• Asian Oncology Nursing
• /
• v.9 no.2
• /
• pp.77-85
• /
• 2009

Purpose: The purpose of this study was to identify symptom cluster experienced by patients with advanced non-small cell lung cancer (NSCLC) on gefitinib treatment. In addition, this study assessed the patterns in severity of the symptom cluster and differences in quality of life (QOL) and function among subgroups by the severity of symptom cluster. Methods: This study was conducted as a secondary analysis of symptoms of 72 patients from a mother study. Factor analysis was used to identify symptom clusters measured with EORTC QLQ-C30 and LC13 symptom related items. Results: Three symptom clusters were identified: cluster 1 was comprised of fatigue, anorexia and dysphagia; cluster 2 of dyspnea, cough and insomnia; and cluster 3 of pain, constipation and nausea/vomiting. These three symptom clusters were improved one week after gefitinib administration. The group with more severe symptom clusters showed significantly lower QOL and function than the group with less severe symptom clusters. Conclusion: Since symptom clusters experienced by the patients with advanced NSCLC influenced on the QOL and function, it is important for nurses to understand and observe their symptom clusters. In addition, there is an necessity to develop nursing interventions to effectively care patients with the symptom clusters.

• Journal of Korean Critical Care Nursing
• /
• v.12 no.1
• /
• pp.1-12
• /
• 2019

Purpose : It is widely accepted that addressing multiple symptoms together is the preferred approach in assessment and intervention and results in reduced negative patient outcomes. Yet, there are few studies examining symptom clusters and their impacts on quality of life longitudinally in patients after heart valve surgery. Methods: A total of 101 patients were recruited from a tertiary hospital and were administered questionnaires (at 3, 6, and 10 weeks after the surgery) assessing participants' characteristics, cardiac symptoms, and quality of life. Factor analysis was used to identify symptom clusters. Hierarchical multiple linear regression was used to predict quality of life. Results: Participants were predominantly 70-years old or more with a mean age of 64.34. The two symptom clusters at 3 weeks after the surgery with education, gender, and occupation accounted for 76.3% of variance in quality of life. Conclusion: Symptom clusters containing various physical and psychological symptoms in patients after the surgery affected quality of life, and the relationship was significant at 3 weeks after the surgery. Because symptom clusters were identified in all three recovery periods, nurses need to acknowledge these clusters, rather than each symptom separately, and to utilize these in providing care and education and in promoting quality of life in these patients.

• Journal of Korean Clinical Nursing Research
• /
• v.20 no.1
• /
• pp.123-133
• /
• 2014

Purpose: The purpose of the study was to investigate symptom clusters experienced by patients on hemodialysis and to identify relations between symptom clusters and quality of life. Methods: Data were collected from 127 patients at 10 local hemodialysis clinics. Symptoms were measured using 10-item physical symptom checklist as well as the Hospital Anxiety depression Scale. Quality of life was measured with the Satisfaction with Life Scale. Data were analyzed using factor analysis, Pearson correlation, and stepwise multiple regression. Results: The most frequently reported symptoms included fatigue, itching, depression, numbness/tingling, and insomnia. Four distinct symptom clusters were identified: cluster 1 was comprised of dry mouth, headache, nausea (gastrointestinal); cluster 2 of decreased appetite, insomnia (basic need); cluster 3 of itching, numbness/tingling (sensory-comfort); and cluster 4 of fatigue, depression (mood-vitality). Among the clusters, the 'basic need' cluster and 'mood-vitality' cluster had a significant negative association with quality of life. The 'mood-vitality' cluster, explained 17.4% of the variance in quality of life. Conclusion: The results of the study indicate that comprehensive symptom assessment provides better symptom management for patients on hemodialysis. Further studies are needed to verify symptom clusters identified in this study.

• Journal of Korean Academy of Nursing
• /
• v.39 no.5
• /
• pp.683-692
• /
• 2009

Purpose: The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma. Methods: This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters. Results: Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression. Conclusion: Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.

