Symptom Clusters In Patients Research Articles

Development of A Nurse-Led Educational Intervention Program in Managing the Nutrition Impact Symptom Cluster in Patients with Nasopharyngeal Carcinoma following the Medical Research Council Framework

Objective:This article aimed to report the experience of developing a complex nurse-led, theory-driven, and evidence-based educational intervention program intended to manage the nutrition impact symptom cluster experienced by patients with nasopharyngeal carcinoma (NPC) during radiotherapy, based on the Medical Research Council (MRC) framework.Methods:The “development” and “feasibility and piloting” phases of the MRC framework were used to guide the intervention development. The development phase included identifying the evidence base through a systematic review, exploring the relevant and guiding theory to enhance the effectiveness of the intervention and conducting a qualitative study to identify the intervention modelling. For the feasibility and piloting phase, we conducted a pilot study to examine the feasibility and estimate the effectiveness of the intervention.Results:The systematic review revealed that nurse-led educational interventions were used commonly for symptom cluster management, with promising effectiveness. The theoretical foundation was provided by the Theory of Unpleasant Symptoms, which indicates that an educational intervention can help patients to manage symptom cluster by influencing psychological, situational, and physiological factors. The qualitative study further provided contents of the intervention based on the perspectives of NPC patients and health professionals. The resulting program involves a nurse-led, family caregiver involvement, educational intervention with two sessions that uses a booklet as a medium. The pilot study found that conducting the educational intervention program was feasible and it also had some favorable effects on managing the nutrition impact symptom cluster in NPC patients.Conclusions:The MRC framework provided a strong structure with which to develop a complex intervention for nutrition impact symptom cluster management through a theory-driven and evidence-based approach. The evaluation of the intervention, the delivery process and the mediation mechanism of change using a rigorous randomized controlled trial design is recommended.

Stability of Symptom Clusters in Patients With Gynecologic Cancer Receiving Chemotherapy.

Patients with gynecologic cancer undergoing chemotherapy experience multiple co-occurring symptoms. Understanding how symptom clusters change over time is essential to the development of interventions that target multiple co-occurring symptoms. The aim of this study was to assess the relative stability of symptom clusters across a chemotherapy cycle in patients with gynecologic cancer. This is a longitudinal, descriptive study. Eligible patients (n = 232) were English-speaking adults (≥18 years old) with gynecologic cancer. Data were collected in the week before patients' second or third cycle of chemotherapy (T1) and at 1 (T2) and 2 (T3) weeks after chemotherapy. Three dimensions of the symptom experience (occurrence, severity, and distress) were assessed using a modified version of the Memorial Symptom Assessment Scale. Symptom clusters for each dimension and time point were identified through exploratory factor analysis. A 5-factor solution was selected for each exploratory factor analysis. Hormonal, respiratory, and weight change clusters were identified across all dimensions and time points. A psychological symptom cluster was identified at T1 for occurrence and severity and at T2 and T3 for all 3 dimensions. A gastrointestinal symptom cluster was identified at T1 for occurrence and at T2 and T3 for all 3 dimensions. The hormonal, respiratory, psychological, and weight change symptom clusters exhibited common symptoms across dimensions and time points. Hormonal, respiratory, weight change, and psychological symptom clusters are relatively stable across a cycle of chemotherapy in patients with gynecologic cancer. Clinicians need to assess patients for multiple co-occurring symptoms and initiate multimodal interventions.

Managing the nutrition impact symptom cluster in patients with nasopharyngeal carcinoma using an educational intervention program: A pilot study.

This study aimed to test the feasibility and estimate the effectiveness of a theory-driven and evidence-based educational intervention program to manage the nutrition impact symptom cluster in patients undergoing radiotherapy for nasopharyngeal carcinoma (NPC). A pilot randomized controlled trial was performed. Forty patients were divided equally into the intervention and control groups. The patients in the intervention group attended 2 face-to-face individual instructional sessions to enhance their knowledge and skills in managing the cluster. The study outcomes were the severity of the nutrition impact symptom cluster, body weight, symptom interference, and quality of life (QOL). A generalized estimating equation model was used to compare the differences in the outcome variables between the groups over 3-time points. The consent rate for the study was 95.2%, and the attrition rate was 5.0%. Although no significant differences between the groups were detected from T1 to T3, favorable effects on relieving the cluster itself (B [95% confidence interval (CI)]=-0.844 [-2.261, 0.572], p=0.243, Cohen's d [95% CI]=-0.37 [-1.00, 0.28]) and improvements in physical well-being (B [95% CI]=0.833 [-3.965, 5.632], p=0.734, Cohen's d [95% CI]=-0.15 [-0.78, 0.49]) and in head and neck cancer-specific QOL (B [95% CI]=0.061 [-4.061, 4.182], p=0.977, Cohen's d [95% CI]=-0.05 [-0.68, 0.59]) were observed in the intervention group compared with the control. The educational intervention program is feasible and has promising effects on relieving the cluster.

