tool. J Palliat Care 12(1):5–11PubMed

15.

Harrold J, Rickerson E, Carroll J, McGrath J, Morales K, Kapo J, et al. (2005) Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population? J Palliat Med 8(3):503–509CrossRefPubMed

16.

Head B, Ritchie C, Smoot T (2005) Prognostication in hospice care: can the palliative performance scale help? J Palliat Med 8(3):492–502CrossRefPubMed

17.

Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C (2006) Use of Palliative Performance Scale in end-of-life prognostication. J Palliat Med 9(5):1066–1075CrossRefPubMed

18.

Weng L, Huang H, Wilkie D, Hoenig N, Suarez M, Marschke M, et al. (2009) Predicting survival with the Palliative Performance Scale in a minority-serving hospice and palliative care program. J Pain Symptom Manag 37(4):642–648CrossRef

19.

McCorkle R, Cooley ME, Shea J (1995) A user’s manual for the Symptom Distress Scale. Unpublished manuscript. New Haven, CT, Yale School of Nursing.

20.

Degner LF, Henteleff PD, Ringer C (1987) The relationship between theory and measurement in evaluations of palliative care services. J Palliat Care 2:8–13

21.

Cowan LF, Young-Graham K, Loveys-Cochrane B (1992) Comparison of a theory of quality of life between myocardial infarction and malignant melanoma: a pilot study. Progress Cardiovasc Nurs 7(1):18–28

22.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213CrossRefPubMed

23.

Wilkie D, Judge MKM, Berry D, Dell J, Zong S, Gilespie R (2003) Usability of a computerized PAINReportIt in the general public with pain and people with cancer pain. J Pain Symptom Manag 25(3):213–224CrossRef

24.

Wilkie D, Kim Y, Suarez M, Dauw C, Stapleton S, Gorman G, et al. (2009) Extending computer technology to hospice research: interactive pentablet measurement of symptoms by hospice cancer patients in their homes. J Palliat Med 12(7):599–602CrossRefPubMedPubMedCentral

25.

Chen M, Lin C (2007) Cancer symptom clusters: a validation study. J Pain Symptom Manag 34(6):590–599CrossRef

26.

Chow E, Fan G, Hadi S, Wong J, Kirou Mauro A, Filipczak L (2008) Symptom clusters in cancer patients with brain metastases. Clin Oncol 20(1):76–82CrossRef

27.

Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, et al. (2000) Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer 89(7):1634–1646CrossRefPubMed

28.

Ivanova M, Ionova T, Kalyadina S, Uspenskaya O, Kishtovich A, Guo H, et al. (2005) Cancer-related symptom assessment in Russia: validation and utility of the Russian M. D. Anderson Symptom Inventory. J Pain Symptom Manag 30(5):443–453CrossRef

29.

Okuyama T, Wang X, Akechi T, Mendoza T, Hosaka T, Cleeland C, et al. (2003) Japanese version of the MD Anderson Symptom Inventory: a validation study. J Pain Symptom Manag 26(6):1093–1104CrossRef

30.

Wang S, Tsai C, Chen B, Lin C (2008) Symptom clusters and relationships to symptom interference with daily life in Taiwanese lung cancer patients. J Pain Symptom Manag 35(3):258–266CrossRef

31.

Wang X, Wang Y, Guo H, Mendoza T, Hao X, Cleeland C (2004) Chinese version of the M. D. Anderson Symptom Inventory: validation and application of symptom measurement in cancer patients. Cancer 101(8):1890–1901CrossRefPubMed

32.

Wang X, Laudico A, Guo H, Mendoza T, Matsuda M, Yosuico V, et al. (2006) Filipino version of the M. D. Anderson Symptom Inventory: validation and multisymptom measurement in cancer patients. J Pain Symptom Manag 31(6):542–552CrossRef

33.

Fodeh SJ, Lazenby M, Bai M, Ercolano E, Murphy T, McCorkle R (2013) Functional impairments as symptoms in the symptom cluster analysis of patients newly diagnosed with advanced cancer. J Pain Symptom Manag 46(4):500–510CrossRef

34.

