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Objectives Identification of biologic pathways of symptom clusters is necessary to develop precision therapies for distressing symptoms. This review examined extant literature evaluating relationships between biomarkers and symptom clusters in cancer survivors. Data Sources PubMed, CINAHL, Web of Science and Cochrane Library were searched using terms “biological markers” or “biomarkers” and “symptom cluster” or “symptom complex” or “multiple symptoms”. Results Biomarkers related to inflammation (e.g., cytokines) were the most studied and showed the most significant relationships with clusters of symptoms. Conclusion This review suggest that clustering of symptoms related to cancer or cancer therapy is linked to immune/inflammatory pathways. Implications for Nursing Practice Understanding the etiology of symptom clusters may guide future nursing interventions for symptom management.

Purpose: Cancer-related fatigue is one of the most debilitating side effects of cancer and cancer therapy. We aimed to investigate co-occurring symptoms associated with persistent fatigue in men receiving external beam radiation therapy (EBRT) for nonmetastatic prostate cancer. Methods: A sample of 47 men with prostate cancer scheduled to receive radiotherapy (RT) were followed at baseline and 1 year after RT. Clinical and demographic data were obtained from chart review. Symptom measurements included urinary dysfunction (American Urological Association symptoms score), fatigue (Functional Assessment of Cancer Therapy – Fatigue questionnaire), sleep disturbance (Patient-Reported Outcomes Measurement Information System – Sleep Disturbance form), pain (physical well-being domain pain item of the Functional Assessment of Cancer Therapy – General), and depressive symptoms (Hamilton Depression Rating Scale). Paired t tests, correlations, general linear models, and logistic regressions were used to determine associations between fatigue and other symptom scores. Results: At 1 year after RT, 34% of subjects continued to experience fatigue. Urinary dysfunction was the best clinical predictor of persistent fatigue. Pain and depressive symptoms further improved the predictive power of the model. A multivariate linear regression model containing all these three clinical variables (urinary dysfunction, pain, and depressive symptoms) explained 74% of total variance associated with persistent fatigue after RT. Conclusions: Persistent fatigue at 1 year after EBRT in prostate cancer survivors is likely related to a cluster of symptoms elicited by chronic inflammation. Therapies that target each of these symptoms will likely reduce fatigue in this patient population.

Context Cancer-related fatigue (CRF) persists months after treatment completion. Although a CRF biomarker has not yet been identified, validated self-report questionnaires are used to define and phenotype CRF in the discovery of potential biomarkers. Objectives The purposes of this study are to identify CRF subjects using three well-known CRF phenotyping approaches utilizing validated self-report questionnaires and to compare the biologic profiles that are associated with each CRF phenotype. Methods Fatigue in men with non-metastatic prostate cancer receiving external beam radiation therapy (EBRT) was measured at: baseline (T1), midpoint (T2), endpoint (T3), and one year post-EBRT (T4) using the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and Patient Reported Outcomes Measurement Information System-Fatigue (PROMIS-F). Chronic fatigue (CF) and non-fatigue (NF) subjects were grouped based on three commonly used phenotyping approaches: 1) T4 FACT-F <43; 2) T1-T4 decline in FACT-F score >3 points; 3) T4 PROMIS-F T-score >50. Differential gene expressions using whole genome microarray analysis were compared in each of the phenotyping criterion. Results The study enrolled 43 men, where 34-38% had CF based on the 3 phenotyping approaches. Distinct gene expression patterns were observed between CF and NF subjects in each of the three CRF phenotyping approaches: 1) Approach 1 had the largest number of differentially expressed genes, and 2) Approaches 2 and 3 had 40 and 21 differentially expressed genes between the fatigue groups, respectively. Conclusion The variation in genetic profiles for CRF suggests that phenotypic profiling for CRF should be carefully considered because it directly influences biomarker discovery investigations.

The NCCN Guidelines for Survivorship are intended to help healthcare professionals working with cancer survivors to ensure that each survivor’s complex and varied needs are addressed. The Guidelines provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment; recommendations to help promote healthful lifestyle behaviors, weight management, and immunizations in survivors; and a framework for care coordination. This article summarizes the recommendations regarding employment and return to work for cancer survivors that were added in the 2021 version of the NCCN Guidelines.

The NCCN Guidelines for Survivorship are intended to help healthcare professionals who work with survivors to ensure that the survivors’ complex and varied needs are addressed. The NCCN Guidelines provide screening, evaluation, and treatment recommendations for the consequences of adult-onset cancer and its treatment; recommendations to help promote physical activity, weight management, and immunizations in survivors; and a framework for care coordination. This article summarizes updates to the NCCN Guidelines pertaining to preventive health for cancer survivors, including recommendations about alcohol consumption and vaccinations.

Background Cancer-related fatigue (CRF) is a complex multidimensional symptom. Identifying the fatigue dimension that may be most bothersome can guide in the development of individualized management strategies. Objective The purpose of this article is to describe the multidimensional fatigue experience of men with prostate cancer. Methods Data for this study were obtained from an ongoing descriptive longitudinal study at the National Institutes of Health, involving men diagnosed with nonmetastatic prostate cancer scheduled to receive external beam radiation therapy. Data were analyzed at 7 time points: baseline, before treatment initiation (T1), treatment midpoint (T2), treatment completion (T3), and 1 month (T4), 3 months (T5), 6 months (T6), and 12 months (T7) after treatment completion. Study data were obtained from medical records and self-report (fatigue, depressive symptoms, and sleep disturbance) questionnaires. Results Scores for total fatigue peaked at T2 and remained significantly different from baseline at T3. After T3, total fatigue scores were not significantly different from baseline. Affective fatigue had the highest scores (worst fatigue) reported during treatment, sensory fatigue scores were highest from T4 to T6, and cognitive fatigue scores were highest at T7. Affective and sensory fatigue scores peaked at T2, whereas behavioral and cognitive fatigue scores peaked at T3. Conclusion Independent changes in specific dimensions of CRF were observed during and post treatment. Implications for Practice Understanding the specific dimensions of CRF and how they change during and post treatment can help guide clinicians to recommend targeted and personalized management strategies.

Purpose This article aims to provide perspectives on the establishment of a consortium for nurse scientists with similar career trajectories interested in cancer‐related symptoms (CRS) research. Hereby, we describe the development of and recent outcomes from the CRS consortium, the lessons learned in establishing the consortium, and future directions to advance the science of CRS. Model and Methods New and innovative strategies are needed to address the complexity of CRS research. A CRS consortium was created to allow a mechanism for oncology nurse scientists with varying expertise to collaborate to advance CRS research. The National Institutes of Health (NIH) Symptom Science Model (SSM) guides the research of the CRS Consortium. Discussion and Conclusions A need for improved CRS assessment and management has been identified. The CRS consortium was created as a collaborative think tank to begin to address this need. Guided by the NIH SSM, CRS consortium members have worked to define symptom phenotypes, enhance understanding of the biologic mechanisms that can contribute to symptom phenotypes, and develop tailored interventions to improve symptom management. Dissemination of the CRS consortium efforts involve publications and presentations. Clinical Implications Nurse scientists interested in symptom science and biobehavorial research face many challenges on how to initiate and sustain independent programs of research. Through the formation of a CRS consortium, oncology nurse scientists can work together to address identified issues in symptom measurement and management.