Symptom Clusters in Patients With Advanced Cancer: A Prospective Longitudinal Cohort Study to Examine Their Stability and Prognostic Significance.
Oncologist
; 29(1): e152-e163, 2024 Jan 05.
Article
in En
| MEDLINE
| ID: mdl-37536276
ABSTRACT
This study's purpose was to assess symptom cluster (SC) stability during disease progression and determine their strength of association with survival in patients with advanced cancer . Consecutively eligible patients with advanced cancer not receiving cancer-specific treatment and referred to a Tertiary Palliative Care Clinic were enrolled in a prospective cohort study. At first consultation (D0) and in subsequent consultations at day 15 (D15) and day 30 (D30), patients rated 9 symptoms through the Edmonton Symptom Assessment System scale (0-10) and 10 others using a Likert scale (1-5). Principal components factor analysis with varimax rotation was used to determine SCs at each consultation. Of 318 patients with advanced cancer, 301 met eligibility criteria with a median age of 69 years (range 37-94). Three SCs were identified neuro-psycho-metabolic (NPM), gastrointestinal, and sleep impairment, with some variations in their constitution over time. Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter median survival was observed continuously for NPM cluster (D0 23 vs. 58 days, P < .001; D15 41 vs. 104 days, P=.004; D30 46 vs. 114 days, P = .002), although the presence of 2 or more SCs on D0 and D15 also had prognostic significance (D0 21 vs. 45 days, P = .005; D30 50 vs. 96 days, P = .040). In a multivariable model, NPM cluster (D0 hazard ratio estimate HR 1.64; 95%CI, 1.17-2.31; P = .005; D15 HR 2.51; 95%CI, 1.25-5.05; P = .009; D30 HR 3.9; 95%CI, 1.54-9.86; P = .004) and hospitalization (D0 HR 2.27; 95%CI, 1.47-3.51; P < .001; D15 HR 2.43; 95%CI, 1.18-5.01; P = .016; D30 HR 3.41; 95%CI, 1.35-8.62; P = .009) were independently and significantly associated with worse survival. Three clinically relevant SCs were identified, and their constitution had small variations, maintaining a stable set of nuclear symptoms through disease progression. Presence of the NPM cluster and hospitalization maintained their prognostic value over time.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Neoplasms
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Aged80
/
Humans
/
Middle aged
Language:
En
Journal:
Oncologist
Journal subject:
NEOPLASIAS
Year:
2024
Document type:
Article
Affiliation country:
Portugal