The Relationship of Cancer Symptom Clusters to Depressive Affect in the Initial Phase of Palliative Radiation

Abstract

Research on comorbidity across cancer symptoms, including pain, fatigue, and depression, could suggest if crossover effects from symptom-specific interventions are plausible. Secondary analyses were conducted on a survey of 268 cancer patients with recurrent disease from a northeastern U.S. city who were initiating palliative radiation for bone pain. Moderator regression analyses predicted variation in depressive affect that could be attributed to symptom clusters. Patients self-reported difficulty controlling each physical symptom over the past month on a Likert scale and depressive symptoms on a validated depression measure (Center for Epidemiologic Studies-Depression [CES-D]) over the past week on a four-category scale. An index of depressive affect was based on items of negative and positive affect from the CES-D. In predicting depressive affect, synergistic interactions of pain with fever, fatigue, and weight loss suggest separate pathways involving pain. A similar interaction with fever occurs when nausea was tested in place of pain. Further, the interaction between pain and fatigue is similar in form to the interaction between difficulty breathing and fatigue (when sleep is not a problem). Follow-up to the latter interaction reveals: 1) additional moderation by hypertension and palliative radiation to the hip/pelvis; and 2) a similar cluster not involving hypertension when appetite problems and weight loss were tested in place of fatigue. The significance and form of these interactions are remarkably consistent. Similar sickness mechanisms could be generating: 1) pain and nausea during fever; 2) pain and fatigue during weight loss; and 3) pain and breathing difficulty when fatigue is pronounced. Crossover effects from symptom-specific interventions appear promising.

Could Sequential Residual Centering Resolve Low Sensitivity in Moderated Regression? Simulations and Cancer Symptom Clusters

“…CES-D somatic items were excluded because they may constitute symptoms of cancer instead of depression. The internal consistency for the eleven items in these data is very good (α = 0.83), which compares favorably to α = 0.85 in the entire CES-D [26].…”

“…In Table 2, the resulting SRC-CS models (1B, 2B, and 3B) condition essential multicollinearity related to two secondary variables, Shortness of breath/difficulty breathing and Nausea/vomiting, from the initial, residualizing regression. These two secondary variables are added to these SRC-CS models because in previous analyses with these data, these common symptoms were revealed to be components of symptom interactions also involving Pain or Fatigue/weakness [26], which could overlap those in the current study. With this essential multicollinearity removed, it is optional whether to retain these secondary variables in the subsequent QMMR models that test each three-way interaction separately, Open Access OJS R. B. FRANCOEUR 35 and both variables are dropped from 1B and 2B.…”

“…The single-item measures of physical symptoms were initially reported to be common measures derived from previous studies [25]. More recently, a review by Francoeur [26] revealed different lines of converging evidence in the literature that collectively support the reliability and validity of selfreported, ordinal, single-item measures of the degree of control across several physical symptoms.…”

Determination of Cutpoints for Low and High Number of Symptoms in Patients with Advanced Cancer

“…Emerging evidence suggests that psychological symptoms contribute to decrements in QOL in patients with advanced cancer. [65][66][67][68] For example, higher depression scores were associated with higher symptom severity scores. 69 In addition, in a study of cancer patients in their last year of life, 68 higher levels of depressive symptoms at enrollment were associated with a worse symptom experience over time.…”

Los grupos de síntomas en personas con cáncer: una revisión integrativa

“…En personas con cáncer recurrente que inician radiación paliativa por dolor óseo se identifican los síntomas dolor, disminución de peso, fatiga, fiebre, disminución de apetito y sueño (52).…”