Memorial Symptom Assessment Scale Research Articles

Symptom clusters and network analysis of patients with intermediate and advanced liver cancer treated with targeted immunotherapy.

This study aims to identify symptom clusters in patients with intermediate and advanced liver cancer receiving targeted immunotherapy, focusing on core and bridge symptoms to establish a foundation for precise symptom management. This study used a cross-sectional survey and utilized convenience sampling from May 2023 to January 2024 at a third-class hospital in Shanghai, China. The severity of symptoms in liver cancer patients during treatment was evaluated using the Memorial Symptom Assessment Scale. Network analysis was employed to depict the interrelation of symptom clusters and identify core and bridge symptoms. The symptoms were classified by severity into five clusters: oral, gastrointestinal, fatigue-related, body image, and pain-sleep. Within the symptom network, the core symptoms were pain, "I don't look like myself," and nausea, while the critical bridge symptoms included pain, itching, and feeling bloated. The strongest connections were observed between nausea and vomiting, followed by taste changes and dry mouth, as well as weight loss and "I don't look like myself." In patients receiving targeted immunotherapy for intermediate and advanced liver cancer, multiple symptoms can emerge simultaneously, forming interconnected clusters. By identifying and intervening in core and bridge symptoms, personalized management strategies can be developed to relieve other symptoms and disrupt connections between symptom clusters, thereby enhancing symptom management efficacy. This study has significant clinical and research implications, offering new insights to improve patients' quality of life and treatment outcomes.

Symptom Clusters in Children With Leukemia Receiving Chemotherapy: A Scoping Review.

Leukemia represents the most prevalent childhood malignancy. Understanding the symptom clusters (SCs) associated with leukemia may help develop an effective care plan for affected children. The aims of this study were to summarize the methods of identifying SCs; ascertain the types, attributes, and changing patterns of SCs during different chemotherapy phases; and provide a point of reference for the subsequent improvement of symptom management in pediatric leukemia. The methodological framework employed was the Joanna Briggs Institute Scoping Review Guide. A comprehensive search was conducted across various databases, including PubMed, EMBASE, CINAHL, Web of Science, MEDLINE, Scopus, and China National Knowledge Infrastructure from inception until July 15, 2023. A total of 14 articles were included in this review, 6 in English and 8 in Chinese. The Memorial Symptom Assessment Scale 10-18 is the most commonly used instrument, whereas factor analysis is the most common statistical method for SC identification. The SCs were classified into 12 categories. The most severe SCs varied across different phases. Specifically, the emotional cluster dominated the prechemotherapy phase, the gastrointestinal cluster surfaced during postinduction therapy, and the consolidation and maintenance therapy phases revealed the self-image disorder cluster. Various consistent and dynamic SCs manifest among pediatric patients with leukemia undergoing chemotherapy. Future research endeavors should formulate clear criteria to determine the stability and consistency of SCs, validate SC composition and characteristics, and devise precise symptom management protocols based on SC characteristics in the distinct chemotherapy phases.

Agreement between patient-reported and clinically documented symptoms of acute myeloid leukemia: Study protocol.

To describe our methods to compare patient-reported symptoms of acute myeloid leukemia and the corresponding documentation by healthcare providers in the electronic health record. Patients with acute myeloid leukemia experience many distressing symptoms, particularly related to chemotherapy. The timely recognition and provision of evidence-based interventions to manage these symptoms can improve outcomes. However, lack of standardized formatting for symptom documentation within electronic health records leads to challenges for clinicians when accessing and comprehending patients' symptom information, as it primarily exists in narrative forms in various parts of the electronic health record. This variability raises concerns about over- or under-reporting of symptoms. Consistency between patient-reported symptoms and clinician's symptom documentation is important for patient-centered symptom management, but little is known about the degree of agreement between patient reports and their documentation. This is a detailed description of the study's methodology, procedures and design to determine how patient-reported symptoms are similar or different from symptoms documented in electronic health records by clinicians. Exploratory, descriptive study. Forty symptoms will be assessed as patient-reported outcomes using the modified version of the Memorial Symptom Assessment Scale. The research team will annotate symptoms from the electronic health record (clinical notes and flowsheets) corresponding to the 40 symptoms. The degree of agreement between patient reports and electronic health record documentation will be analyzed using positive and negative agreement, kappa statistics and McNemar's test. We present innovative methods to comprehensively compare the symptoms reported by acute myeloid leukemia patients with all available electronic health record documentation, including clinical notes and flowsheets, providing insights into symptom reporting in clinical practice. Findings from this study will provide foundational understanding and compelling evidence, suggesting the need for more thorough efforts to assess patients' symptoms. Methods presented in this paper are applicable to other symptom-intensive diseases.

