Purpose/Objectives: To inductively explore the existence of symptom clusters among a homogenous group of patients with inoperable lung cancer close to diagnosis and to explore if the symptom clusters are consistent when examined with different instruments and analytical methods.
Setting: Lung medicine department at two university hospitals in Sweden.
Sample: 400 patients (52% men, 48% women) newly diagnosed with lung cancer with a mean age of 64.5 years.
Methods: Data were analyzed from various questionnaires, including the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, the EORTC LC13, and the Symptom Distress Scale. Items in the instruments were adapted to increase their correspondence. Symptom clusters were analyzed with Pearson correlations, cluster analysis, factor analysis, and Cronbach alphas.
Main Research Variables: Symptom clusters.
Findings: Three clusters were found to be notably consistent across instruments and analyses: first, a pain cluster consisting of pain, nausea, bowel issues, appetite loss, and fatigue; second, a mood cluster consisting of mood, outlook, concentration, and insomnia; and third, a respiratory cluster consisting of breathing and cough, with fatigue and appetite loss closely related to more than one cluster in several analysis.
Conclusions: The authors found consistent symptom clusters for a large cohort of patients with lung cancer at a comparable point in their cancer trajectory, across different measurement tools and statistical methods.
Implications for Nursing: The symptom cluster consistency for patients with lung cancer is an important finding because the relevance of symptom cluster research is questionable if consistency is lacking across data collection and analysis approaches. Achieving consistency is possible in symptom cluster research across instruments and analysis methods if instrument items are comparable.
Aaronson, N.K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N.J., et al. (1993). The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365-376.
Barsevick, A.M. (2007). The concept of symptom clusters. Seminars in Oncology Nursing, 23(2), 89-98.
Barsevick, A.M., Whitmer, K., Nail, L.M., Beck, S.L., & Dudley, W.N. (2006). Symptom cluster research: Conceptual, design, measurement, and analysis issues. Journal of Pain and Symptom Management, 31(1), 85-95.
Beck, S.L. (2004). Symptom clusters: Impediments and suggestions for solutions. Journal of the National Cancer Institute. Monographs, 32, 137-138.
Bender, C.M., Ergyn, F.S., Rosenzweig, M.Q., Cohen, S.M., & Sereika, S.M. (2005). Symptom clusters in breast cancer across three phases of the disease. Cancer Nursing, 28(3), 219-225.
Bergman, B., Aaronson, N.K., Ahmedzai, S., Kaasa, S., & Sullivan, M. (1994). The EORTC QLQ-LC13: A modular supplement to the EORTC core quality-of-life questionnaire (QLQ-C30) for use in lung cancer clinical trials. EORTC study group on quality of life. European Journal of Cancer, 30A(5), 635-642.
Chan, C.W., Richardson, A., & Richardson, J. (2005). A study to assess the existence of the symptom cluster of breathlessness, fatigue, and anxiety in patients with advanced lung cancer. European Journal of Oncology Nursing, 9(4), 325-333.
Chen, M.L., & Lin, C.C. (2007). Cancer symptom clusters: A validation study. Journal of Pain and Symptom Management, 34(6), 590-599.
Chen, M.L., & Tseng, H.C. (2006). Symptom clusters in cancer patients. Supportive Care in Cancer, 14(8), 825-830.
Chow, E., Fan, G., Hadi, S., & Filipczak, L. (2007). Symptom clusters in cancer patients with bone metastases. Supportive Care in Cancer, 15(9), 1035-1043.
Dodd, M.J., Miaskowski, C., & Lee, K.A. (2004). Occurrence of symptom clusters. Journal of the National Cancer Institute. Monographs, 32, 76-78.
Dodd, M.J., Miaskowski, C., & Paul, S.M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28(3), 465-470.
Fan, G., Filipczak, L., & Chow, E. (2007). Symptom clusters in cancer patients: A review of the literature. Current Oncology, 14(5), 173-179.
Gift, A.G., Jablonski, A., Stommel, M., & Given, C.W. (2004). Symptom clusters in elderly patients with lung cancer. Oncology Nursing Forum, 31(2), 202-212.
Hazard Munro, B. (2001). Statistical methods for health care research (4th ed.). Philadelphia: Lippincott Williams and Wilkins.
Henoch, I., Bergman, B., Gustafsson, M., Gaston-Johansson, F., & Danielson, E. (2008). Dyspnea experience in patients with lung cancer in palliative care. European Journal of Oncology Nursing, 12(2), 86-96.
Kim, H.J., McGuire, D.B., Tulman, L., & Barsevick, A.M. (2005). Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nursing, 28(4), 270-282.
Kirkova, J., & Walsh, D. (2007). Cancer symptom clusters—A dynamic construct. Supportive Care in Cancer, 15(9), 1011-1013.
Lovgren, M., Levealahti, H., Tishelman, C., Runesdotter, S., Hamberg, K., & Koyi, H. (2007). Time spans from first symptom to treatment in patients with lung cancer—The influence of symptoms and demographic characteristics. Acta Oncologica, 47(3), 397-405.
McCorkle, R., Cooley, M., & Shea, J. (1998). User's manual for symptom distress scale. Philadelphia: School of Nursing, University of Pennsylvania.
McCorkle, R., & Quint-Benoliel, J. (1983). Symptom distress, current concerns, and mood disturbance after diagnosis of life-threatening disease. Social Science and Medicine, 17(7), 431-438.
McCorkle, R., & Young, V. (1978). Development of a symptom distress scale. Cancer Nursing, 1(5), 373-378.
Miaskowski, C., Aouizerat, B.E., Dodd, M., & Cooper, B. (2007). Conceptual issues in symptom clusters research and their implications for quality-of-life assessment in patients with cancer. Journal of the National Cancer Institute. Monographs, 37, 39-46.
Miaskowski, C., Dodd, M., & Lee, K. (2004). Symptom clusters: The new frontier in symptom management research. Journal of the National Cancer Institute. Monographs, 32, 17-21.
Nicklasson, M., & Bergman, B. (2007). Validity, reliability, and clinical relevance of EORTC QLQ-C30 and LC13 in patients with chest malignancies in a palliative setting. Quality of Life Research, 16(6), 1019-1028.
Sarna, L., & Brecht, M.L. (1997). Dimensions of symptom distress in women with advanced lung cancer: A factor analysis. Heart and Lung, 26(1), 23-30.
Tanaka, K., Akechi, T., Okuyama, T., Nishiwaki, Y., & Uchitomi, Y. (2002). Factors correlated with dyspnea in advanced lung cancer patients: Organic causes and what else? Journal of Pain and Symptom Management, 23(6), 490-500.
Tishelman, C., Degner, L.F., Rudman, A., Bertilsson, K., Bond, R., Broberger, E., et al. (2005). Symptoms in patients with lung carcinoma: Distinguishing distress from intensity. Cancer, 104(9), 2013-2021.
Tishelman, C., Petersson, L.M., Degner, L.F., & Sprangers, M.A. (2007). Symptom prevalence, intensity, and distress in patients with inoperable lung cancer in relation to time of death. Journal of Clinical Oncology, 25(34), 5381-5389.
Walsh, D., & Rybicki, L. (2006). Symptom clustering in advanced cancer. Supportive Care in Cancer, 14(8), 831-836.
Wells, N., & Ridner, S.H. (2008). Examining pain-related distress in relation to pain intensity and psychological distress. Research in Nursing and Health, 31(1), 52-62.