Identifying Symptom Clusters for Acute Dermatitis-Exploratory Analysis of a Randomized Control Trial Comparing...

A "symptom cluster" is commonly known as two or more symptoms that occur concurrently. Patients with breast cancer often experience multiple symptoms simultaneously. The purpose of this study was to investigate acute radiation dermatitis symptom clusters in breast cancer patients using Mepitel film (MF) versus standard of care (SOC) aqueous cream during radiation therapy (RT).

A secondary analysis was performed of the MF versus SOC randomized control trial (n = 376) for the prophylaxis of radiation dermatitis in patients undergoing breast cancer radiation treatment. To identify potential symptom clusters, a principal component analysis (PCA) with varimax rotation was performed on patient-reported Skin Symptom Assessment (SSA) items at baseline and at the 2-week and 3-month follow-ups.

Symptom clusters varied based on time point and treatment arm. Two to three symptom clusters were identified for both treatment arms at each follow-up. Patients in the MF arm had the item "trouble fitting brassieres" clustered with "edema" and/or "pain/soreness" at each time point. The items "blistering/peeling" and "erythema," as well as the items "pruritus," "pain/soreness," and "pigmentation," were clustered together at both follow-ups. Patients in the SOC arm had items "erythema" and "pruritus" commonly clustering together across time points. The item "edema" was often clustered with "trouble fitting brassieres" or "pain/soreness."

Symptom clusters should be managed together to optimize improvement in patients. Further research using the SSA or other skin-symptom questionnaires is required to build upon the symptom clusters found in the present study, as well as to compare how symptoms differ between treatment methods.