Lower Income, Smoking, Cardiopulmonary Comorbidities, and Higher Symptom Burden Influence the Occurrence of Cough in Patients Receiving Chemotherapy.

To identify subgroups of patients with distinct cough occurrence profiles and evaluate for differences among these subgroups. Outpatients receiving chemotherapy (N = 1,338) completed questionnaires six times over two chemotherapy cycles. Occurrence of cough was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups with distinct cough occurrence profiles. Parametric and nonparametric tests were used to evaluate for differences. Four distinct cough profiles were identified (None, Decreasing, Increasing, and High). Risk factors associated with membership in the High class included lower annual household income; history of smoking; self-reported diagnoses of lung disease, heart disease, and back pain; and having lung cancer. Clinicians need to assess all patients with cancer for cough and provide targeted interventions.

Symptom clusters and their impacts on the quality of life of patients with lung cancer receiving immunotherapy: A cross-sectional study.

The objective of this study was to identify symptom clusters in lung cancer patients receiving immunotherapy and explore their impact on the quality of life of patients. Immunotherapy is widely used in lung cancer; however, there is little understanding of symptom clusters and their impacts on the quality of life of this population. Cross-sectional study. The survey contained the Memorial Symptom Assessment Scale (MSAS), Quality of Life Questionnaire-Lung Cancer 43 and a self-designed General Information Evaluation Form. Symptom clusters were identified using exploratory factor analysis (EFA) based on the symptom scores. Spearman correlation analysis was performed to evaluate the associations between each symptom cluster and the patients' quality of life. Multiple linear regression analysis was employed to examine the impact of the symptom clusters on quality of life. This study adhered to the STROBE guidelines. In total, 240 participants completed the survey. Five symptom clusters were identified and named according to their characteristics: emotional-related symptom cluster, lung cancer-related symptom cluster, physical symptom cluster, skin symptom cluster and neural symptom cluster. All symptom clusters, except for the neural symptom cluster, had a significantly detrimental impact on patient quality of life. Lung cancer patients undergoing immunotherapy experience a range of symptoms, which can be categorized into five clusters. These symptom clusters have a negative impact on patients' quality of life. Future research should focus on developing interventions for each symptom cluster and their influencing factors. In the data collection phase, lung cancer patients undergoing immunotherapy were recruited to participate in the survey.

The effectiveness of reminiscence therapy on the symptom management, the life satisfaction, and the self-transcendence in palliative care patients: a randomized controlled trial

PurposeTo examine the effect of individualized reminiscence therapy on the management of global distress and physical and psychological symptoms, life satisfaction and self-transcendence levels of palliative care patients.MethodsIn a single-center palliative care service in western Turkey, 48 patients without cognitive impairment and able to communicate were included in the study. However, 44 patients completed the study. Patients who met the inclusion criteria were randomly assigned to the reminiscence therapy (intervention), unstructured social interviewing (placebo), and control groups (16 people for each group) before the start of the study. The sessions for the interview and placebo groups were conducted face-to-face in the patient's room (while the patient was sitting or lying down) for 15 days (2 weeks), every other day, for a total of eight sessions (each session was approximately 30 min). Data collection instruments—the Memorial Symptom Assessment Scale, the Contentment with Life Assessment Scale, and the Self-Transcendence Scale—were collected at baseline (first day) and after the intervention (day 15th). Statistical significance level was accepted as p < 0.05.ResultsThere was no decrease in physical and total symptom burden (p > 0.05). There were significant reductions in general distress and psychological symptoms in the intervention and placebo groups within the group (p < 0.05), but there were no significant differences between the control group and all groups when compared (p > 0.05). Group × time interactions were statistically significant for life satisfaction and self-transcendence (p < 0.001), and there was a substantial increase in the intervention group compared to the other groups.ConclusionIt may be recommended that reminiscence therapy intervention be included in routine nursing care as it may contribute positively to the psychological recovery of palliative care patients approaching the end of life.Trial registrationClinicalTrails.gov (Registration number: NCT05242016). Prospectively registered on 1 February 2022.

