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Symptom clusters in patients with advanced cancers
Winson Y Cheung1, Lisa W Le, Camilla Zimmermann
1Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Summary
Advanced cancer patients exhibit distinct symptom clusters, varying by primary cancer site. Identifying these clusters may improve palliative care and therapeutic benefits for patients with advanced cancers.
Area of Science:
- Oncology
- Palliative Care
- Symptom Science
Background:
- Cancer symptom clusters are frequently observed but understudied in outpatients with advanced disease.
- Previous research often focused on inpatients, early-stage cancers, or single cancer types.
Purpose of the Study:
- To explore symptom clusters among outpatients with diverse advanced cancers.
- To identify inter-relationships between nine symptoms assessed by the Edmonton Symptom Assessment Scale (ESAS).
Main Methods:
- Principal Component Analysis (PCA) was used to analyze ESAS symptom scores from 1,366 advanced cancer outpatients.
- Data were collected from January 2005 to October 2007 at Princess Margaret Hospital's Oncology Palliative Care Clinics.
- PCA was performed on the entire cohort and within specific primary cancer sites.
Main Results:
- Two major symptom clusters were identified in the overall cohort: Cluster 1 (fatigue, drowsiness, nausea, decreased appetite, dyspnea) and Cluster 2 (anxiety, depression).
- These clusters accounted for 45% and 10% of the total variance, respectively, with high internal reliability (Cronbach's alpha ≈ 0.80).
- Symptom cluster patterns differed across various primary cancer sites.
Conclusions:
- Distinct symptom clusters exist in advanced cancer outpatients and are influenced by the primary cancer site.
- Targeting symptom clusters, rather than individual symptoms, may offer greater therapeutic advantages.
- Further research is needed to develop targeted palliative interventions for advanced cancer patients.
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