#3113 Evaluating the PCL-C as a measure of trauma and PTSD symptoms in patients with functional neurological symptom disorder

AimsFunctional Neurological Symptom Disorder (FNSD) is common and disabling. Historically trauma was considered an essential aetiological factor, but the precise contribution of trauma to the disorder, and resulting disability, remains controversial. The PCL-C is a self-reported screening tool for PTSD symptoms based on DSM-IV criteria. A previous study in patients with FNSD demonstrated high scores on the PCL-C, with a reduction in scores following psychotherapy. However strong correlations with other psychological co-morbidities raised the possibility that the PCL-C may be capturing non-specific distress rather than indicators of previous traumatisation. The present study aimed to investigate (i) whether underlying factors measured by the PCL-C can distinguish specific trauma-memory-related symptoms from less specific emotion-regulation-related symptoms, (ii) the extent to which individual factors correlate with other psychopathology and health-related quality of life (HRQoL) measures and (iii) whether different factors change with psychotherapy, all in patients with FNSD.MethodsAn exploratory factor analysis of PCL-C responses from 473 FNSD patients pre-and post-psychotherapy was performed to generate1-4 factor models. The final factor model was determined through confirmatory factor analysis. Relationships between PCL-C factors, measures of comorbidities (depression, somatisation and anxiety) and HRQoL were assessed using regression analysis. Pre- and post-psychotherapy scores were compared.ResultsThe best model for the PCL-C comprised of two-factors: factor 1 (intrusive symptoms) explained 55.2% of the variance, whilst factor 2 (emotional dysregulation) explained 7.8% of the variance. Both factors reduced in severity after psychotherapy, but factor 2 reduced by more and correlated more strongly with a decrease in depression and anxiety than factor 1. Changes in depression, anxiety, somatic symptoms and mental HRQoL predicted 61.9% of the change in factor 2, but only 49.2% in factor 1. Improvements in mental HRQoL were strongly associated with a decrease in factor 2, but less so in factor 1.DiscussionThe factor analysis revealed the PCL-C represents two correlated but distinguishable symptom clusters in patients with FNSD: intrusive symptoms and emotional dysregulation. Both were elevated in our patient sample. The high level of intrusive symptoms suggests many patients with FNSD experience classical post-traumatic symptoms, which may indicate that subjective traumatic experiences contribute to pathogenesis and resulting disability. These symptoms showed some reduction with psychotherapy, but the greater reduction in emotional dysregulation symptoms and associated improvements in mental HRQoL suggest that psychotherapy may be more effective in reducing the burden of comorbidities and providing better coping strategies than in addressing core symptoms of the underlying disorder.

Symptom Clusters in Patients With Gynecologic Cancer Receiving Chemotherapy.

To describe ratings of symptom occurrence, severity, and distress for 38 symptoms and to identify and compare the number and types of symptom clusters identified using these ratings. Although patients with gynecologic cancer experience multiple co-occurring symptoms, little is known about how these symptoms cluster together. Eligible patients (N = 232) had gynecologic cancer and were receiving chemotherapy. Symptoms were assessed using the Memorial Symptom Assessment Scale. Symptom clusters were identified through exploratory factor analysis. Geomin-rotated factor loadings with absolute values of 0.3 or greater were considered meaningful. Factor solutions (i.e., symptom clusters) were assessed for simple structure and clinical relevance. Lack of energy, hair loss, and "I don't look like myself" were the most common, severe, and distressing symptoms. Hormonal, respiratory, and weight change clusters were identified across all three dimensions. Research that explores how symptom clusters change over time and their underlying mechanisms is warranted.