A Structural Equation Model of the Relationship Between Symptom Burden, Psychological Resilience, Coping Styles, Social Support, and Psychological Distress in Elderly Patients With Acute Exacerbation Chronic Obstructive Pulmonary Disease in China

PurposeThe prevalence of psychological distress is frequently observed among old adults with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, current researches are insufficient to clarify the correlation among these relevant factors. This study examined the effects of symptom burden, psychological resilience, coping styles and socialsupporton psychological distress Methods255 elderly patients with AECOPD were conveniently selected in Taian, Shandong Province. The General Information Questionnaire, Distress Thermometer, The Revised Memorial Symptom Assessment Scale, Connor-Davidson Resilience Scale, Simplified Coping Style Questionnaire, Perceived Social Support Scale were used to investigate. The relationship among factors was estimated by using a structural equation model ResultsPsychological distress score of elderly patients with AECOPD was (5.25±1.01); coping styles, psychological resilience, symptom burden, social support directly affected psychological distress (the direct effects were -0.934, 0.174, 0.169 and -0.086); coping styles had the largest total effect on psychological distress (the total effect was -0.934); psychological resilience indirectly affected psychological distress through coping styles (the indirect effect was -0.743); symptom burden indirectly affected psychological distress through psychological resilience (the indirect effect was 0.254); social support indirectly affected psychological distress through symptom burden, psychological resilience, and coping styles (the indirect effect was -0.799) ConclusionThe psychological distress of elderly patients with AECOPD is at a moderate level; coping styles, psychological resilience and social support have positive effects on alleviating the psychological distress of elderly patients with AECOPD; symptom burden is negatively correlated with psychological distress. Healthcare professionals should pay more attention to elderly patients with AECOPD who are particularly prone to experiencing higher levels of psychological distress, especially in the presence of low coping style, limited psychological resilience, inadequate levels of social support, and high symptom burden.

Symptom Clusters and Their Impact on Spiritual Well-Being Among Women with Breast Cancer.

To explore symptom experience and symptom clusters among Jordanian women with breast cancer and investigate whether these clusters predict patients' spiritual well-being. A sample of 142 Jordanian women with breast cancer were asked to complete the Memorial Symptom Assessment Scale (MSAS), Functional Assessment of Chronic Illness Therapy- Spiritual Well-being (FACIT-Sp) scale, and socio-demographic questionnaire. Exploratory factor analysis was used to group symptoms into clusters, and multiple linear regression was used to explore the symptom clusters that predict spiritual well-being. The most prevalent symptoms among women with breast cancer were fatigue, anxiety, tension, and pain. All these symptoms have a prevalence greater than 50%. Three clusters were found: treatment-related symptom cluster consisting of eight symptoms, gastrointestinal symptom cluster consisting of seven symptoms, and psychological symptom cluster consisting of five symptoms. The psychological symptom cluster was the only cluster predicting the women's spiritual well-being (t (141) = -3.049; p < 0.01). Women with breast cancer experience several concurrent symptoms and symptom clusters. Screening for psychological symptom clusters and their treatment improves patients' spiritual well-being. The majority of women with breast cancer did not receive any complementary therapies and hardly any spiritual or psychological support, which should be provided in the future to support their spiritual well-being.

