Prospective Longitudinal Evaluation of a Symptom Cluster in Breast Cancer

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• 作者：Stacy D. Sanford ; PhD^a ; ^{ssanford@nmff.org" class="auth_mail} ; Jennifer L. Beaumont ; MS^b ; Zeeshan Butt ; PhD^b ; Jerry J. Sweet ; PhD^c ; David Cella ; PhD^b ; Lynne I. Wagner ; PhD^b
• 关键词：Breast cancer ; oncology ; sleep disturbance ; fatigue ; cognitive impairment ; depression ; anxiety ; emotional distress ; symptom cluster
• 刊名：Journal of Pain and Symptom Management
• 出版年：April, 2014
• 年：2014
• 卷：47
• 期：4
• 页码：721-730
• 全文大小：362 K

文摘

Context

Symptom cluster research expands cancer investigations beyond a focus on individual symptoms in isolation.

Objectives

We conducted a prospective longitudinal study of sleep, fatigue, depression, anxiety, and perceived cognitive impairment in patients with breast cancer undergoing chemotherapy.

Methods

Patient-reported outcome measures were administered prior to chemotherapy, at Cycle 4 Day 1, and six months after initiating chemotherapy. Participants were divided into four groups and assigned a symptom cluster index (SCI) score based on the number/severity of symptoms reported at enrollment.

Results

Participants (N聽=聽80) were mostly women (97.5%) with Stage II (69.0%) breast cancer, 29-71聽years of age. Scores on all measures were moderately-highly correlated across all time points. There were time effects for all symptoms, except sleep quality (nonsignificant trend), with most symptoms worsening during chemotherapy, although anxiety improved. There were no significant group聽脳聽time interactions; all four SCI groups showed a similar trajectory of symptoms over time. Worse performance status and quality of life were associated with higher SCI score over time.

Conclusion

With the exception of anxiety, the coherence of the symptom cluster was supported by similar patterns of severity and change over time in these symptoms (trend for sleep quality). Participants with higher SCI scores prior to chemotherapy continued to experience greater symptom burden during and after chemotherapy. Early assessment and intervention addressing this symptom cluster (vs. individual symptoms) may have a greater impact on patient performance status and quality of life for patients with higher SCIs.