Symptom clusters in patients with advanced cancers

Abstract

9566 Background: It has been observed that certain cancer symptoms such as pain, depression and fatigue frequently occur together. Prior research on symptom patterns has focused on inpatients, early stage cancers, or a single cancer type or metastatic site. Our aim was to explore symptom clusters among outpatients with various types of advanced cancers. Methods: Symptom scores measured by Edmonton Symptom Assessment Scale (ESAS) were routinely collected for patients attending Oncology Palliative Care Clinics at Princess Margaret Hospital from January 2004 to October 2007. Principal component analysis (PCA) was performed for the entire patient cohort and within specific disease sites to determine interrelationships of the 9 ESAS symptoms. Regression analyses were used to identify patient characteristics that were associated with symptom clusters and severity of symptom distress. Results: A total of 1,366 patients were included: 50% were male and median age was 64 years (range 18 to 74). The 3 most prevalent symptoms were fatigue, poor general well-being and decreased appetite. PCA of symptoms for the entire patient cohort revealed 2 major symptom clusters: cluster 1 (fatigue, drowsiness, nausea and decreased appetite) and cluster 2 (anxiety, depression and poor general well-being). There was high internal reliability in the clusters (Cronbach’s alpha coefficient 0.80 and total variance 10–47%). Neither patient gender nor age predicted for symptom clusters (all p>0.05). Results from PCA of symptoms within the main cancer sites were tabulated (see table). Conclusions: In patients with advanced cancers, cancer site is associated with distinct symptom clusters which are not influenced by patient demographics. Further prospective studies are warranted in order to develop cancer-specific palliative interventions for this patient population. ESAS Symptom CNS H&N Breast Lung GI GU Gyne Pain 0.70* 0.23 0.87* 0.74* 0.73* 0.71* 0.55* Fatigue 0.77* 0.64* 0.43 0.60 0.56* 0.73* 0.60* Nausea 0.22 0.10 0.28 0.41* 0.78* 0.15 0.21 Depression 0.33 0.83* 0.47 0.31 0.79* 0.17 0.14 Anxiety 0.25 0.79* 0.20 0.17 0.84* 0.20 0.16 Drowsiness 0.80* 0.24 0.57* 0.33 0.73* 0.45 0.12 Appetite 0.10 0.19 0.28 0.81* 0.03 0.77* 0.76* Well-being 0.33 0.68* 0.32 0.68* 0.39 0.73* 0.78* Dyspnea 0.65* 0.77* 0.24 0.01 0.27 0.44 0.59* Values listed represent factor loading in principal component analysis where * indicates possible symptom clustering within the disease site. CNS: central nervous system; H&N: head and neck; GI: gastrointestinal; GU: genitourinary; Gyne: gynecological. No significant financial relationships to disclose.