Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy

Han, Claire J.; Reding, Kerryn W.; Cooper, Bruce A.; Paul, Steven M.; Conley, Yvette P.; Hammer, Marilyn J.; Kober, Kord M.; Levine, Jon D.; Miaskowski, Christine

doi:10.1016/j.jpainsymman.2019.07.029

Cited by 32 publications

(87 citation statements)

References 54 publications

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“…Our findings regarding the significantly higher co-occurrence rates for eleven common GI symptoms in the high compared to the none class adds to the growing body of literature on the identification of a GI symptom cluster in patients with breast [35], lung [28], GI [11], and gynecological [12] cancers. In addition, across all four CID classes, greater than 40% of the patients reported the occurrence of dry mouth, nausea, and change in the way food tastes prior to their second or third cycle of CTX.…”

Section: Discussionsupporting

confidence: 57%

Distinct diarrhea profiles during outpatient chemotherapy

Díaz

Kober

Viele

et al. 2020

Support Care Cancer

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Distinct Diarrhea Profiles During Outpatient Chemotherapy by Rafael Diaz Purpose: Chemotherapy-induced diarrhea (CID) is a common symptom that occurs in 50% to 80% of patients. Given that the majority of the data on the occurrence and severity of CID is based on physicianrated toxicity criteria, this study's purposes were to: identify subgroups of patients with distinct CID profiles and determine how these subgroups differ in terms of demographic and clinical characteristics; severity, frequency, and distress of CID; the co-occurrence of common GI symptoms, and QOL. Methods: Patients (n=1133) completed the Memorial Symptom Assessment Scale six times over two cycles of chemotherapy (CTX). Latent profile analysis was used to identify subgroups of patients with distinct diarrhea profiles. Differences among these subgroups were evaluated using parametric and nonparametric statistics. Results: Four distinct diarrhea profiles were identified: none (58.3%), decreasing (22.0%), increasing (5.2%), and high (14.5%). Compared to the none class, patients in the high class had a lower functional status, a worse comorbidity profile, were more likely to have gastrointestinal cancer, and were more likely to receive CTX on a 14 day cycle. No differences were found among the classes in the percentages of patients who received CTX with a targeted therapy. Conclusion: Given that CID occurred in over 40% of the patients, clinicians should assess for this symptom and other common GI symptoms and initiate appropriate pharmacologic and dietary interventions.

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Section: Discussionsupporting

confidence: 57%

Distinct diarrhea profiles during outpatient chemotherapy

Díaz

Kober

Viele

et al. 2020

Support Care Cancer

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“…Of the 23 studies included in this review, 10 used a longitudinal design to evaluate for symptom clusters in oncology patients receiving chemotherapy (online supplemental table 2). Six studies were conducted in the USA,45–50 two in Sweden,51 52 one in China,53 and one in South Korea 54. Sample sizes ranged from 5154 to 540 50.…”

Section: Resultsmentioning

confidence: 99%

Symptom clusters in patients receiving chemotherapy: A systematic review

Harris

Kober

Conley

et al. 2021

BMJ Support Palliat Care

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Background and purposeSince 2001, symptom cluster research has grown considerably. However, because multiple methodological considerations remain, ongoing synthesis of the literature is needed to identify gaps in this area of symptom science. This systematic review evaluated the progress in symptom clusters research in adults receiving primary or adjuvant chemotherapy since 2016.MethodsEligible studies were published in English between 1 January 2017 and 17 May 2021; evaluated for and identified symptom clusters ‘de novo;’ and included only adults being treated with primary or adjuvant chemotherapy. Studies were excluded if patients had advanced cancer or were receiving palliative chemotherapy; symptoms were measured after treatment; symptom clusters were pre-specified or a patient-centred analytic approach was used. For each study, symptom instrument(s); statistical methods and symptom dimension(s) used to create the clusters; whether symptoms were allowed to load on more than one factor; method used to assess for stability of symptom clusters and associations with secondary outcomes and biomarkers were extracted.ResultsTwenty-three studies were included. Memorial Symptom Assessment Scale was the most common instrument and exploratory factor analysis was the most common statistical method used to identify symptom clusters. Psychological, gastrointestinal, and nutritional clusters were the most commonly identified clusters. Only the psychological cluster remained relatively stable over time. Only five studies evaluated for secondary outcomes.DiscussionWhile symptom cluster research has evolved, clear criteria to evaluate the stability of symptom clusters and standardised nomenclature for naming clusters are needed. Additional research is needed to evaluate the biological mechanism(s) for symptom clusters.PROSPERO registration numberCRD42021240216.

