Stable Symptom Clusters and Evolving Symptom Networks in Relation to Chemotherapy Cycles

ContextThe existence of stable symptom clusters with variations or changes in cluster membership and the merging of symptom clusters over time urge us to investigate how symptom relationships change over time.ObjectivesTo identify stable symptom clusters and understand networks among symptoms using longitudinal data.MethodsSecondary data analysis was conducted using data from a nonblinded randomized clinical trial, which evaluated the effect and feasibility of the developed cancer symptom management system. For the present study, data from all participants of the original trial were analyzed (N = 249). The severity of 20 symptoms was measured before the start of chemotherapy (CTx) and during the initial four cycles of CTx. Symptom clusters were identified using principal component and hierarchical cluster analyses, and network analysis was used to explore the relationships among symptoms.ResultsThree common symptom clusters were identified. The first cluster consisted of anxiety, depression, sleep disturbance, pain, and dyspnea. Fatigue, difficulty concentrating, and drowsiness formed a second stable cluster throughout the CTx cycles. The third cluster comprised loss of appetite, taste change, nausea, and vomiting. In terms of the symptom networks, close relationships were recognized, irrespective of symptom severity level, between anxiety and depression, fatigue and drowsiness, and loss of appetite and taste change. Fatigue was the most central symptom with the highest strength. Edge thickening after starting CTx demonstrated evolving symptom networks in relation to CTx cycles.ConclusionStable symptom clusters and evolving networks were identified. The most central symptom was fatigue; however, the paucity of studies that investigated symptom networks and central symptoms calls for further investigations on these phenomena. Identification of central symptoms and underlying mechanisms will guide efficient symptom management. Future studies will need to focus on developing comprehensive interventions for managing symptom clusters or targeting central symptoms.     

Identification of Symptom Clusters in Patients With Chronic Venous Leg Ulcers

ContextPatients with venous leg ulcers experience multiple symptoms, including pain, depression, and discomfort from lower leg inflammation and wound exudate. Some of these symptoms impair wound healing and decrease quality of life (QOL). The presence of co-occurring symptoms may have a negative effect on these outcomes. The identification of symptom clusters could potentially lead to improvements in symptom management and QOL.ObjectivesTo identify the prevalence and severity of common symptoms and the occurrence of symptom clusters in patients with venous leg ulcers.MethodsFor this secondary analysis, data on sociodemographic characteristics, medical history, venous history, ulcer and lower limb clinical characteristics, symptoms, treatments, healing, and QOL were analyzed from a sample of 318 patients with venous leg ulcers who were recruited from hospital outpatient and community nursing clinics for leg ulcers. Exploratory factor analysis was used to identify symptom clusters.ResultsAlmost two-thirds (64%) of the patients experienced four or more concurrent symptoms. The most frequent symptoms were sleep disturbance (80%), pain (74%), and lower limb swelling (67%). Sixty percent of patients reported three or more symptoms at a moderate-to-severe level of intensity (e.g., 78% reported disturbed sleep frequently or always; the mean pain severity score was 49 of 100, SD 26.5). Exploratory factor analysis identified two symptom clusters: pain, depression, sleep disturbance, and fatigue; and swelling, inflammation, exudate, and fatigue.ConclusionTwo symptom clusters were identified in this sample of patients with venous leg ulcers. Further research is needed to verify these symptom clusters and to evaluate their effect on patient outcomes.     

The Effect of the Pain Symptom Cluster on Performance in Women Diagnosed with Advanced Breast Cancer: The Mediating Role of the Psychoneurological Symptom Cluster

