Article

Symptom Clusters in Cancer Patients with Brain Metastases

Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
Clinical Oncology (Impact Factor: 2.83). 03/2008; 20(1):76-82. DOI: 10.1016/j.clon.2007.09.007
Source: PubMed

ABSTRACT To explore the presence of symptom clusters in patients with brain metastases.
Patients with brain metastases referred to an outpatient palliative radiotherapy clinic were asked to rate their symptom distress using the Edmonton Symptom Assessment Scale (ESAS). Baseline demographic data were obtained. To determine interrelationships between symptoms, a principal component analysis with 'varimax rotation' was carried out on the nine ESAS items. Follow-up was carried out by telephone 1, 2, 4, 8 and 12 weeks after radiation.
Between January 1999 and January 2002, 170 patients with brain metastases provided complete baseline data on the ESAS. The most common primary cancer sites were lung, breast and gastrointestinal. Fatigue was the highest scored symptom, followed by a poor sense of well-being, anxiety, drowsiness and poor appetite. The four most prevalent symptoms were fatigue (91.7%), a poor sense of well-being (88.1%), drowsiness (82.2%) and anxiety (82.1%). Three symptom clusters were found at baseline. Cluster 1 included fatigue, drowsiness, shortness of breath and pain. Cluster 2 included anxiety and depression. Cluster 3 included poor appetite, nausea and a poor sense of well-being. Fatigue, nausea, drowsiness and poor appetite showed an overall increase in symptom severity over time; whereas fatigue, drowsiness and poor appetite were experienced to some extent by a greater proportion of patients at week 12 compared with baseline. Symptom clusters emerged in all weeks of follow-up, but consisted of different symptoms in each week.
Symptom clusters seemed to exist in patients with brain metastases before and after whole brain radiotherapy. However, different symptoms clustered at various time points. The effectiveness of whole brain radiotherapy in providing palliative relief to patients with brain metastases needs to be explored with regards to symptom clusters.

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    • "Recently, a multivariate projection technique , known as principal component (PC) analysis, has been employed to investigate the relationships among multiple variables for various medical purposes, such as in the interpretation of repetitive nerve stimulation results (Cengiz and Kuruo lu, 2006). This technique has also become popular in studies dealing with cancer, such as evaluating various symptom clusters in patients suffering from brain and bone metastases (Chow et al., 2008; Hadi et al., 2008). "
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    • "Most studies of symptom clusters have grouped symptoms using symptom inventory types of instruments (e.g., MD Anderson Symptom Inventory) with factor analysis and cluster analysis. (Cleeland, Mendoza et al. 2000; Gift, Stommel et al. 2003; Wang, Tang et al. 2003; Gift, Jablonski et al. 2004; Wang, Wang et al. 2004; Chen and Tseng 2006; Wang, Laudico et al. 2006; Fan, Hadi et al. 2007; Gleason, Case et al. 2007; Chow, Fan et al. 2008; Hadi, Fan et al. 2008; Kim, Barsevick et al. 2008; Tseng, Cleeland et al. 2008; Wang, Tsai et al. 2008; Cheung, Le et al. 2009). A challenge with this approach is that it does not allow one to distinguish among patient subgroups on symptom severity scores or on different patterns of low and high symptom severity across subgroups. "
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