Significance of Symptom Clustering in Palliative Care of Advanced Cancer Patients

Abstract Patients with advanced cancer often experience multiple concurrent symptoms. To explore this symptom clustering and its associated parameters, we prospectively surveyed 427 consecutive patients on admission to the Palliative Care Unit. There were 222 males (52.0%) and 205 females (48.0%), w...

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Bibliographic Details
Published in:Journal of pain and symptom management 2010-04, Vol.39 (4), p.655-662
Main Authors: Tsai, Jaw-Shiun, MD, Wu, Chih-Hsun, MS, Chiu, Tai-Yuan, MD, MHSci, Chen, Ching-Yu, MD
Format: Article
Language:English
Subjects:
Adult
advanced cancer patients
Aged
Aged, 80 and over
Anesthesia & Perioperative Care
Biological and medical sciences
Cluster Analysis
Clustering
Comorbidity
Female
Functional performance
hospice palliative care
Humans
Male
Medical sciences
Middle Aged
Neoplasms - diagnosis
Neoplasms - epidemiology
Pain - diagnosis
Pain - epidemiology
Pain Medicine
Palliative care
Palliative Care - statistics & numerical data
Pharmacology. Drug treatments
Prevalence
Psychological distress
Risk Assessment
Risk Factors
Sensitivity and Specificity
Survival Analysis
Survival Rate
Symptom cluster
Symptoms
Taiwan - epidemiology
Terminally ill people
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Summary:Abstract Patients with advanced cancer often experience multiple concurrent symptoms. To explore this symptom clustering and its associated parameters, we prospectively surveyed 427 consecutive patients on admission to the Palliative Care Unit. There were 222 males (52.0%) and 205 females (48.0%), with a median age of 66 years (range: 27–93 years). The main tumor sites were lung (19.9%), liver (18.0%), and colorectum (11.0%). The median survival was 13 days (1–418 days). Symptoms were assessed using a face-valid Symptom Reporting Form. We identified five symptom clusters by exploratory factor analysis. Clusters were named “loss of energy,” “poor intake,” “autonomic dysfunction,” “aerodigestive impairment,” and “pain complex.” We used nonhierarchical cluster analysis to divide the 394 patients with complete data into six groups. Each group was characterized by a particular pattern that was composed of different symptom clusters. Survival, functional performance, bone metastasis, and fluid accumulation were significantly associated with symptom clustering in six groups of patients. The severity of psychological distress also related to their physical deterioration. These data suggest that different underlying mechanisms associate with symptom clustering. Further elucidation of these processes may assist in symptom management.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2009.09.005