Development and testing of the hemodialysis symptom distress scale (HSD-22) to identify the symptom cluster by using exploratory factor analysis

BackgroundPatients receiving hemodialysis (HD) often experience multiple symptoms concurrently and these symptoms may impact their quality of life. A valid and reliable tool is needed to assess the symptom distress of patients receiving HD in terms of the perspective of symptom clusters. Although many studies have explored symptom clusters related to patients receiving HD, the clusters formed had problems with overlapping, vagueness, lack of cluster-specificity, and difficulty in discerning their common mechanism under the cluster.AimsTo develop reliable measurement tool to identify the symptom clusters of patients undergoing HD.DesignA cross-sectional descriptive study.MethodsTo examine the physiological properties of the HD symptom distress (HSD) scale, 216 participants were recruited from a HD center of a medical university hospital in southern Taiwan from February 2019 to April 2019. Construct validity was evaluated by exploratory factor analysis (EFA), and the internal consistency and test–retest reliability were estimated by Cronbach’s alpha and intraclass correlation coefficient (ICC).ResultsThe CVI value of the HSD was 0.89. The HSD scale was composed of five factors with 22 items, including insufficient energy/vitality, cardiac–pulmonary distress, sleep disturbance, musculoskeletal distress, and gastrointestinal distress, with factor loading ranging from 0.62 to 0.87, explaining 65.5% of the total variance. Cronbach’s alpha coefficient of the HSD total scale was 0.93, and five subscales ranged from 0.73 to 0.89. The test-retest reliability was 0.92 (p < 0.001) by using the intraclass correlation coefficient (ICC) for the HSD-22 scale.Conclusion / implicationTheoretical testing from our study indicated that the HSD-22 scale had satisfactory validity and reliability. Therefore, this assessment tool can be employed to identify the symptom clusters of patients receiving HD in the clinical setting. Such identification enables healthcare professionals to provide interventions to release patients’ symptom distress efficiently.

Chronic Obstructive Pulmonary Disease Symptom Cluster Composition, Associated Factors, and Methodologies: A Systematic Review.

This systematic review details symptom clusters, their compositions, and associated factors and appraises the methodologies of studies that reported symptom clusters in patients with chronic obstructive pulmonary disease (COPD). Ten studies were eligible for inclusion in this study. Four common symptom clusters were identified. Two theoretical frameworks, four statistical methods, and various symptom assessment tools were used to identify symptom clusters. Factors associated with symptom clusters included demographic, clinical, and biological factors. No studies examined the subjective experiences of symptom clusters. Overall, inconsistencies were identified in the composition of symptom clusters across studies. This may be due to variations in study design, assessment tools, and statistical methods. Future studies should attempt to arrive at a common definition, especially that is theoretically derived, for symptom clusters, standardize the criteria for symptoms for inclusion in the clusters, and focus on patients’ subjective experience to inform which clusters are clinically relevant.

Characteristics of gastrointestinal metastasis in lung cancer: Single-center experience from Eastern India

Background: Lung cancer is one of the most common cancers associated with a poor prognosis. Gastrointestinal (GI) metastasis among lung cancer patients is often misdiagnosed or missed as a diagnosis. With a paucity of literature on this theme, we conducted a study to understand the clinicopathological characteristics of GI metastasis in lung cancer patients. Materials and Methods: A retrospective review of 793 primary lung cancer patients registered from January 2018 to December 2018 was done at a tertiary cancer hospital. The present study focused on lung cancer patients with an objective to find out the cases of GI metastasis. GI metastasis was confirmed on radiological imaging in the records and positron emission tomography, magnetic resonance imaging, or computed tomography scans. Quantitative variables were either expressed in terms of mean and standard deviation or categorized and expressed in percentages. Pearson's correlation coefficient was used to find the correlation between different symptom clusters in patients with GI metastasis in lung cancer. Results: Of the 793 lung cancer patients, 31 (3.9%) patients had metastasis to the GI tract, with as high as 70.97% (22/31) patients presenting with peritoneal/omental deposits. Of the 31 patients with GI metastasis, five (16.13%) patients were symptomatic, four patients had intestinal obstruction, and one had intestinal perforation. Due to advanced metastatic cancer and poor performance status, patients were provided palliative care and symptom management as they were deemed unfit for surgical intervention. Conclusion: With the advent of targeted and immunological therapies, patients with metastatic lung cancers are surviving longer. Palliative care specialists must work in close collaboration with oncologists to identify an impending GI complication at an early stage to direct specific interventions to avert the complication.

