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Congruence Between Latent Class and K-Modes Analyses in the Identification of Oncology Patients With Distinct Symptom Experiences
Authors:Nikoloas Papachristou  Payam Barnaghi  Bruce A Cooper  Xiao Hu  Roma Maguire  Kathi Apostolidis  Jo Armes  Yvette P Conley  Marilyn Hammer  Stylianos Katsaragakis  Kord M Kober  Jon D Levine  Lisa McCann  Elisabeth Patiraki  Steven M Paul  Emma Ream  Fay Wright  Christine Miaskowski
Institution:1. School of Health Sciences, University of Surrey, Guilford, UK;2. School of Nursing, University of California, San Francisco, California, USA;3. Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK;4. European Cancer Patient Coalition, Brussels, Belgium;5. Florence Nightingale Faculty of Nursing and Midwifery, King''s College, London, UK;6. School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;g. Department of Nursing, Mount Sinai Medical Center, New York, New York, USA;h. Faculty of Nursing, University of Peloponnese, Efstathiou & Stamatikis Valioti and Plateon, PC, Sparti, Greece;i. School of Medicine, University of California, San Francisco, California, USA;j. School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece;k. School of Nursing, Yale University, New Haven, Connecticut, USA
Abstract:

Context

Risk profiling of oncology patients based on their symptom experience assists clinicians to provide more personalized symptom management interventions. Recent findings suggest that oncology patients with distinct symptom profiles can be identified using a variety of analytic methods.

Objectives

The objective of this study was to evaluate the concordance between the number and types of subgroups of patients with distinct symptom profiles using latent class analysis and K-modes analysis.

Methods

Using data on the occurrence of 25 symptoms from the Memorial Symptom Assessment Scale, that 1329 patients completed prior to their next dose of chemotherapy (CTX), Cohen's kappa coefficient was used to evaluate for concordance between the two analytic methods. For both latent class analysis and K-modes, differences among the subgroups in demographic, clinical, and symptom characteristics, as well as quality of life outcomes were determined using parametric and nonparametric statistics.

Results

Using both analytic methods, four subgroups of patients with distinct symptom profiles were identified (i.e., all low, moderate physical and lower psychological, moderate physical and higher Psychological, and all high). The percent agreement between the two methods was 75.32%, which suggests a moderate level of agreement. In both analyses, patients in the all high group were significantly younger and had a higher comorbidity profile, worse Memorial Symptom Assessment Scale subscale scores, and poorer QOL outcomes.

Conclusion

Both analytic methods can be used to identify subgroups of oncology patients with distinct symptom profiles. Additional research is needed to determine which analytic methods and which dimension of the symptom experience provide the most sensitive and specific risk profiles.
Keywords:Symptom clusters  cancer  latent class analysis  machine learning  clustering  chemotherapy  k-modes analysis
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