Prospective Longitudinal Evaluation of a Symptom Cluster in Breast Cancer

• Published in: Journal of pain and symptom management Vol. 47; no. 4; pp. 721 - 730
• Main Authors: Sanford, Stacy D., PhD, Beaumont, Jennifer L., MS, Butt, Zeeshan, PhD, Sweet, Jerry J., PhD, Cella, David, PhD, Wagner, Lynne I., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2014; Elsevier
• Subjects: Adult; Aged; Anesthesia & Perioperative Care; Antineoplastic Agents - therapeutic use; Anxiety; Anxiety-Depression; Biological and medical sciences; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - physiopathology; Breast Neoplasms - psychology; Chemotherapy; cognitive impairment; depression; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; emotional distress; fatigue; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Longitudinal Studies; Male; Mammary gland diseases; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; Nervous system (semeiology, syndromes); Neurology; oncology; Pain Medicine; Pharmacology. Drug treatments; Prospective Studies; Quality of Life; Severity of Illness Index; sleep disturbance; Sleep problems; Socioeconomic Factors; symptom cluster; Symptoms; Time Factors; Tumors; United States > US; anxiety; fatigue; sleep disturbance; emotional distress; symptom cluster; Breast cancer; cognitive impairment; depression; oncology; Affect affectivity; Breast disease; Cognitive disorder; Prospective; Cancerology; Anxiety; Neurological disorder; Mood disorder; Evaluation; Nervous system diseases; Sleep disorder; Depression; Fatigue; Cluster; Emotional disorder; Malignant tumor; Mammary gland diseases; Symptomatology; Psychological distress; Cancer
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2013.05.010

Abstract Context Symptom cluster research expands cancer investigations beyond a focus on individual symptoms in isolation. Objectives We conducted a prospective longitudinal study of sleep, fatigue, depression, anxiety, and perceived cognitive impairment in patients with breast cancer undergoing chemotherapy. Methods Patient-reported outcome measures were administered prior to chemotherapy, at Cycle 4 Day 1, and six months after initiating chemotherapy. Participants were divided into four groups and assigned a symptom cluster index (SCI) score based on the number/severity of symptoms reported at enrollment. Results Participants ( N  = 80) were mostly women (97.5%) with Stage II (69.0%) breast cancer, 29–71 years of age. Scores on all measures were moderately-highly correlated across all time points. There were time effects for all symptoms, except sleep quality (nonsignificant trend), with most symptoms worsening during chemotherapy, although anxiety improved. There were no significant group × time interactions; all four SCI groups showed a similar trajectory of symptoms over time. Worse performance status and quality of life were associated with higher SCI score over time. Conclusion With the exception of anxiety, the coherence of the symptom cluster was supported by similar patterns of severity and change over time in these symptoms (trend for sleep quality). Participants with higher SCI scores prior to chemotherapy continued to experience greater symptom burden during and after chemotherapy. Early assessment and intervention addressing this symptom cluster (vs. individual symptoms) may have a greater impact on patient performance status and quality of life for patients with higher SCIs.