Subgroups of Patients With Cancer With Different Symptom Experiences and Quality-of-Life Outcomes: A Cluster Analysis

Miaskowski, Christine; Cooper, Bruce A.; Paul, Steven M.; Dodd, Marylin; Lee, Kathryn; Aouizerat, Bradley E.; West, Claudia; Cho, Maria; Bank, Alice

doi:10.1188/06.onf.e79-e89

Cited by 255 publications

(362 citation statements)

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“…To determine whether distinct subgroups of patients experiencing differing levels of symptom burden were present, we modeled our cluster analysis on the work by Miaskowski et al [16] and employed a hierarchical cluster analysis with squared Euclidean distances used in the proximities matrix and weighted average linkage used as the clustering method [32]. These analyses were applied to symptom the presence or absence from the MSAS measured at the end of chemotherapy treatment.…”

Section: Determining Patient Subgroupsmentioning

confidence: 99%

“…In addition, studies have shown that the number or intensity of symptoms reported by patients is correlated with their perception of quality of life (QOL) [3][4][5][6][7][8]. Thus, previous research has focused on identifying distinct subgroups of patients [11][12][13][14][15][16] who report similar outcomes, and more recently, on clusters of related or similar symptoms (symptom clusters) [3][4][5][6][7][8][9][10]17].…”

Section: Introductionmentioning

confidence: 99%

“…More recently, a cluster analysis of patients with different types of cancers identified four relatively distinct subgroups of patients based on differential experiences on four highly prevalent and related symptoms-fatigue, sleep disturbance, depression, and pain [16]. These four symptoms were measured by psychometrically validated scales including the Lee Fatigue Scale, General Sleep Disturbance Scale, Center for Epidemiological Studies-Depression Scale, and a numeric rating scale of worst pain intensity.…”

Section: Introductionmentioning

confidence: 99%

“…The four subgroups of patients were: all low levels of symptoms (n=67, 35%), low fatigue and high pain (n=28, 15%), high fatigue and low pain (n=68, 35%), and all high levels of symptoms (n=28, 15%). The authors [16] also explored whether the patient groups differed on selected demographic, disease, and treatment characteristics and on functional status (Karnofsky Performance Status Scale) and QOL (Multidimensional Quality-of-Life Scale-Cancer). Overall, patients in the "all low" group reported the best functional status and QOL.…”

Section: Introductionmentioning

confidence: 99%

“…Finally, the study examined whether differences between subgroups were related to differences on demographic characteristics (e.g., age, marital status, education, income, and employment) or disease and treatment characteristics (e.g., tumor stage, surgery type, and chemotherapy regimen). Based on the mixed results in the literature with some studies showing no association [13] and others showing differences between patient subgroups [15,16], this objective was considered exploratory.…”

Section: Introductionmentioning

confidence: 99%

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Exploring the differential experience of breast cancer treatment-related symptoms: a cluster analytic approach

Gwede

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Münster

et al. 2007

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Section: Determining Patient Subgroupsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Exploring the differential experience of breast cancer treatment-related symptoms: a cluster analytic approach

Gwede

Small

Münster

et al. 2007

Support Care Cancer

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Physical symptom burden in patients with desmoid‐type fibromatosis and its impact on health‐related quality of life and healthcare use

et al. 2023

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Background Desmoid‐type fibromatosis (DTF) has a highly variable clinical course with varying intensity of symptoms. The objectives of this study were to identify subgroups of DTF patients based on physical symptom burden and to compare symptom burden subgroups on health‐related quality of life (HRQoL) and healthcare use (univariate and multivariate). Methods Desmoid‐type fibromatosis patients from the United Kingdom and the Netherlands received cross‐sectional questionnaires on HRQoL (EORTC QLQ‐C30), DTF‐specific HRQoL (DTF‐QoL) and healthcare utilisation. Latent class cluster analysis was performed to identify subgroups based on patients' symptom burden using EORTC QLQ‐C30 and DTF‐QoL physical symptom items. Multivariate linear and logistic regression analyses were conducted to examine associations of symptom burden with HRQoL and healthcare utilisation, respectively. Results Among 235 DTF patients, four symptom burden clusters were identified, with low symptom burden (24%), intermediate symptom burden‐low pain (20%), intermediate symptom burden‐high pain (25%) and high symptom burden (31%). DTF patients with high symptom burden had clinically relevant lower HRQoL scores compared to patients with low and intermediate symptom burden (p < 0.001) and reported more general and DTF‐related visits to their general practitioner compared to the low symptom burden cluster (p < 0.01). In the multivariate analyses, symptom burden was independently associated with both HRQoL and healthcare utilisation. Conclusions This study identified four distinct subgroups of DTF patients based on their level of symptom burden, with a considerable number of patients being highly symptomatic. Knowledge of the level of symptom burden DTF patients experience can help to identify patients at risk of poorer outcomes and tailor supportive care to the individual needs of DTF patients.

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Symptom burden in cancer survivors 1 year after diagnosis

Shi¹,

Smith²,

Michonski³

et al. 2011

Cancer

227

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Background Few studies have examined risk for severe symptoms during early cancer survivorship. Using baseline data from the American Cancer Society’s Study of Cancer Survivors-I, we examined cancer survivors with high symptom burden, identified risk factors associated with high symptom burden, and evaluated the impact of high symptom burden on health-related quality of life (HRQoL) 1 year post-diagnosis. Methods Participants were enrolled from 11 state cancer registries approximately 1 year after diagnosis and surveyed by telephone or mail. Outcomes measures were the Modified Rotterdam Symptom Checklist and Profile of Mood States-37 (to assess symptom burden) and the Satisfaction with Life Domains Scale-Cancer (to assess HRQoL). Results Of 4903 survivors, 4512 (92%) reported symptoms related to their cancer and/or its treatment. Two-step clustering yielded 2 sub-groups, one with low symptom burden (n=3113) and one with high symptom burden (n=1399). Variables associated with high symptom burden included metastatic cancer (odds ratio [OR], 2.05), number of comorbid conditions (OR, 1.76), remaining on active chemotherapy (OR, 1.93), younger age (OR, 2.31), lacking insurance/being underinsured (OR, 1.57), having lower income (OR, 1.61), being unemployed (OR, 1.27), or being less educated (OR, 1.29). Depression, fatigue, and pain had the greatest impact on HRQoL in survivors with high symptom burden, who also had lower HRQoL (P < .0001). Conclusions More than 1 in 4 cancer survivors had high symptom burden 1 year post-diagnosis, even after treatment termination. These results indicate a need for continued symptom monitoring and management in early posttreatment survivorship, especially for the underserved.

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Subgroups of Patients With Cancer With Different Symptom Experiences and Quality-of-Life Outcomes: A Cluster Analysis

Abstract: The findings from this study need to be replicated before definitive clinical practice recommendations can be made. Until that time, clinicians need to assess patients for the occurrence of multiple symptoms that may place them at increased risk for poorer outcomes.

Cited by 255 publications

References 46 publications

Exploring the differential experience of breast cancer treatment-related symptoms: a cluster analytic approach

Exploring the differential experience of breast cancer treatment-related symptoms: a cluster analytic approach

Physical symptom burden in patients with desmoid‐type fibromatosis and its impact on health‐related quality of life and healthcare use

Symptom burden in cancer survivors 1 year after diagnosis

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