D-CRSE: Diminishing chemotherapy-related side effects through patient education, a mixed-methods pilot study

Objectives Patient education materials regarding self-management of chemotherapy-related side effects are limited, which may result in patients using disreputable sources. We created a brochure that educates patients on common side effects, tools to address problems themselves, and guidance on when to contact their oncologist or seek emergency care. This mixed-methods study conducted at Penn State Cancer Institute evaluates the feasibility of using an educational brochure to improve patient outcomes through education. Methods Chemotherapy naïve patients with breast or gastrointestinal (GI) cancer were enrolled in a single-arm clinical trial from December 2021 to 2022. Participants received the educational brochure and were asked to provide their initial impressions. They completed The Emotional Thermometer Scale (ETS) and the Memorial Symptom Assessment Scale (MSAS) to measure changes in patient symptoms and mental health throughout their chemotherapy course at 0, 6, and 12-week intervals. The drop-out rate was recorded as a measure of study feasibility. Results The study participants were split between the following cancer types: 77.8% breast and 22.2% GI cancer. A significant decrease in overall mean ETS score was observed between baseline and week 6 (p = 0.001) and 12 (p = 0.0004), respectively. Moreover, the mean MSAS psychological symptoms decreased significantly at week 12 compared to baseline (p = 0.005), while no change was observed in physical symptoms (p = 0.101). Of the 40 participants who completed baseline surveys, 37 had at least one additional visit for a drop-out rate of 7.5%. Conclusion This mixed-methods pilot study was successful in demonstrating the feasibility of distributing a standardized educational brochure as an intervention for chemotherapy patients. While participants’ emotional scores and psychological symptoms decreased over time, physical symptoms did not, which aligns with side effect progression from cumulative chemotherapy burden.

Effect of a Manual Lymphatic Drainage with Rehabilitation Exercise on Edema, Pain, And Lower Extremity Function in Gynecological Cancer After Surgery

This study aimed to determine the effects of manual lymphatic drainage with rehabilitation exercises on edema, pain, and lower extremity function in patients with gynecological cancer after surgery. The study included 20 patients with gynecological cancer with a Numeric Rating Scale (NRS) pain score &gt;3, who were either inpatients or outpatients in Seoul. The patients were randomly assigned to either the experimental group (n=10) or control group (n=10). The experimental group underwent manual lymphatic drainage with rehabilitation exercises, whereas the control group underwent manual lymphatic drainage with diaphragmatic breathing. Each patient was treated for 50 min twice a week for 4 weeks. Before and after the experiment, edema, pain, lower extremity function, and quality of life were evaluated using the Circumference Tape, Numeric Rating Scale, Lower Extremity Functional Scale, and Memorial Symptom Assessment Scale. The results of this study were as follows. First, the edema between the experimental and control groups significantly decreased before and after the intervention; however, there was no significant difference in the comparison between the groups. Second, the pain scores between the experimental and control groups significantly decreased before and after the intervention, and there was a significant difference in the comparison between the groups. Third, the lower extremity function between the experimental and control groups significantly increased before and after the intervention, and there was no significant difference between the groups. Forth, the quality of life between the experimental and control groups significantly increased before and after the intervention, and there was significant difference in the comparison between the group. The physical symptoms were significantly different between the groups; however, the emotional symptoms were not. The analysis of this experiment showed that, both the groups were effective in improving edema, pain, lower extremity function, and quality of life in patients with gynecological cancer undergoing surgery. In particular, manual lymphatic drainage with rehabilitation exercises was more effective than manual lymphatic drainage with diaphragmatic breathing for edema and physical symptoms of patients with gynecological cancer after surgery.

The association between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health related quality of life in newly diagnosed ovarian cancer patients

ObjectiveTo assess cognitive function in patients newly diagnosed with ovarian cancer (OC) before treatment and explore the relationship between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health-related quality of life in them. MethodsFrom May 2021 to February 2022, 105 women newly diagnosed with OC were enrolled in the Cancer Center of Fudan University, Shanghai, China. Objective and subjective cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) scale and Perceptual Deficits Questionnaire (PDQ). Symptoms and quality of life were evaluated using the Memorial Symptom Assessment Scale (MSAS) and Functional Assessment of Cancer Therapy-Ovarian Cancer (FACT-O), respectively. ResultsThis study included 105 newly diagnosed OC patients, with an average age of 49.73 (±8.48) years. Of these, 72.38% had impaired neuropsychological test scores, especially in delayed recall, abstraction, and visuospatial/executive function. Retrospective, and prospective memory were the most serious perceived deficits. The results of the MoCA test were not associated with PDQ (Rs = -0.180, P = 0.067) and significantly correlated with the distress index, physiological and total scores of the MSAS, and emotional well- being of the FACT-O. The PDQ positively correlated with all MSAS dimensions but not with the FACT-O. ConclusionThe incidence of neuropsychological impairment in patients newly diagnosed with OC was high, with no association with self-perceived cognitive deficits. It is recommended that healthcare providers include cognitive impairment in symptom management in this population, who may benefit from early assessment, prevention, and intervention.

