Symptom Clusters and Symptom Burden in Cancer Survivors

CONTEXT: Limited information is available on the symptom burden and symptom clusters in cancer survivors. OBJECTIVES: Describe the occurrence, severity, and distress of 44 symptoms; determine risk factors associated with a higher symptom burden; and evaluate for symptom clusters using symptom occurrence rates. METHODS: Survivors (n = 1147) were recruited using an online survey. Symptom burden and symptom clusters were assessed using the Memorial Symptom Assessment Scale that included 44 symptoms and evaluated occurrence, severity, and distress. Simultaneous multivariable linear regression analysis was performed to determine risk factors associated with a higher symptom burden. Exploratory factor analysis was used to identify symptom clusters using ratings of symptom occurrence. RESULTS: Survivors reported an average ten concurrent symptoms. Survivors who are younger, female, with a higher comorbidity burden, evidence of metastatic disease, and a poorer functional status were at increased risk for a higher symptom burden. Six symptom clusters were identified (i.e., psychological cluster, cancer and treatment-related cluster, respiratory cluster, pain cluster, weight loss cluster, epithelial cluster). CONCLUSION: Additional research is warranted to confirm the prevalence rates for the various symptoms and symptom clusters; identify additional risk factors for a higher symptom burden; and determine the underlying mechanisms for the symptom clusters. Future studies need to develop and test targeted interventions for each of the symptom clusters within and across various types of cancer.