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“…Factor extraction was based on scree plot (eigenvalues >1). When we applied factor analysis, the common factor was extracted using the principal axis iteration method (pa) with orthogonal rotations (varimax), factor loadings greater than 0.4 was considered for retention (17,18), and factors with clinical explanatory significance were selected; because NLR, LMR, PLR, and PNI were calculated from neutrophil count, lymphocyte count, monocyte count, platelet, and serum albumin. In order to avoid multicollinearity, only 14 independent variables including gender, age, diagnosis, marital status, body mass index (BMI), pathological stage, presence or absence of ostomy, chemotherapy regimen, difference between weight before chemotherapy and weight before surgery, hemoglobin, NLR, LMR, PLR, and PNI were included.…”

Section: Discussionmentioning

confidence: 99%

“…Relevant studies (16,17) have found symptom clusters in CRC patients, while the potential predictor of symptom clusters remains largely unknown. In this study, we identified 4 symptom clusters in radical resected CRC patients who had just undergone their first cycle of adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Serum biomarkers predict adjuvant chemotherapy-associated symptom clusters in radical resected colorectal cancer patients

Li¹,

Lu²,

Xia³

et al. 2022

J Gastrointest Oncol

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Background: Due to individual heterogeneity, patients at the same stage of colorectal cancer (CRC) who receive the same chemotherapy may experience different symptom clusters. Identifying the precise factors that predict symptom clusters is of great clinical significance for precision care and for improving the quality of life of patients. The present study investigated the relationship between serum biomarkers and adjuvant chemotherapy-related symptom clusters in radically resected CRC patients. Methods: Serum biomarkers and clinical/pathological characteristics of the radical resected CRC patients were collected before the first cycle of adjuvant chemotherapy. A demographic questionnaire and M.D.Anderson Gastrointestinal Cancer Symptom Scale (MDASI-GI) were performed on the third day after chemotherapy and exploratory factor analysis was performed to determine the symptoms clusters. Multiple linear regression and correlation analysis were also performed to evaluate the correlation between serum biomarkers and chemotherapy-related symptom clusters.Results: A total of 4 chemotherapy-related symptom clusters were determined in the enrolled radical resected CRC patients, including a fatigue-psychological symptom cluster, gastrointestinal symptom cluster, neurotoxic symptom cluster, and constipation-abdominal distension symptom cluster. Further analysis showed that the gastrointestinal symptom cluster was significantly associated with age, gender, weight change status, neutrophil to lymphocyte ratio (NLR), and body mass index (BMI). Additionally, the fatiguepsychological symptom cluster was found to be significantly associated with high NLR. The neurotoxic symptom cluster was found to be significantly associated with low hemoglobin level.Conclusions: Serum biomarkers and clinical characteristics of the radical resected CRC patients could be used to predict chemotherapy-related symptoms clusters.

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Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy

Cited by 32 publications

References 54 publications

Distinct diarrhea profiles during outpatient chemotherapy

Distinct diarrhea profiles during outpatient chemotherapy

Symptom clusters in patients receiving chemotherapy: A systematic review

Serum biomarkers predict adjuvant chemotherapy-associated symptom clusters in radical resected colorectal cancer patients

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