Article

Identifying Symptom Clusters in Breast Cancer: Implications on Patient Quality of Life.

Authors:
  • Pinnacle Dermatology
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Abstract

s: Thirty-Second Annual CTRC‐AACR San Antonio Breast Cancer Symposium‐‐ Dec 10‐13, 2009; San Antonio, TX Background: Patients undergoing treatment for advanced cancer often experience multiple symptoms. These symptoms occur with varying frequency, intensity, and impact. Pain, fatigue, insomnia, anorexia and dyspnea are consistently among the 10 most prevalent symptoms associated with cancer and its treatment. We conducted a multivariate analysis to investigate the impact of cancer symptoms on patient quality of life (QoL) in breast cancer.Material and Methods: A consecutive series of 226 breast cancer patients treated at the Cancer Treatment Centers of America at Southwestern Regional Medical Center between Jan 2001 and Nov 2006. Cancer symptoms were assessed using the symptom subscales of European Organization for Research Treatment of Cancer - Quality of Life Questionnaire (QLQ-C30). Symptom scores range from 0-100 with lower scores indicating better while higher scores indicating worse symptoms. QoL was assessed using Ferrans and Powers Quality of Life Index (QLI). QLI measures overall QoL and QoL in 4 major subscales: health/physical, social/economic, psychological/spiritual, and family. QLI scores range from 0-30 with higher scores indicating better QoL. The relationship between QLQ-C30 symptoms and QLI was evaluated using multivariate linear regression.Results: Of 226 patients, 98 were newly diagnosed while 128 had failed prior treatment before coming to our hospital. The mean age was 52.5 years (range = 27-82 years). We found that every 10 unit increase in fatigue (p=.004) and pain (p=.001) was significantly associated with 0.65 and 0.66 unit decline in QLI health/physical subscale after controlling for age, treatment history, stage at diagnosis and other cancer symptoms. Similarly, every 10 unit increase in insomnia (p=.02) was significantly associated with 0.35 unit decline in QLI family subscale. Finally, every 10 unit increase in pain (p=.01) and insomnia (p=.03) was significantly associated with 0.34 and 0.21 unit decline in overall QoL.Discussion: We found fatigue, pain and insomnia to be independent predictors of QoL after controlling for each other, age, treatment history and stage at diagnosis. Recognition and timely treatment of symptom clusters could result in improved QoL in patients with breast cancer. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5043.

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... The study of symptom clusters and QOL in older breast cancer survivors has revealed seven clinically distinct symptom clusters (musculoskeletal, neurocognitive, dryness, urinary, circulatory, sleep and hormonal symptoms), and these symptom clusters are significantly related to multiple QOL dimensions (Roiland & Heidrich, 2011). Furthermore, QOL was lower in breast cancer patients with higher degrees of symptoms (i.e., fatigue, sleep disorder, depression or pain) than in those with lower degrees of symptoms (Dodd et al., 2010;Kim & Kim, 2011;Lis et al., 2009). As these concurrent symptoms are the cause of reduced QOL and functional status in breast cancer patients (Dodd et al., 2010;Kim & Kim, 2011;Lis et al., 2009;Roiland & Heidrich, 2011), identifying the symptom clusters of breast cancer survivors could be beneficial for a better understanding of the significant symptoms and effective symptom management methods. ...
... Furthermore, QOL was lower in breast cancer patients with higher degrees of symptoms (i.e., fatigue, sleep disorder, depression or pain) than in those with lower degrees of symptoms (Dodd et al., 2010;Kim & Kim, 2011;Lis et al., 2009). As these concurrent symptoms are the cause of reduced QOL and functional status in breast cancer patients (Dodd et al., 2010;Kim & Kim, 2011;Lis et al., 2009;Roiland & Heidrich, 2011), identifying the symptom clusters of breast cancer survivors could be beneficial for a better understanding of the significant symptoms and effective symptom management methods. ...
Article
We investigated the symptom clusters and effects of symptom clusters on the quality of life of Korean breast cancer survivors. We recruited 241 breast cancer survivors and collected cross‐sectional data on their symptoms. To determine inter‐relationships among symptoms, a principal component analysis with varimax rotation was performed based on the patient’s symptoms (fatigue, nausea/vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, anxiety, depression, systemic therapy side effects, breast symptoms and arm symptoms). The first symptom cluster consisted of psychological (anxiety and depression) and general (appetite loss, fatigue, insomnia and dyspnoea) symptoms, whereas the second symptom cluster consisted of physical (arm symptom, breast symptom, pain and systemic therapy side effects) and gastrointestinal (nausea/vomiting and constipation) symptoms. Subgroup cluster analysis showed that breast cancer survivors with higher‐scoring symptoms had significantly poorer quality of life in both psychological–general symptom cluster and physical–gastrointestinal symptom cluster subgroups, with subgroup‐specific patterns. The symptom clusters differed depending on stage and functional status of breast cancer survivors. Breast cancer survivors may have a specific pattern of symptom clusters. Some symptom clusters may have a negative impact on the quality of life. Identifying symptom clusters of breast cancer survivors may have clinical implications by improving symptom management.
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