Wang X, Fairclough D, Liao Z, Komaki R, Chang J, Mobley G, et al. (2006) Longitudinal study of the relationship between chemoradiation therapy for non-small-cell lung cancer and patient symptoms. J Clin Oncol 24(27):4485–4491CrossRefPubMed

35.

Henoch I, Ploner A, Tishelman C (2009) Increasing stringency in symptom cluster research: a methodological exploration of symptom clusters in patients with inoperable lung cancer. Oncol Nurs Forum 36(6):E282–E292CrossRefPubMed

36.

Tsai L, Li I, Lai Y, Liu C, Chang T, Tu C (2007) Fatigue and its associated factors in hospice cancer patients in Taiwan. Cancer Nurs 30(1):24–30CrossRefPubMed

37.

Hofman M, Ryan J, Figueroa Moseley C, Jean Pierre P, Morrow G (2007) Cancer-related fatigue: the scale of the problem. Oncologist 12(1):4–10CrossRefPubMed

38.

Cheville A (2009) Cancer-related fatigue. Phys Med Rehabil Clin N Am 20(2):405–416CrossRefPubMed

39.

Cheung W, Le L, Zimmermann C (2009) Symptom clusters in patients with advanced cancers. Support Care Cancer 17(9):1223–1230CrossRefPubMed

40.

Gift A, Jablonski A, Stommel M, Given CW (2004) Symptom clusters in elderly patients with lung cancer. Oncol Nurs Forum 31(2):202–212CrossRefPubMed

41.

Sarna L, Brecht ML (1997) Dimensions of symptom distress in women with advanced lung cancer: a factor analysis. Heart Lung. 26(1):23–30CrossRefPubMed

42.

Ridner S (2005) Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Care Cancer 13(11):904–911CrossRefPubMed

43.

Fox S, Lyon D (2007) Symptom clusters and quality of life in survivors of ovarian cancer. Cancer Nurs 30(5):354–361CrossRefPubMed

44.

Chen M, Tseng H (2006) Symptom clusters in cancer patients. Support Care Cancer 14(8):825–830CrossRefPubMed

45.

Morgan AE, Lindley CM, Berry JI (1994) Assessment of pain and patterns of analgesic use in hospice patients. Am J Hosp Palliat Med 11(1):13,9 22CrossRef

46.

Portenoy R, Sibirceva U, Smout R, Horn S, Connor S, Blum R, et al. (2006) Opioid use and survival at the end of life: a survey of a hospice population. J Pain Symptom Manag 32(6):532–540CrossRef

47.

Bercovitch M, Adunsky A (2004) Patterns of high-dose morphine use in a home-care hospice service: should we be afraid of it? Cancer 101(6):1473–1477CrossRefPubMed

48.

Lundorff L, Peuckmann V, Sjogren P (2008) Pain management of opioid-treated cancer patients in hospital settings in Denmark. Acta Anaesthesiol Scand 52(1):137–142CrossRefPubMed

49.

Barsevick A, Whitmer K, Nail L, Beck S, Dudley W (2006) Symptom cluster research: conceptual, design, measurement, and analysis issues. J Pain Symptom Manag 31(1):85–95CrossRef

Title: Symptom clusters in patients with cancer in the hospice/palliative care setting
Authors: Stephen J. Stapleton
Janean Holden
Joel Epstein
Diana J. Wilkie
Publication date: 01-09-2016
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 9/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-016-3210-6

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2016

International field testing of the psychometric properties of an EORTC quality of life module for oral health: the EORTC QLQ-OH15

Bisphosphonate-related osteonecrosis of the jaw: a review of the potential efficacy of low-level laser therapy

Opioids for management of episodic breathlessness or dyspnea in patients with advanced disease

Cancer-related fatigue: appraising evidence-based guidelines for screening, assessment and management

Agreement between personally generated areas of quality of life concern and standard outcome measures in people with advanced cancer

Risk of secondary lymphedema in breast cancer survivors is related to serum phospholipid fatty acid desaturation

Keynote webinar | Spotlight on antibody–drug conjugates in cancer