Background: Pain, depression, anxiety, sleep disturbances, and constipation were reported in different symptom clusters at different stages of breast cancer. Managing symptom clusters rather than individual symptoms can improve performance status. Aim: The study examined the effect of pain symptom cluster (pain and constipation) on performance when mediated by the psychoneurological symptom cluster (depression, anxiety, and sleep disturbances) using age as a moderator. Design: A secondary analysis. Settings: Palliative care center at a tertiary medical center in northeast Ohio. Participants: Eighty-six women diagnosed with advanced breast cancer. Method: A quantitative cross-sectional approach. Results: Ordinal logistic regression showed that pain symptom cluster did not have a significant mediation effect on performance. Odds ratio indicated that subjects with pain symptom cluster were 63% more likely to be bedridden (odds ratio = 1.63, confidence interval = .69-3.84). Women who reported pain symptom cluster were 5% more likely to have psychoneurological symptom cluster (odds ratio = 1.05, confidence interval = .400-2.774). Stratified analysis of age showed no differences in performance. Post-hoc analysis showed that the components of pain symptom cluster had a significant effect on psychoneurological symptom cluster (odds ratio: 3 [1.18-7.62]). Conclusions: Pain, constipation, depression, anxiety, and sleep disturbances were highly prevalent in women with advanced breast cancer. However, they tended to cluster in different symptom clusters. Although some findings were not significant, they all supported the direction of the tested hypotheses. Variations in symptom clusters research, including methodology, instruments, statistical tests, and chosen symptom cluster correlation coefficient, should be addressed.     

Symptom clusters and physical function for patients receiving chemotherapy

OBJECTIVES: To examine the literature on symptom clusters and the impact of co-occurring symptoms on the physical function of patients with cancer during treatment. DATA SOURCES: Research and review articles. CONCLUSION: Unmanaged symptoms occur in what are often called symptom clusters. A focus on known and frequently present co-occurring symptoms, such as pain, fatigue, and sleep disturbance, might be the most efficient and effective way to manage specific symptoms and improve patient functioning. IMPLICATIONS FOR NURSING PRACTICE: Nurses should select assessments that identify multiple symptoms and define their co-occurrence.     

Symptom clusters in children with cancer

OBJECTIVES: To discuss the symptoms of fatigue, sleep disturbance, and pain in children undergoing cancer treatment, and a framework for the clustering of these symptoms. DATA SOURCES: Published articles, research studies, and clinical experience. CONCLUSION: Symptoms experienced by children undergoing cancer treatment are distressing, prevalent, and rarely occur in isolation. Multiple symptoms may share underlying mechanisms, influence the severity of the distress experienced, and interfere with a child's ongoing development. Developing knowledge of the relationships among symptoms may be important for improving quality of life during cancer treatment while supporting the child's development. IMPLICATIONS FOR NURSING PRACTICE: Nurses must be aware of the symptom distress occuring in children with cancer to manage its symptoms and its treatments.     

Symptom Burden Clusters: A Challenge for Targeted Symptom Management. A Longitudinal Study Examining Symptom Burden Clusters in Breast Cancer

ContextAlthough there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters.ObjectivesTo explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer.MethodsIn this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups.ResultsThree clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with “change in the way food tastes” as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden.ConclusionThis study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients.     

Symptom cluster and physical activity in relapsing‐remitting multiple sclerosis

We compared the explanatory power of two symptom clusters that consisted of either three or five symptoms as correlates of physical activity in individuals with relapsing‐remitting multiple sclerosis (RRMS; N = 218). The data were primarily analyzed using covariance modeling in Mplus 3.0. A symptom cluster of fatigue, depression, and pain had a moderate, negative relationship with physical activity, and this relationship was comparable in magnitude with a symptom cluster of fatigue, depression, pain, perceived cognitive dysfunction, and poor sleep quality. The relationships were attenuated after controlling for exercise history and neurological impairment. Such findings further support the consideration of a narrowly defined cluster of three symptoms as an independent correlate of physical activity in persons with RRMS. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:398–412, 2010     

Nonmalignant Pain Symptom Subgroups in Nursing Home Residents

Context

Despite many nursing home residents experiencing pain, research about the multidimensional nature of nonmalignant pain in these residents is scant.

Perspectives Unifying Symptom Interpretation

Purpose: To introduce the symptom interpretation model (SIM) and facilitate understanding symptoms from an intrapersonal perspective. Determining an individual's interpretation of symptoms is critical to understanding the resulting decisions.
Organizing Construct : SIM is based on an illness representation model, knowledge structures theroy, and propositions about reasoning. Individuals name and assign meaning to environmental stimuli. Based on this interpretation, behaviors are selected for symptom management.
Methods : Theory derivation was used to develop SIM for understanding comparisons of known and new symptoms in a behavioral outcomes context.
Conclusions : Symptom familiarity reinforces patterns about symptom management. SIM enriches understanding of symptom experiences. Comprehensive assessment, including the intraindividual perspective, is essential to successful symptom management.     