Nutrition Impact Symptom Clusters in Patients With Head and Neck Cancer Receiving Concurrent Chemoradiotherapy

ObjectivesThe objective of this study was to identify the nutrition impact symptom (NIS) clusters in patients with head and neck cancer (HNC) receiving concurrent chemoradiotherapy (CCRT) and explore their relationships with the weight loss rate (WLR). MethodsThis longitudinal study included 169 patients. At baseline (T1), the demographics, clinical information, and weight before radiotherapy (RT) were recorded. At the third week (T2) and the end of RT (T3), we assessed the weight, prevalence, severity, and interference of the NIS with the Head and Neck Patient Symptom Checklist. The mean scores of the severity of NIS at T2 and T3 were used as a whole to perform the exploratory factor analysis and identify the symptom clusters. Cronbach's α coefficient was used to evaluate the internal consistency of the symptom clusters. Generalized estimating equations were used to analyze the relationships between clusters and the WLR. ResultsWe extracted three clusters from 14 NISs: the RT-specific symptom cluster including pain, difficulty swallowing, oral mucositis, thick saliva, difficulty chewing, and dry mouth (Cronbach's α = 0.820); the gastrointestinal symptom cluster including nausea, loss of appetite, feeling full, vomiting, and taste change (Cronbach's α = 0.592); the psychological status cluster including depressed, anxious, and lack of energy (Cronbach's α = 0.710). The multivariable model showed that participants with more serious RT-specific symptom cluster (β = 1.020, 95% CI: 0.570–1.471, P < 0.001) had higher WLR. ConclusionsThe NIS had close internal connections with each other, so the strategies applied by healthcare professionals should focus on multiple related symptoms, especially to manage the RT-specific symptom cluster.

Prevalence and Risk Factors of Anxiety and Depression in Patients with Postherpetic Neuralgia: A Retrospective Study

Objectives: Pain and psychological disorders are the 2 most commonly occurring symptom clusters in patients with postherpetic neuralgia (PHN). This study aimed to investigate the risk factors for anxiety and depressive disorders in patients with PHN. Methods: Retrospectively, we examined the potential risk factors of anxiety and depression among patients with PHN from the clinic medical records of the Third Affiliated Hospital of Sun Yat-Sen University from 2017 to 2019. The Chinese version of the Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Patients were retrospectively allocated to 2 groups – PHN with and without anxiety/depression – and compared to identify the differential patient characteristics. Results: Cases of 661 patients who were diagnosed with PHN were included. Anxiety and depression developed in 69.0% (456/661) and 65.8% (435/661) of the enrolled patients with PHN, respectively. Results of univariate regression analyses showed that female sex, magnitude of pain intensity, time from onset of rash and extent of spread of rashes were significantly associated with anxiety and depression in patients with PHN. Multivariate analysis revealed that both anxiety and depression states significantly correlated with female sex, magnitude of pain intensity, and extent of spread of rashes. Conclusions: Anxiety and depression were not uncommon in patients with PHN. Women with PHN who experience severe pain and develop extensive rashes have a high risk of developing anxiety and depressive disorders.

Symptom Clusters in Patients with End-Stage Renal Disease Undergoing Hemodialysis.

BackgroundEnd-stage renal disease (ESRD) patients undergoing hemodialysis have to face many symptoms from disease progression and treatment. These symptoms cause suffering and affect physical, psychological, emotional, social, and spiritual of the patients, resulting in decreased quality of life and might increase the death rate of these patients. Therefore, the study of symptoms in ESRD patients undergoing hemodialysis will lead to effective symptom management and maximize benefits for the patients. The purpose of this study was to explore the symptom clusters of ESRD patients undergoing hemodialysis.Materials and MethodsThe sample of this descriptive study consisted of 150 ESRD patients undergoing hemodialysis from two dialysis centre of the university hospital and specialized kidney hospital in Bangkok. The instruments consisted of Personal Information Questionnaire (PIQ) and Dialysis Symptom Index-THAI (DSI-THAI). The data were analyzed by exploratory factor analysis.ResultsThe 8 clusters of symptoms were found: 1) gastrointestinal, 2) musculoskeletal and fluid volume 3) neurological 4) irritation of the mucous membranes and skin 5) depression 6) sleep disturbance 7) sexual 8) anemic.ConclusionThe results of this study can be raised awareness and used as the information for the health-care provider to develop the intervention to manage unpleasant symptoms which lead to improving the quality of life.

Gut Microbiome Associated with the Psychoneurological Symptom Cluster in Patients with Head and Neck Cancers.