Symptoms and quality of life among men starting treatment for metastatic castration-resistant prostate cancer – a prospective multicenter study

BackgroundMen with metastatic castration-resistant prostate cancer (mCRPC) have an incurable disease. Along with prolonging life, symptom management is one of the main goals with treatment. This is also important from a palliative care perspective where the life prolonging outcomes should be balanced with quality of life (QoL) in this late phase. It is also essential in symptom management to view different dimensions of symptoms, for example how severe or distressing symptoms are, to support best QoL. Therefore, more knowledge is needed about the symptom experience when these treatments are initiated and thus the aim of this study was to describe different dimensions of symptoms in men with mCRPC starting their first-line of life-prolonging treatment, and to describe the association between symptom burden and QoL.MethodsBaseline data from a prospective longitudinal study of 143 men with mCRPC starting their first-line life-prolonging treatment were used. Symptoms were measured using the Memorial Symptom Assessment Scale (MSAS) and global QoL was measured by the EORTC QLQ C-30. Data was analyzed using descriptive- and multivariable linear regression analyses.ResultsOn average, the men had more than 10 symptoms (range 0–31 of 33). 50% or more reported sweats, lack of energy, pain, problems with sexual activity and sexual desire. The symptoms they reported as most severe, or most distressing were not always the ones that were reported as most frequent. There was an association between QoL and physical symptoms, and also between QoL, and analgesic use and prostate-specific antigen (PSA) values.ConclusionEven if some men with mCRPC report many symptoms, the dimensions of severity and distress levels vary, and the most frequent symptoms was not always the most burdensome or distressing. There was an association between high physical symptom burden and QoL, suggesting that it is not the number of symptoms that affects QoL but rather the subjective perceived impact of the physical symptoms experienced. The knowledge of how men with mCRPC experience and perceive their symptoms may help health care professionals in symptom management aiming to improve QoL, which is a cornerstone in integrating early palliative care.

Abstract 7440: Symptom network analysis and unsupervised clustering of a cohort of oncology patients identifies drivers of symptom burden and patient subgroups with distinct symptom patterns

Abstract Purpose: Inter-individual variability in oncology patients’ symptom experiences poses significant challenges in prioritizing symptoms for targeted intervention(s). In this study, computational approaches were used to unbiasedly characterize the heterogeneity of the symptom experience of oncology patients to elucidate their symptom patterns and drivers of symptom burden. Methods: Severity ratings for 32 symptoms on the Memorial Symptom Assessment Scale from 3088 oncology patients were analyzed. Gaussian Graphical Model symptom networks were constructed for the entire cohort and subgroups identified through unsupervised clustering of symptom co-severity patterns. Symptom network characteristics were analyzed and compared using permutation-based statistical tests. Demographic and clinical characteristic differences between subgroups were assessed using multinomial logistic regression. Results: Network analysis of the entire cohort revealed three core symptom clusters: constitutional, gastrointestinal-epithelial, and psychological. Lack of energy was identified as central to the network, suggesting that it plays a crucial role in driving overall symptom burden and may be the most salient to target clinically. Unsupervised clustering of patients based on shared symptom co-severity patterns identified six patient subgroups with distinct symptom patterns and demographic and clinical characteristics. The first subgroup represented a baseline cohort of patients who are most affected by common constitutional symptoms of cancer care. The second subgroup represented patients with severe overall symptom burden. The third subgroup represented patients primarily experiencing neuropathy. The fourth subgroup represented patients with advanced disease and treatment-related symptoms but relatively high quality of life. The fifth subgroup represented younger patients with pronounced psychological disease burden. The sixth subgroup represented patients with minimal symptom burden. Age, treatment status, and Karnofsky Performance Score were the strongest determinants of subgroup membership, but their interplay (in one case even with ethnicity) reaffirms the complex multi-factorial nature of the symptom experience. For each subgroup, symptoms with the highest network centralities that should be prioritized for management were identified. Conclusions: This study provides a translational research framework for clinicians to better understand and address the symptom care needs of oncology patients. The framework combines unbiased stratification of patients and in-depth modeling of symptom relationships to capture the heterogeneity in their experiences. When validated, the identified core symptoms and associated clinical determinants may inform precision-based symptom management. Citation Format: Brandon H. Bergsneider, Terri S. Armstrong, Yvette P. Conley, Bruce Cooper, Marilyn Hammer, Jon D. Levine, Steven Paul, Christine Miaskowski, Orieta Celiku. Symptom network analysis and unsupervised clustering of a cohort of oncology patients identifies drivers of symptom burden and patient subgroups with distinct symptom patterns [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7440.