• Journal of Korean Clinical Nursing Research
• /
• v.14 no.1
• /
• pp.61-70
• /
• 2008

Purpose: Women with gynecologic cancer often experience various physical and psychological symptoms relating to the cancer and its treatment. The purpose of this study was to identify symptom clusters. Method: A survey was conducted on 184 women with diagnoses of cervical, ovarian or endometrial cancer. Fifty symptoms were assessed for prevalence, severity and interference, and symptom clusters were identified. Cluster analysis was done using SPSS version 12.0. Results: Fatigue was identified as the most prevalent symptom (81.52%), lack of vaginal lubrication (2.26) as the most severe symptom, and lack of vaginal lubrication as the most interfering one (2.15). Identified six clusters were: Anorexia-pain cluster (loss of appetite, taste change, weight loss, appearance change, alopecia, weakness, pain), Fatigue cluster (lack of concentration, lack of memory, fatigue, dry mouth), Urinary-bowel distress cluster (urinary difficulty, constipation), Abdominal discomfort cluster (lower abdominal pain, abdominal pain, bloating), Emotional distress (sadness, anxiety-worry, nervousness, restlessness), and Menopausal cluster (sweating, hot flush, fever). Conclusion: The result of this study provides fundamental data to health care professionals in developing interventions for effective symptom management for women with gynecologic cancer by understanding identified 6 symptom clusters.

• Korean Journal of Adult Nursing
• /
• v.21 no.6
• /
• pp.705-717
• /
• 2009

Purpose: The purpose of this study was to identify symptom clusters in patients with breast cancer and to investigate the associations among them with functional status and quality of life (QOL). Methods: A convenient sample of 303 patients was recruited from an oncology-specialized hospital. Results: Two distinct clusters were identified: A gastrointestinal- fatigue cluster and a pain cluster. Each cluster significantly influenced functional status and QOL. Based on these two clusters, we identified subgroups of symptom clusters using K-means cluster analysis. Three relatively distinct patient subgroups were identified in each cluster: mild, moderate, and severe group. Disease-related factors (i.e., stage, metastasis, type of surgery, current chemotherapy, and anti-hormone therapy) were associated with these subgroups of symptom clusters. There were significant differences in functional status and QOL among the three subgroups. The subgroup of patients who reported high levels of symptom clusters reported poorer functional status and QOL. Conclusion: Clinicians can anticipate that breast cancer patients with advanced stage, metastasis, and who receive mastectomy, and chemotherapy will have more intense gastrointestinal-fatigue or pain symptoms. In order to enhance functional status and QOL for patients with breast cancer, collective management for symptoms in a cluster may be beneficial.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.17
• /
• pp.7153-7158
• /
• 2014

Background: Non-Hodgkin's lymphoma (NHL) patients demonstrate multiple symptoms in diagnosis and treatment processes. This cross-sectional descriptive study aimed to determine the symptoms and symptom clusters in such patients receiving chemotherapy. Materials and Methods: The study was carried out on a total of 110 inpatients and outpatients receiving treatment in 7 hospitals in Ankara, Turkey. A questionnaire form and the Memorial Symptom Assessment Scale (MSAS) were applied. Percentages, means, t test, one way analysis of variance (ANOVA) and cluster analysis were used for statistical analyses. Results: The most prevalent symptoms in this study were lack of energy, hair loss and change in the way food tastes. The most severe symptoms were hair loss, change in the way food tastes and constipation. The top three most distressing symptoms were taste change, constipation and mouth sores. Seven symptom clusters were determined in this study. Conclusions: Findings of the study will provide an understanding of symptom experiences of Non-Hodgkin's lymphoma patients receiving chemotherapy and will guide determining appropriate nursing interventions. Receiving care of desired quality will contribute to increasing quality of life of affected individuals.

