Transitions in Symptom Cluster Subgroups Among Men Undergoing Prostate Cancer Radiation Therapy

Abstract

Background Prostate cancer is a common type of cancer worldwide and in the United States. However, little information has been reported on the symptoms of men overtime who receive radiation therapy. Objective Identify subgroups of men at pre-and post radiation therapy on general and treatment-related symptoms and to determine transitions in subgroup membership overtime. Methods Men (n=84) receiving completed questionnaires on fatigue, insomnia, pain, depression, anxiety, and sexual, urinary and bowel problems at pre-and posttreatment. Latent class analysis identified subgroups. One-way ANOVAs determined subgroups differed on symptoms, participant characteristics, and quality of life. Latent transition analysis examined subgroup transitions overtime. Results At pretreatment four subgroups identified: Resilient group with little to no symptom reporting, Adjusted group with moderately high treatment-related symptoms, low insomnia, depression, and anxiety, Distressed group consistently high on most symptoms, and Emerging group with moderately high fatigue, depression, and anxiety with few treatment-related symptoms. At posttreatment similar results to groups at pretreatment: Resilient, Adjusted and Distressed groups with an Impacted group having high pain, insomnia, depression, urinary, and bowel symptoms. Quality of life and participant characteristics further distinguished groups at pre-and posttreatment. Income level predicted a transition in group membership. Conclusions Men can be classified into distinctly different subgroups overtime. Implications for Practice Assessment and intervention with men in subgroups such as Distressed and Emerging before and during treatment may lessen potential for remaining distressed, or moving into Impacted group where symptom severity is high at posttreatment. Interventions to reduce multiple symptoms are vitally needed.

Symptom and function profiles of men with localized prostate cancer

“…Our findings are consistent with previous studies that applied similar methods for subgroup analyses of HRQOL in patients with cancer. One study of 84 men with prostate cancer who received radiation therapy also identified 4 HRQOL subgroups or profiles . From best to poorest HRQOL 8 weeks after starting therapy, the profiles were labeled as “resilient,” “adjusted,” “emerging,” and “distressed.” Similar to our study, younger men were more likely to be in the distressed profile.…”

Distinct Subgroups of Patients With Lung Cancer Receiving Chemotherapy: A Latent Transition Analysis

“…A few cross-sectional studies ( 13 – 15 ) classified patients into subgroups using LCA, but a limited number of studies used longitudinal data. Four studies explored subgroups of patients prior and after chemotherapy based on symptom occurrence or severity in a heterogeneous sample ( 16 , 17 ) or specific cancer type of patients ( 18 , 19 ). Different distinct subgroups, transition status, and patient characteristics were identified using LCA and LTA.…”

Moving beyond Table 1: A critical review of the literature addressing social determinants of health in chronic condition symptom cluster research

“…Income and economic status were also implicated in psychoneurological symptom clusters, with five studies ( n = 4 cancer and n = 1 COPD) finding significant relationships between lower income or self‐reported poor economic status and higher levels of symptoms such as pain, fatigue, and depression (Chu et al, 2019; Dirksen et al, 2016; Ji et al, 2017; Langford et al, 2016; Lim et al, 2017). Again, specific symptoms included in the psychoneurological symptom cluster differed across studies, with one study including posttraumatic stress type symptoms (e.g., re‐experiencing; Chu et al, 2019).…”

“…Among the most analyzed Social and Community Context variables were age (n =44, 37.29%), sex/gender (n =24, 20.33%), and race/ ethnicity (n =18, 18.64%). Regarding age, 16 studies in oncology populations found a significant association between age and symptom clusters (Baden et al, 2020;Bjerkeset et al, 2020;Bobevski et al, 2018;Dirksen et al, 2016;Fox et al, 2020;Gehrman et al, 2017;Jeon et al, 2019;Lee et al, 2020;Lemanska et al, 2017;Levkovich et al, 2018;H. Li et al, 2020;Nho et al, 2017;Papachristou et al, 2018;Ren et al, 2017;Seib et al, 2017;Wang et al, 2019).…”