Symptoms and Problem Clusters in Cancer and Non-Cancer Patients in Specialized Palliative Care—Is There a Difference?

• Published in: Journal of pain and symptom management 2014-07, Vol.48 (1), p.26-35
• Main Authors: Stiel, Stephanie, Dipl Psych, Matthies, Dominik M.K, Seuß, Dominik, MSc, Walsh, Declan, MD, Lindena, Gabriele, MD, Ostgathe, Christoph, MD
• Format: Article
• Language: English
• Subjects: Activities of daily living; Aged; Anesthesia & Perioperative Care; Anxiety; Biological and medical sciences; Cancer; Cluster Analysis; Eating behaviour; Female; Germany; Humans; Inpatients; Male; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasms - physiopathology; Neoplasms - therapy; non-cancer; Pain Medicine; Palliative Care; Pharmacology. Drug treatments; problems; Symptoms; Tumors
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2013.08.018

Abstract Context In clinical practice, some symptoms and problems frequently occur in combination, which may have consequences for symptom management. Objectives Facing a growing number of non-cancer patients in palliative care, this study aimed to differentiate symptom clusters in the non-cancer population from those in cancer patients. Methods Inpatient data from the German Hospice and Palliative Care Evaluation between 2007 and 2011 were used for a cluster analysis of a 16-item symptom and problem checklist. An agglomerative hierarchical method was chosen. Coefficients from distance matrix ranging between 0 and 1 were calculated to indicate the interrelationship of clustered symptoms. Results The analysis identified five clusters in cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.125); 3) wound care and disorientation/confusion (d = 0.229); 4) organization of care and overburdening of family (d = 0.202); and 5) weakness, tiredness, need for assistance with activities of daily living, and loss of appetite (d = 0.207). Five comparable clusters were identified in non-cancer patients: 1) nausea and vomiting (d = 0.000); 2) anxiety, tension, and feeling depressed (d = 0.166); 3) organization of care and overburdening of family (d = 0.187); 4) weakness and need for assistance with activities of daily living (d = 0.139); and 5) tiredness and loss of appetite (d = 0.182). Conclusion As symptom clusters do not significantly differ between cancer and non-cancer patients, specific frequent symptoms in non-cancer patients should be assessed. Identification of symptom clusters may help to target therapies and focus the use of medications to improve patients' quality of life.