• Journal of Hospice and Palliative Care
• /
• v.16 no.3
• /
• pp.139-144
• /
• 2013

Advanced cancer patients tend to present multiple concurrent symptoms which are often moderate or severe in intensity. To date, the majority of studies have focused on either a single symptom, such as pain, fatigue, or depression or associated symptoms. While this approach has advanced understanding of some symptoms, it has offered clinicians not much guidance for treating several multiple concurrent symptoms in cancer patients. So in recent years, a few symptom management studies attempted a new approach of focusing on symptom clusters instead of individual symptoms. A symptom cluster is defined as two or more concurrent symptoms that are related to each other. If we better understand symptom clusters, interrelations of symptoms, and their common mechanisms in advanced cancer patients, clinicians can more effectively control multiple, concurrent symptoms and reduce drug side effects. And clinicians can also predict any other symptoms, functional performance, and the relationship between symptom clusters and survival in advanced cancer patients. At present, there is inconsistency in symptom clusters due to many unexplained mechanisms and various means to assess and analyze symptoms. Still, with further study, the approach to symptom clusters rather than individual symptoms could more effectively control symptoms and improve patients' quality of life.

• Journal of Korean Academy of Nursing
• /
• v.45 no.3
• /
• pp.378-387
• /
• 2015

Purpose: Acute myocardial infarction (AMI) leads to death if the patient does not receive emergency treatment. Thus it is very important to recognize the symptoms in the early stage. The purpose of this study was to identify clusters of symptoms that represent AMI in Koreans. Methods: The study used a retrospective, descriptive design with secondary data analysis. Data were abstracted from 725 medical records of AMI patients admitted from June 1, 2006 to August 15, 2014 at a university hospital. Results: Analysis of the AMI symptoms revealed five symptom clusters; Cluster 1 (n=140): middle chest pain (100%), shortness of breath, and cold sweating, Cluster 2 (n=256): substernal pain (100%), cold sweating, and shortness of breath, Cluster 3 (n=47): substernal pain (95.7%), left arm pain, shortness of breath, cold sweating, left shoulder pain, right arm pain, and the lower neck pain, Cluster 4 (n=212): shortness of breath (28.3%), left chest pain, and upper abdominal pain, and Cluster 5 (n=70): cold sweating (100%), left chest pain, shortness of breath, left shoulder pain, and upper abdominal pain. Length of hospital stay and mortality rate were significantly different according to symptom clusters (F=2.52, p =.040; F=3.62, p =.006, respectively). Conclusion: Symptom clusters of AMI from this study can be used for AMI patients in order to recognize their symptoms at an early stage. The study findings should be considered when developing educational prevention programs for Koreans with AMI.

• Journal of Korean Clinical Nursing Research
• /
• v.23 no.1
• /
• pp.20-29
• /
• 2017

Purpose: The purpose of this study was to investigate symptoms experienced by patients who reported fever at the emergency room (ER) and to identify any existing cluster of symptom related to fever. Methods: The study used a retrospective and descriptive design with secondary data analysis. Data were abstracted from 665 medical records of patients with fever who visited ER from September 1, 2015 to August 31, 2016 at a tertiary hospital. Results: The most frequently reported symptoms included cold (43.9%), myalgia (24.1%), headache (16.2%), general weakness (15.3%), respiratory symptoms (12.3%), gastrointestinal (GI) symptoms (12.0%), mental change (4.5%), sweating(1.8%), and warmth (0.9%). Analysis of the symptoms related to fever revealed seven symptom clusters; Cluster 1 (n=190) included cold (100%) and myalgia (28.9%); Cluster 2 (n=37), headache (100%) and myalgia (32.4%); Cluster 3 (n=33), GI symptoms (100%), general weakness, headache, and cold; Cluster 4 (n=34), cold (100%), myalgia, headache, and respiratory symptoms; Cluster 5 (n=241), respiratory symptoms (10.8%); Cluster 6 (n=76): myalgia (75.0%) and general weakness, and Cluster 7 (n=54), cold (87.0%), general weakness, and respiratory symptoms. Conclusion: The results of this comprehensive symptom assessment are hoped to be helpful in developing better symptom management for ER patients with fever than before. Further research is warranted to verify the symptom clusters of this study in different clinical settings.