The Role of Inflammation in the Pain,Fatigue, and Sleep Disturbance Symptom Cluster in Advanced Cancer

Context

Symptom researchers have proposed a model of inflammatory cytokine activity and dysregulation in cancer to explain co-occurring symptoms including pain, fatigue, and sleep disturbance.

Symptom management strategies used by elderly patients after coronary artery bypass surgery

The purpose of this secondary analysis was to describe symptom management strategies used by elderly patients (n = 236) 3 and 6 weeks after coronary artery bypass surgery (CABS). Three weeks after surgery, the most frequently used strategies were rest to manage shortness of breath (53%) and fatigue (53%), medications for incision pain (24%), and repositioning for swelling (35%) and sleep disturbance (18%). Overall, fewer patients experiencing sleep disturbances (39%), incision pain (39%), swelling (46%), and appetite problems (17%) reported using a strategy to manage their symptom. Nurses must assist patients in symptom identification and problem solving to accomplish effective symptom management.     

Advancing the science of symptom management

Since the publication of the original Symptom Management Model (Larson et al. 1994), faculty and students at the University of California, San Francisco (UCSF) School of Nursing Centre for System Management have tested this model in research studies and expanded the model through collegial discussions and seminars. AIM: In this paper, we describe the evidence-based revised conceptual model, the three dimensions of the model, and the areas where further research is needed. BACKGROUND/RATIONALE: The experience of symptoms, minor to severe, prompts millions of patients to visit their healthcare providers each year. Symptoms not only create distress, but also disrupt social functioning. The management of symptoms and their resulting outcomes often become the responsibility of the patient and his or her family members. Healthcare providers have difficulty developing symptom management strategies that can be applied across acute and home-care settings because few models of symptom management have been tested empirically. To date, the majority of research on symptoms was directed toward studying a single symptom, such as pain or fatigue, or toward evaluating associated symptoms, such as depression and sleep disturbance. While this approach has advanced our understanding of some symptoms, we offer a generic symptom management model to provide direction for selecting clinical interventions, informing research, and bridging an array of symptoms associated with a variety of diseases and conditions. Finally, a broadly-based symptom management model allows the integration of science from other fields.     

Insomnia: An Underrecognized Nonmotor Symptom in Parkinson Disease

Insomnia is a highly prevalent nonmotor symptom among patients with Parkinson disease (PD) and significantly impacts their quality of life. It is typically an underdiagnosed and untreated symptom of PD. Accurate assessment, ruling out other potential etiologies, and a combination of nonpharmacologic and pharmacologic interventions are important strategies in the management of insomnia in patients with PD. The goal of treatment is to improve sleep duration, sleep quality, and overall quality of life. Nurse practitioners play an integral role in the recognition, assessment, and management of insomnia in PD.     

Symptom management for cancer patients: a trial comparing two multimodal interventions

The results of a randomized controlled trial that tested the effects of eight-week, six-contact multidimensional interactive interventions for symptom management are presented. Four hundred and thirty-five cancer patients with solid tumors undergoing chemotherapy were randomized to receive either nurse-assisted symptom management (NASM) or automated telephone symptom management (ATSM). A prior trial established the effectiveness of NASM compared with conventional care. Seventeen symptoms commonly experienced by patients undergoing chemotherapy were rated on a scale from 0 to 10 and were evaluated at baseline, at each of the six intervention contacts, and postintervention observation at 10 weeks. Both groups achieved significant reduction in symptom severity over baseline, and there was no difference between groups on symptom severity at 10 weeks. Randomization accounted for possible reductions in severity due to response shifts. Severity of symptoms reported by patients at each of the six intervention contacts was measured using a Rasch model. Symptom pattern was different for lung and non-lung cancer patients, and they were analyzed separately. Longitudinal analyses revealed that lung cancer patients with greater symptom severity withdrew from later intervention contacts of the ATSM. The results suggest that both NASM and ATSM achieved a clinically significant reduction in symptom severity. The NASM may be more effective than ATSM in retaining lung cancer patients in the intervention. Further testing of ATSM supplemented by NASM for patients with severe symptoms is warranted.     