Simple SummaryPatients with head and neck cancers (HNCs) report a cluster of psychoneurological symptoms (i.e., the PNS cluster), including pain, fatigue, sleep disturbance, depressive symptoms, and cognitive dysfunction across different treatments. The aim of this longitudinal study was to examine associations between the gut microbiome and the PNS cluster in 13 patients with HNCs pre- and post-radiotherapy. Patients with the high PNS cluster showed a greater decrease in microbial evenness than those with the low PNS cluster from pre- to post-radiotherapy. The high and low PNS clusters showed significant gut microbiome dissimilarities. Patients with the high PNS cluster had higher abundances of Bacteroidetes, Ruminiclostridium9, Tyzzerella, Eubacterium_fissicatena, and DTU089. Patients with the low PNS cluster had higher abundances in Lactococcus, Phascolarctobacterium, and Desulfovibrio. Glycan metabolism and vitamin metabolism were different between the high and low PNS clusters pre- and post-radiotherapy.Cancer patients experience a cluster of co-occurring psychoneurological symptoms (PNS) related to cancer treatments. The gut microbiome may affect severity of the PNS via neural, immune, and endocrine signaling pathways. However, the link between the gut microbiome and PNS has not been well investigated in cancer patients, including those with head and neck cancers (HNCs). This pilot study enrolled 13 patients with HNCs, who reported PNS using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (CTCAEs). Stool specimens were collected to analyze patients’ gut microbiome. All data were collected pre- and post-radiation therapy (RT). Associations between the bacterial abundances and the PNS clusters were analyzed using the linear discriminant analysis effect size; functional pathway analyses of 16S rRNA V3-V4 bacterial communities were conducted using Tax4fun. The high PNS cluster had a greater decrease in microbial evenness than the low PNS cluster from pre- to post-RT. The high and low PNS clusters showed significant differences using weighted UniFrac distance. Those individuals with the high PNS cluster were more likely to have higher abundances in phylum Bacteroidetes, order Bacteroidales, class Bacteroidia, and four genera (Ruminiclostridium9, Tyzzerella, Eubacterium_fissicatena, and DTU089), while the low PNS cluster had higher abundances in family Acidaminococcaceae and three genera (Lactococcus, Phascolarctobacterium, and Desulfovibrio). Both glycan metabolism (Lipopolysaccharide biosynthesis) and vitamin metabolism (folate biosynthesis and lipoic acid metabolism) were significantly different between the high and low PNS clusters pre- and post-RT. Our preliminary data suggest that the diversity and abundance of the gut microbiome play a potential role in developing PNS among cancer patients.

Symptom Clusters in Patients with HCC: A Systematic Review

Background HCC patients suffering from various symptoms during palliative care. Effective symptom management can reduce patient's painful symptom experience and improve their quality of life. The researches on symptom management have shifted from single symptom to multiple symptoms occurring simultaneously. Meanwhile, different studies varied considerably on the symptom clusters and its composition. Objectives The aim of this systematic review was to summarize the compositions, measures, and analytical techniques of symptom clusters in patients with HCC. Method We conducted a comprehensive search to identify published studies about symptom clusters in patients with HCC. Databases including National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Database (VIP), Wanfang Technology Journal full-text database, PubMed, EMbase and Web of Science and the studies included is from January 1, 2001 to November 24, 2019. Results There are seven articles compliance with inclusion criteria. Four symptom clusters were most commonly reported: Cluster 1: nausea/vomiting; Cluster 2: pain/fatigue/sleep disturbance/dry mouth/lack of appetite/change in taste; Cluster 3: sadness/distress/nervous; Cluster 4: jaundice/abdominal distension/itching/diarrhea/constipation. Conclusion This systematic review summarized the statistical methods, assessment tools, symptom clusterand composition of 7 included studies. Due to the lack of consensus on the definition of symptom cluster, the differences of statistical methods, assessment tools, sample characteristics and measuring time, the conclusion of the symptom cluster of HCC patients varied considerably in combinations.

The use of long acting antipsychotics in outpatient care

To determine the frequency of administration, efficacy and safety of long acting antipsychotics in day-to-day psychiatric practice in outpatient clinics. The study included 90 patients with schizophrenia treated with haloperidol decanoate (n=18), rispolept consta (n=19), clopixol depot (n=25), paliperidone palmitate (n=25). Symptoms of schizophrenia were assessed with PANSS during 12 months. The use of long acting antipsychotics has proven to be effective and safe to control all symptom clusters in patients regardless of the disease duration.