Chemotherapy-related symptoms in children with leukemia: application of latent profile analysis and network analysis.

Children with leukemia may experience a range of chemotherapy-related symptoms. Identifying subgroups and their distinct characteristics of symptoms may improve symptom management. We aimed to identify subgroups and their distinct characteristics of chemotherapy-related symptoms in children with leukemia. A cross-sectional survey was conducted among 500 children with leukemia, who completed questionnaires that assessed their demographic and clinical characteristics, as well as the Memorial Symptom Assessment Scale. Latent profile analysis was conducted to identify subgroups of symptoms. Additionally, multiple regression analysis and network analysis were utilized to reveal the characteristics of each subgroup. Four subgroups were identified: "Profile 1: low symptom burden subgroup" (26.2%), "Profile 2: moderate symptom burden subgroup in transitional period" (14.8%), "Profile 3: moderate psychological symptom burden subgroup" (35.6%), and "Profile 4: high symptom burden subgroup" (23.4%). Multiple logistic regression analysis indicated that lower primary caregiver's education level, lower family monthly income, self-paid medical expenses, induction remission period, and consolidation enhancement period were associated with more severe symptoms of subgroups. Network analysis further revealed that nausea was the core symptom in Profiles 1 and 2, while the core symptom in Profile 3 was "I don't look like myself." Additionally, worrying was the core symptom in Profile 4. There exists heterogeneity in chemotherapy-related symptoms. Four subgroups and their corresponding characteristics of children with varying symptom severity were identified. Identifying these subgroups will facilitate personalized care, maximize intervention effectiveness, and alleviate symptom burden.

Symptom assessment in cancer patients using the Memorial Symptom Assessment Scale

Objective: Cancer is a chronic disease characterized by the unregulated proliferation and abnormal spread of cells. Symptoms that occur after chemotherapy treatment, which is the most commonly used treatment in cancer, negatively affect morbidity, effectiveness of treatment and quality of life. This study aimed to determine symptoms in cancer patients undergoing chemotherapy using the Memorial Symptom Assessment Scale (MSAS) Material and Methods: A total of 273 cancer patients who applied to Ümraniye Training and Research Hospital emergency department as outpatients and were hospitalized in the internal medicine department were included in the study between 5/1/2014 and 6/4/2014. The study was conducted prospectively. Of the 273 participants, 41.3% were female (N = 112) and 58.7% were male (N = 159). The mean age of the participants was 62.46 ± 12.913 years (range, 32-92 years). Participants were divided into 6 groups based on diagnosis: Lung cancers, gastrointestinal cancers, cancers of the reproductive system, hematologic cancers, cancers of the urinary system and others. Each participant used the Memorial Symptom Assessment Scale (MSAS) containing 32 symptoms to rate whether they had experienced each symptom during the past week. Of these 32 items, 24 provide information on the intensity and frequency of symptoms, while 8 provide information on severity and distress. Results: The most common types of symptoms based on the Memorial Symptom Rating Scale were lack of energy (72.9%), pain (71.1%) and difficulty concentrating (60.8%), while the least common symptoms were feeling “I don’t look like myself” (4.4%), swelling of arms and legs and changes in skin (7.3%) and constipation (8.4%). Conclusion: Cancer patients have a lower quality of life due to the side effects of the treatments they receive or the impact of the cancer itself. The most common symptoms in the patients screened in this study were lack of energy and pain. In light of these data, determining the factors affecting the quality of life in cancer patients may be guiding in determining the symptomatic treatment for these patients and facilitating patient care.

