Identification and Validation of Symptom Clusters in Patients with Hepatocellular Carcinoma

Abstract

Purpose:The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma. Methods: This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters. Results: Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression. Conclusion: Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.

Effects of Acupressure on Fatigue and Depression in Hepatocellular Carcinoma Patients Treated with Transcatheter Arterial Chemoembolization: A Quasi-Experimental Study

“…Our study also found that patients experienced highest levels of fatigue and depression at T5 (5 days after treating TACE initiation) in both groups. The level of fatigue was moderate; this finding was similar to previous studies [ 4 , 11 , 12 ], in which most cancer patients suffered from fatigue during and after treatment. The time point of peak fatigue and depression was at treatment completion and preparation for hospital discharge, and these distressing problems may impact physical function and daily living.…”

“…Research also verified that Taiwanese patients with HCC receiving TACE experienced moderate levels of fatigue which peaked at 2 days after initial TACE [ 9 ]. In several studies [ 4 – 6 , 10 ] of HCC patients receiving TACE, it was reported that fatigue was the most common adverse effect causing sleep disturbances [ 5 ], reduced physical and emotional status [ 11 ], and produced a negative effect on overall quality of life [ 12 ].…”

Symptoms and symptom clusters in patients with hepatocellular carcinoma and commonly used instruments: An integrated review

“… Symptoms and symptom clusters impact on QoL: Patients with lower symptoms had significantly higher QoL scores than those with higher symptoms. 7 1, 2, 5 Cho et al., 2009 [ 17 ] Korea To explore cancer-related symptom clusters. Observational study with cross-sectional survey - factor analysis.…”

“…Ten studies focused on symptom prevalence and symptom severity primarily occurring in HCC patients [ 8 , 9 , 11 , [16] , [17] , [18] , [19] , [20] , 23 , 25 ]. Three studies focused on the specific symptoms which occurred, including sleep disturbance [ 24 ], fatigue, depression [ 22 , 24 ], and pain [ 21 , 22 ].…”

“…Patients with different stages and treatments had different concurrent symptoms. Five studies explored the symptom prevalence in patients with early to advanced stage HCC receiving multiple active HCC treatments [ 9 , [16] , [17] , [18] , [19] ]. The most prevalent symptoms included fatigue, lack of energy, stomach or abdominal pain/distension, loss of appetite, change in taste, sleep disturbance, distress, and sadness [ 9 , [16] , [17] , [18] , [19] ].…”