Symptom clusters in cancer patients

Goals of work Cancer patients often experience multiple symptoms, many of which have been reported to correlate with each other. The goals of this study were to understand which cancer-related symptoms cluster together and to test the conceptual meanings of the revealed symptom clusters.Patients and methods Patients with various cancer diagnoses (N=151) were recruited from a medical center in northern Taiwan. The 13-item M.D. Anderson symptom inventory was used to assess patients’ symptom severity. Selected symptoms were factored using principal-axis factoring with oblique rotation. The known-group technique was used to validate the conceptual meanings of revealed factors.Main results Patients’ symptom severity ratings fit a three-factor solution that explained 55% of the variance. These three factors (symptom clusters) were named sickness symptom cluster, gastrointestinal symptom cluster, and emotional symptom cluster. Patients with pain and with advanced diseases had significantly higher mean scores in the sickness symptom cluster than patients without pain and with earlier-stage diseases. The patients’ functional status was negatively correlated with mean scores in the sickness symptom cluster. Patients under chemotherapy demonstrated significantly higher mean scores in the gastrointestinal symptom cluster than patients under other treatments. Patients with anxiety or depression also had significantly higher mean scores in the emotional symptom cluster than patients without anxiety or depression.Conclusions This study identified three underlying symptom clusters and verified their conceptual meaning in cancer patients. Knowing these symptom clusters may help healthcare professionals understand plausible mechanisms for the aggregation of symptoms.     

Psychoeducational Intervention for Symptom Management of Fatigue,Pain, and Sleep Disturbance Cluster Among Cancer Patients: A Pilot Quasi-Experimental Study

Objectives

To assess the feasibility of conducting a trial of a psychoeducational intervention involving the provision of tailored information and coaching to improve management of a cancer-related symptom cluster (fatigue, pain, and sleep disturbance) and reduce symptom cluster impacts on patient health outcomes in the Vietnamese context and to undertake a preliminary evaluation of the intervention.

Mind-Body Treatments for the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Persons with Cancer

ContextCo-occurring pain, fatigue, and sleep disturbance comprise a common symptom cluster in patients with cancer. Treatment approaches that target the cluster of symptoms rather than just a single symptom need to be identified and tested.ObjectivesTo synthesize evidence regarding mind-body interventions that have shown efficacy in treating two or more symptoms in the pain-fatigue-sleep disturbance cancer symptom cluster.MethodsA literature search was conducted using CINAHL, Medline, and PsychInfo databases through March 2009. Studies were categorized based on the type of mind-body intervention (relaxation, imagery/hypnosis, cognitive-behavioral therapy/coping skills training [CBT/CST], meditation, music, and virtual reality), and a preliminary review was conducted with respect to efficacy for pain, fatigue, and sleep disturbance. Mind-body interventions were selected for review if there was evidence of efficacy for at least two of the three symptoms. Forty-three studies addressing five types of mind-body interventions met criteria and are summarized in this review.ResultsImagery/hypnosis and CBT/CST interventions have produced improvement in all the three cancer-related symptoms individually: pain, fatigue, and sleep disturbance. Relaxation has resulted in improvements in pain and sleep disturbance. Meditation interventions have demonstrated beneficial effects on fatigue and sleep disturbance. Music interventions have demonstrated efficacy for pain and fatigue. No trials were found that tested the mind-body interventions specifically for the pain-fatigue-sleep disturbance symptom cluster.ConclusionEfficacy studies are needed to test the impact of relaxation, imagery/hypnosis, CBT/CST, meditation, and music interventions in persons with cancer experiencing concurrent pain, fatigue, and sleep disturbance. These mind-body interventions could help patients manage all the symptoms in the cluster with a single treatment strategy.     

需求理论下肺癌化疗患者对消化道症状群认知态度及饮食营养管理需求的质性研究

目的：探究需求理论下肺癌化疗患者对消化道症状群的真实认知态度及饮食营养管理需求的质性研究。方法：采用目的抽样方法,选取2021年10～11月南昌市某三甲医院呼吸科收治的16例肺癌化疗患者为研究对象,进行半结构式深入访谈,并运用现象学分析法进行资料分析。结果：通过访谈归纳出三个主题,分别是肺癌化疗患者普遍出现消化道症状但缺乏多渠道的正向行为;肺癌化疗患者对消化道症状群信息管理平台需求较高;肺癌化疗患者出现消化道不适症状时,对营养、饮食的信息需求较大。结论：医护人员应准确评估患者对消化道症状群的认知情况及饮食营养管理需求,实现对消化道症状群的科学管理,提高患者营养水平和生活质量。