Stability and consistency of symptom clusters in younger versus older patients receiving chemotherapy

BackgroundBy 2035, the number of newly diagnosed cancer cases will double and over 50% will be in older adults. Given this rapidly growing demographic, a need exists to understand how age influences oncology patients’ symptom burden. The study purposes were to evaluate for differences in the occurrence, severity, and distress of 38 symptoms in younger (< 60 years) versus older (≥ 60 years) oncology patients undergoing chemotherapy and to evaluate for differences in the stability and consistency of symptom clusters across the two age groups.MethodsA total of 1329 patients were dichotomized into the younger and older groups. Patients completed demographic and clinical questionnaires prior to the initiation of their second or third cycle of chemotherapy. A modified version of Memorial Symptom Assessment Scale was used to evaluate the occurrence, severity, and distress of 38 common symptoms associated with cancer and its treatment. Differences between the two age groups in demographic and clinical characteristics and ratings of occurrence, severity, and distress for the 38 symptoms were evaluated using parametric and nonparametric tests. Exploratory factor analyses were done within each age group to identify symptom clusters using symptom occurrence rates.ResultsCompared to the younger group (14.8 (± 7.0)), older adults reported a lower mean number of symptoms (12.9 (± 7.2)). Older patients experienced lower occurrence rates for almost 50% of the symptoms. Regarding symptom clusters, an eight-factor solution was selected for both age groups. Across the two age groups, the eight symptom clusters (i.e., physical and cognitive fatigue, respiratory, psychological, hormonal, chemotherapy-related toxicity, weight gain, gastrointestinal, epithelial) were stable. However, symptoms within the physical and cognitive, chemotherapy-related toxicity, and gastrointestinal clusters were not consistent across the age groups.ConclusionsTo be able to provide tailored and effective symptom management interventions to older oncology patients, routine assessments of the core symptoms unique to the symptom clusters identified for this group warrants consideration. The underlying mechanism(s) for these inconsistencies in symptom burden is an important focus for future studies.

Identifying central symptom clusters and correlates in patients with lung cancer post-chemotherapy: A network analysis

ObjectiveThis study aims to investigate the network structures of symptoms and symptom clusters in patients with lung cancer post-chemotherapy, with a focus on identifying the central symptom cluster. Understanding the central cluster is crucial for targeted and effective symptom management. MethodsSymptom occurrence and severity were assessed using the Memorial Symptom Assessment Scale (MSAS). Principal component analysis (PCA) was employed to explore symptom clusters, while network analysis unveiled the network structure and pinpointed the central symptom cluster. ResultsThe study included 512 patients with lung cancer. Four distinct symptom clusters emerged: sickness behavior, psychological, lung cancer-specific, and epithelial. The sickness behavior symptom cluster was identified as the central symptom cluster. ConclusionsThis research designates the sickness behavior symptom cluster as central in post-chemotherapy patients with lung cancer, offering valuable insights for clinical nurses in devising more effective symptom management strategies. Trial registrationChiCTR2300070944 (Chinese Clinical Trial Register).

Factors influencing self-management behaviors in persons with lupus nephritis: A cross-sectional study.

