Abstract
PurposeThe aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis.MethodsWe analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test.ResultsThe following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively).ConclusionIn terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.
Highlights
It is well-known that patients with advanced cancer experience various distressing symptoms as their end-of-life approaches
We performed an observational study to examine the existence of symptom clusters based on a patient-reported QOL assessment tool in terminally ill patients with cancer hospitalized in a palliative care unit
Our results suggest that physicianassessed performance status is a better prognostic factor than the patient-reported status in terminally ill patients with cancer hospitalized in a palliative care unit
Summary
It is well-known that patients with advanced cancer experience various distressing symptoms as their end-of-life approaches. Dong et al demonstrated that patients with advanced cancer had four common symptom clusters: anxiety–depression, nausea–vomiting, nausea–appetite loss, and fatigue–dyspnea–drowsiness–pain. A few studies included in this review were conducted on terminally ill cancer patients [3]. We consider that it is valuable to explore symptom clusters in terminally ill patients with cancer using tools specific to palliative patient populations, such as the QLQ-C15PAL
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