Stability of symptom clusters in patients with gastrointestinal cancers receiving chemotherapy.

193 Background: Patients with gastrointestinal (GI) cancers who undergo chemotherapy (CTX) experience on average of thirteen symptoms. These co-occurring symptoms often cluster together and can influence various patient outcomes including quality of life (QOL). However, little evidence is available on how these symptoms change during a cycle of chemotherapy (CTX). An evaluation of how these symptom cluster together and how these symptom clusters change over time may provide useful information to guide symptom management strategies tailored to multiple symptoms. Objectives: The purpose of this study was to identify and compare symptom clusters using three symptom dimensions (i.e., occurrence, severity, and distress) at different time points during CTX (i.e., prior to CTX [T1], one week after CTX administration [T2], and two weeks after CTX administration [T3]) in patients with GI cancers. Methods: A modified version of the Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress of 38 symptoms. Exploratory factor analyses were used to create the symptom clusters. Results: Five distinct symptom clusters were identified across the three symptom dimensions and the three assessments (i.e., psychological, CTX-related, weight change, GI, and epithelial). Psychological, CTX-related and weight change clusters were relatively stable for all three symptom dimensions as well as across time. GI cluster was identified only at T1, while epithelial cluster was identified at T2 and T3 for all three symptom dimensions. Conclusions: The number and types of symptom clusters appear to be relatively stable over time and across the symptom dimensions. Timely management of symptom clusters should be continued over the course of CTX including the recovery phases. Further studies are needed to explore the mechanisms of symptom clusters in patients with GI cancers undergoing CTX.

Stability and Impact of Symptom Clusters in Patients With End-Stage Renal Disease Undergoing Dialysis

ContextPatients with end-stage renal disease undergoing dialysis experience multiple concurrent symptoms. These symptoms cluster together and have negative impacts on patient outcomes. However, information on changes in symptom clusters over time is limited. ObjectivesThis longitudinal study examined the stability of symptom clusters and their impacts on health-related quality of life and functional status over a period of one year. MethodsEligibility criteria were patients diagnosed with end-stage renal disease; had received dialysis consecutively for at least three months; and had given written informed consent. Dialysis Symptom Index, Kidney Disease Quality of Life 36, and Karnofsky Performance Status Scale were used to evaluate the impacts of symptom clusters and outcomes. Exploratory factor analyses and multiple regression analyses were used to determine symptom clusters and their associations with patient outcomes. ResultsAmong the 354 recruited patients, 271 completed the 12-month assessment. Four symptom clusters were identified across the three assessments, namely, uremic, gastrointestinal, skin, and emotional. Within each cluster, the specific symptoms were varied. The uremic symptom cluster accounted for the largest amount of variability. Across the three assessments, a higher uremic cluster factor score was associated with poorer physical well-being, whereas a higher emotional cluster factor score was consistently associated with poorer mental well-being. ConclusionSymptoms in patients on dialysis clustered in relatively stable patterns. The four symptom clusters identified had consistent negative effects on various aspects of patients' well-being. Our findings suggest the need for ongoing symptom assessment and early recognition of symptoms that may contribute to adverse patient outcomes.

Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy

ContextLimited evidence suggests that patients with gastrointestinal (GI) cancers receiving chemotherapy (CTX) experience an average of 13 co-occurring symptoms. An alternative to counting symptoms is to evaluate for symptom clusters. ObjectivesIn a sample of patients with GI cancers receiving CTX (n = 399), we evaluated the occurrence, severity, and distress of 38 symptoms in the week before patients' second or third cycle of CTX (Time 1 [T1]), approximately one week after CTX (Time 2 [T2]), and approximately two weeks after CTX (Time 3 [T3]); evaluated for differences in the number and types of symptom clusters at each of these three assessments using ratings of occurrence, severity, and distress; and evaluated for changes in symptom clusters over time. MethodsModified version of the Memorial Symptom Assessment Scale collected data on 38 common symptoms. Exploratory factor analyses were used to create the symptom clusters. ResultsFive distinct symptom clusters were identified across the three symptom dimensions and the three assessments (i.e., psychological, CTX-related, weight change, GI, and epithelial). Psychological, CTX-related, and weight change clusters were relatively stable across all three symptom dimensions and time. Across all three symptom dimensions, GI cluster was identified only at T1 and epithelial cluster was identified at T2 and T3. ConclusionThe number and types of symptom clusters appear to be relatively stable over time and across the symptom dimensions. Ongoing assessment and management of these clusters is warranted across the entire course of CTX. The underlying mechanism for these clusters warrants investigation.

