Symptom clusters in newly-diagnosed brain tumor patients

Abstract

8587 Background: A symptom cluster is 2 or more co-occurring symptoms. Patients with brain tumors experience disease and treatment-related symptoms that impact their health-related quality of life (QOL). Identifying symptom clusters will facilitate treatment and improve QOL outcomes. Methods: 66 patients were enrolled in a phase III, placebo-controlled, double-blind, prospective randomized clinical trial assessing the effect of prophylactic d-methylphenidate (d-MPH) on QOL in newly diagnosed brain tumor patients receiving brain radiation therapy (RT). Inclusion criteria were: age ≥ 13 years, primary or metastatic brain tumor, partial or whole brain RT with a total dose of ≥ 2,500 cGy in ≥ 10 fractions, KPS ≥ 70, and life expectancy ≥ 3 months. Patients received d-MPH 5–15 mg BID (or placebo) starting week 1 of RT and continuing for 8 weeks post-RT. QOL data were collected at baseline, the end of RT, and 4, 8, and 12 weeks following RT using the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and the Center for Epidemiologic Studies Depression Scale (CES-D). Symptom data were analyzed using exploratory factor analysis, multi-dimensional scaling (MDS), and cluster analysis. Results: The study failed to show a treatment effect for d-MPH (Butler J et al, Int J Radiat Oncol Biol Physics 63 [Supp1]:80, 2005).Thus, both d-MPH and placebo patients were analyzed together. 58 and 48 patients were analyzed at baseline and the end of RT, respectively. Two symptom clusters were identified using exploratory factor analysis and supported by MDS and cluster analysis: an expressive language cluster including difficulty reading, writing, and finding the right words, and a mood cluster including feeling sad, anxious, and having depressed mood. Conclusions: Two symptom clusters were identified in patients undergoing brain RT: an expressive language cluster and a mood cluster. This suggests that interventions that target both cognitive function and mood should be utilized. Further research on symptom clusters in cancer patients is needed. This study was supported by NCI grant 1 U10 CA81851. No significant financial relationships to disclose.

Identifying symptom clusters in paediatric cancer patients using the Memorial Symptom Assessment Scale

“…In a study by Yeh et al (2008), difficulty concentrating or paying attention, insomnia, lack of energy, feeling drowsy, feelings of sadness, worrying, irritability and sweating formed one symptom cluster, while Ivanova et al (2005) reported that emotional stress and sadness formed a separate cluster in their analysis. Gleason et al (2007) identified a similar symptom cluster called psychological status which included sadness, depression and anxiety in their study on patients newly diagnosed with brain tumours, although again, this study was conducted on an adult sample. Chen and Lin (2007) also found a psychological symptom cluster using the M.D.…”

Methods for Examining Cancer Symptom Clusters Over Time

“…In this approach, the same statistical technique is repeated at each time point. There are several techniques from which to choose, including exploratory factor analysis (EFA; Chen et al, 2011;Gleason et al, 2007;E. Kim et al, 2009;H.…”

Qualitative Longitudinal Analysis of Symptoms in Patients with Primary and Metastatic Brain Tumours

“…Because some items exhibited flooring or ceiling effects and some cells were sparse, we dichotomized the responses (0, 'not at all', 'a little bit' and 'somewhat', and 1, 'quite a bit' and 'very much'). Although patients in the two studies completed their FACT brain subscale assessment at different time points following initiation of their study intervention with donepezil, d-MPH or the placebo (study A at the end of radiation, then 4, 8 and 12 weeks following onset of d-MPH or placebo, and study B at 6, 12, 24 and 30 weeks following onset of donepezil), the symptoms that were experienced by patients in both studies were similar (Gleason et al, 2007). Furthermore, we inspected the patterns of change in symptoms over time within each study and did not find detectable differences.…”

“…As a result, 13 items from the FACT brain subscale were included in the final analysis. A factor analysis unambiguously separates the items into three domains (Gleason et al, 2007), which we labelled cognition problems (six items), emotional problems (four items) and physical and functional problems (three items). We provided a representative item for each domain: 'I am losing hope in the fight against my illness' (emotional domain), 'I have difficulty expressing my thoughts' (cognitive domain) and 'I have a lack of energy' (physical domain).…”

“…Consequently, individual differences between patients in overall proneness to symptoms are to be expected, i.e. a patient who suffers more than other patients in his or her disease state from one symptom is expected to have other more severe symptoms as well (Gleason et al, 2007). In this paper, we propose to incorporate random effects to account for these individual differences in overall proneness to symptoms that are not captured by observed patient profiles, so that the states of the HMM solely reflect qualitatively distinct health or disease states.…”