Symptom Clusters in Patients with Brain Tumors: A Systematic Review

To identify composition, predictors, outcomes and stability of symptom clusters in brain tumor patients and to examine assessment tools and statistical methods.

The PubMed, Web of Science, Embase, CINAHL, and Cochrane Library databases were systematically searched. Two reviewers independently screened the titles, abstracts and full texts. Data were extracted and synthesized based on the aims of the review.

Eleven studies were included, covering eight symptom assessment tools and four analysis methods. Four symptom clusters in patients with primary brain tumors were identified: lack of energy cluster/ affective cluster/ gastrointestinal cluster/ neurocognitive cluster. Three symptom clusters in patients with brain metastases were identified: somatic stress cluster/ gastrointestinal cluster/ neurocognitive cluster. Longitudinal instability of symptom clusters was found. The severity of symptom clusters has a significant negative correlation with quality of life, performance status and functioning. There is little information on the predictors.

Although major symptom clusters of patients with primary brain tumors and brain metastases have been identified, methodological differences have affected the homogeneity of the inferences drawn. It is necessary to standardize the selection of assessment tools and statistical methods for symptom cluster research to facilitate comparison and combination across studies, and further clarify the temporal trajectories, predictive factors, and underlying mechanisms.

Knowledge of symptom clusters contributes to the adoption of prevention strategies and management measures and the adjustment of treatments, thus alleviating symptom distress and improving quality of life.