A bibliometric analysis of heart failure symptom clusters

Objective To investigate and analyze the domestic and oversea studies on heart failure symptom clusters through a bibliometric analysis, and provide evidence basis for future clinical nursing research. Methods The CNKI the Wanfang Science and Technology Journal Full-text Database, the China Biomedical Literature Database (CBM) , the PubMed, and the Web of Science database were searched for the articles both in Chinese and English about heart failure symptom clusters published from database establishment dates to August 31st, 2018 and analyzed on their published years, distribution of journals, and research content. Results A total of 21 articles complied with the standard were retrieved with the first published article dated back to 2009. Among them, there were 13 cross-sectional studies, 4 longitudinal studies, 3 reviews, and 1 tool development. Although different studies had differences in research design, sample characteristics, assessment tools, and analytical methods, the main findings were basically the same: somatic symptom cluster and emotional symptom cluster were common symptom clusters in patients with heart failure; somatic symptom cluster mainly included shortness of breath, dyspnea, fatigue, declined physical strength, dyscoimesis; emotional symptom cluster mainly included anxiety, depression, cognitive disorder; there was still controversy about the classification of edema. Conclusions At present, the research on heart failure symptom clusters in China and abroad is still at the initial exploration stage, and the research results are still unstable. In the future, we can further develop long-term dynamic observation of heart failure symptom clusters and explore corresponding symptom management strategies. Key words: Bibliometrics; Heart failure; Symptom cluster

Therapy of the status of symptom clusters in patients with cancer receiving FOLFOX6 chemotherapy

Objective To invest the status of symptom clusters in patients with cancer receiving FOLFOX6 chemotherapy during the course of chemotherapy. Methods Total 100 patients with cancer receiving FOLFOX6 chemotherapy were investigated using MD. Anderson Symptom Inventory-Chinese (MDASI-C). Results The top severity of symptoms were lack of appetite and nausea during chemotherapy; weary was the highest score during the intermission of chemotherapy. Exploratory factor analysis showed four main symptom clusters: gastrointestinal symptom clusters, physical symptom clusters, mental symptom clusters and subjective feeling clusters. There were no significant difference in the scores of subjective feeling clusters between chemotherapy and the first day after discharge (P>0.05), other symptom clusters also declined slowly; the symptom clusters began to ease significantly from the three day after discharge (P<0.05). Conclusion Patients with cancer suffer from multiple symptoms during FOLFOX6 chemotherapy and during the intermission of chemotherapy. The results are good for establishing early predictions of symptom clusters in intermission of chemotherapy. Key words: Neoplasm; Chemotherapy; Symptoms clusters; Continuing nursing

Symptom clusters in patients with breast cancer receiving radiation therapy.

Symptoms experienced by breast cancer patients often cluster together in groups known as "symptom clusters". The aim was to determine the symptom clusters in women with non-metastatic breast cancer treated by radiation therapy (RT). Edmonton Symptom Assessment Scale (ESAS) scores were taken from breast cancer patients receiving RT before, at completion of RT, and after RT. Exploratory factor analysis (EFA), principal component analysis (PCA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the nine ESAS items at all three time points. This study included 1224 patients. The PCA and EFA identified the same two symptom clusters before the start of RT: 1) pain, tiredness, nausea, drowsiness, appetite, and dyspnea; 2) depression, anxiety, and wellbeing. The HCA further split the symptoms into three clusters. Wellbeing, depression, and anxiety consistently clustered together. Among the ESAS scores collected at the end of and after RT, each statistical method identified different symptom clusters. For the symptom clusters experienced at the end of RT, the following symptoms were always in the same cluster: wellbeing, depression, and anxiety; nausea and appetite; drowsiness and dyspnea. Following RT, depression and anxiety consistently clustered together, with nausea and appetite in a second cluster. Among the symptom clusters derived before, at the end of RT, and after RT, the following symptoms consistently presented together: depression and anxiety, nausea and appetite, pain and tiredness, and drowsiness, dyspnea, and tiredness. Understanding symptom clusters in this population can improve management of symptoms.