TY - JOUR
T1 - Symptom burden clusters
T2 - A challenge for targeted symptom management. A longitudinal study examining symptom burden clusters in breast cancer
AU - Kenne Sarenmalm, Elisabeth
AU - Browall, Maria
AU - Gaston-Johansson, Fannie
N1 - Funding Information:
This study was supported by grants from the Health & Medical Care Committee of the Regional Executive Board , Western Region of Götaland, and the King Gustav V Jubilee Clinic Cancer Research Foundation , Gothenburg, Sweden. The authors declare no conflicts of interest.
PY - 2014/4
Y1 - 2014/4
N2 - Context Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters. Objectives To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer. Methods In 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. Results Three 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. Conclusion This 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.
AB - Context Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters. Objectives To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer. Methods In 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. Results Three 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. Conclusion This 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.
KW - Breast cancer
KW - health status
KW - quality of life
KW - sense of coherence
KW - symptom burden
KW - symptom burden clusters
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U2 - 10.1016/j.jpainsymman.2013.05.012
DO - 10.1016/j.jpainsymman.2013.05.012
M3 - Article
C2 - 23916827
AN - SCOPUS:84898835050
SN - 0885-3924
VL - 47
SP - 731
EP - 741
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 4
ER -