Patients with lupus nephritis experience disease symptoms and side effects from treatment. Although self-management behaviors are important in patients with this disease, there is limited research on the factors influencing these behaviors. This study aimed to examine the factors influencing self-management behaviors in patients with lupus nephritis. This cross-sectional study was conducted in 240 patients with lupus nephritis at a university hospital in Thailand between August 2019 and December 2020 using a random sampling method. Data were collected using a demographic and clinical characteristic questionnaire, Self-Management Behavior Questionnaire, Self-efficacy for Managing Chronic Disease: A 6-item Scale, Knowledge about Lupus Nephritis Questionnaire, Family Support Scale, Social Networks in Adult Life Questionnaire, and Memorial Symptom Assessment Scale for Lupus Nephritis. Descriptive statistics and multiple linear regression analyses were employed. The participants reported a moderate level of self-management behaviors. Multiple regression analyses revealed that disease duration, income, symptoms, self-efficacy, knowledge, family support, social networks, and classes of lupus nephritis significantly explained 21% of the variance in self-management behaviors (R2 = 0.21; F(8,231) = 7.73; p <0.001). Family support (β = 0.32, p <0.001) and symptoms (β = -0.23, p <0.001) were significant determinants of self-management behaviors in patients with lupus nephritis. The findings provide valuable insight for nurses to better understand the factors influencing self-management behaviors in patients with lupus nephritis. Patients with low family support and high symptom severity may face difficulty in performing self-management behaviors. Nurses should pay more attention to these patients and provide family-based interventions to optimize self-management behaviors in this population.

Inter-reporter differences in symptom burdens in Japanese children with cancer.

Recent studies about inter-reporter differences and patient-reported outcomes (PROs) in childhood cancer from Western countries showed that caregiver proxy reports tend to overestimate symptom burdens in comparison with children's self-reports. However, the results from Western countries may not be generalizable to Asian countries. This paper is a secondary analysis of a validation study of the Japanese pediatric version of the Memorial Symptom Assessment Scale including 88 dyads of children aged 7-12 years and 74 dyads of children aged 13-18 years and their caregivers. The study assessed the inter-reporter differences of eight and 31 symptom burdens calculated as symptom scores in children aged 7-12 years and 13-18 years, respectively, and the association between inter-reporter differences and the characteristics of children and caregivers. The majority of children and caregivers scored equally at the dyadic level for almost all symptoms. However, 37.5% of symptoms in children aged 7-12 years and 10.0% of symptoms in children aged 13-18 years showed significant inter-reporter differences, suggesting a general tendency of caregivers to underestimate their children's symptom burden. The caregiver's age was the characteristic most frequently associated with magnitude of inter-reporter differences. Caregiver proxy reports may be a reliable source of PROs in Japanese children with cancer, as self-reported and caregiver proxy-reported symptom burdens were generally concordant. However, as some significant inter-reporter differences were observed, an effort should be made within the medical community to evaluate the parent-child relationship to minimize inter-reporter differences and achieve better symptom management.

SYMPTOM BURDEN, POSITIVE AFFECT AND RESILIENCY IN OLDER ADULTS EXPERIENCING NORMAL AGING

Abstract Older adults (age≥65) with multimorbid disease burden may be at chronic risk for bothersome symptoms, which can consequently reduce positive affect (e.g., feelings of excitement and enthusiasm). However, we hypothesized that individuals with more resiliency (the ability to “bounce back” from distress) may experience positive affect despite symptom burden. We conducted secondary analysis of baseline self-report survey data (collected between 8/2023-10/2023) from a prospective study of resiliency in older adults residing in nine continuing care retirement communities (CCRCs) across the U.S. Eligible participants lived independently in CCRCs and scored &amp;gt;11/15 on the five-minute Montreal Cognitive Assessment. Surveys assessed symptom burden (Condensed Memorial Symptom Assessment Scale), resiliency (Current Experience Scale), and positive affect (Positive and Negative Affect Schedule-Positive Affect). Bivariate correlations and multiple linear regression evaluated associations of symptom burden and resiliency with positive affect. Participants (M age =81, SD=5.6) were predominantly White (96%) and female (75%). Greater symptom burden correlated with lower positive affect (r=-.295, p&amp;lt;.001) and lower resiliency (r=-2.56, p&amp;lt;.001). In a multiple regression model, lower symptom burden (β = -.136, p=.003) and more resiliency (β=.626, p&amp;lt;.001) were independently associated with greater positive affect. The overall model accounted for 45.4% of variance in positive affect (F(2, 284) =117.198, p&amp;lt;.001). Lower symptom burden and more resiliency contributed to more positive affect among older adults in senior living communities. Because resiliency and positive affect are both potentially modifiable targets for intervention, longitudinal study and psychosocial interventions should explore the effects of increased resiliency on positive affect and general well-being over time.