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Stability of symptom clusters and sentinel symptoms during the first two cycles of adjuvant chemotherapy

 Sun Young Rha  ;  Mira Park  ;  Jiyeon Lee 
 SUPPORTIVE CARE IN CANCER, Vol.27(5) : 1687-1695, 2019 
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Issue Date
Adult ; Aged ; Cancer Pain/drug therapy ; Chemotherapy, Adjuvant/adverse effects ; Chemotherapy, Adjuvant/methods ; Cluster Analysis ; Fatigue/chemically induced ; Female ; Humans ; Male ; Middle Aged ; Nausea/chemically induced ; Neoplasms/diagnosis ; Neoplasms/drug therapy* ; Neoplasms/physiopathology* ; Neoplasms/prevention & control ; Palliative Care/methods ; Sleep Wake Disorders/diagnosis ; Symptom Assessment ; Vomiting/chemically induced
Cancer ; Chemotherapy ; Sentinel symptom ; Symptom cluster
PURPOSE: Ascertaining the stability of symptom clusters and identifying sentinel symptoms have been top priorities in symptom cluster research. Identifying sentinel symptoms would help to determine the underlying mechanisms of symptom clusters and facilitate effective symptom management. This study aimed to evaluate the stability of symptom clusters during the 1st and 2nd cycles of adjuvant chemotherapy (CTx) and to identify sentinel symptoms. METHODS: This is a secondary data analysis of data from the Paradigm Shift in Chemotherapy-Induced Nausea and Vomiting (PS-CINV) study. Data utilized were from cancer patients who received adjuvant chemotherapy and completed symptom evaluation in the 1st and 2nd cycles (N = 209). The severity of 20 symptoms was evaluated on a 0-to-10 numeric rating scale. Principal component and hierarchical cluster analyses identified symptom clusters, and principal variable analysis identified sentinel symptoms. RESULTS: Among 20 symptoms, 13 symptoms formed 4 symptom clusters in the 1st cycle: a physical-psychological (pain, dyspnea, sleep disturbance, anxiety, depression), a gastrointestinal (nausea, loss of appetite, taste change), a fatigue-cognitive (fatigue, difficulty concentrating, drowsiness), and a urosexual (urinary problem, sexual problem) symptom cluster. During the 2nd cycle, stable symptom clusters were identified, with merging of the physical-psychological and fatigue-cognitive symptom clusters, resulting in three clusters. Sentinel symptoms were identified in the following order: anxiety, loss of appetite and fatigue (1st cycle) and loss of appetite, depression, and fatigue (2nd cycle). CONCLUSION: Symptom clusters demonstrated phase-specific stability. The current study identified a core set of symptoms that form stable symptom clusters during the 1st and 2nd cycles of CTx. Principal variable analysis identified sentinel symptoms which could facilitate efficient symptom management.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Rha, Sun Young(라선영) ORCID logo https://orcid.org/0000-0002-2512-4531
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