Symptom clusters and their temporal patterns in breast cancer patients undergoing chemotherapy: a systematic review of cross-sectional and longitudinal studies

Background: Patients with breast cancer undergoing chemotherapy commonly experience multiple co-occurring symptoms, which often cluster together to form symptom clusters, characterized by temporal variability and a significant clinical burden. Objective: The aim of this systematic review was to identify common symptom clusters in breast cancer patients during chemotherapy, to examine their temporal development during the different treatment phases, and to summarize the implications for personalized symptom management in clinical nursing practice. Methods: In line with the PRISMA guidelines, a systematic literature search was carried out in eight databases covering studies published up to 25 September 2025. Eligible studies were required to identify clusters of symptoms using statistical methods. Both cross-sectional and longitudinal studies have been undertaken. The selection of the study, data extraction and quality assessment were carried out independently by two evaluators. Results: A total of 24 studies (N = 5,234 patients) were enrolled. Thirteen different symptom clusters were identified, most frequently involving gastrointestinal, psychological, neurological, and hormone-related symptoms. The composition and severity of the clusters varied between the stages of chemotherapy. Gastrointestinal clusters were highest in the early treatment cycles, while fatigue, cognitive, and psychosocial clusters persisted or intensified in later or post-chemotherapy phases. Evidence from longitudinal studies suggested that symptom patterns evolve and clusters reconfigure over time. Conclusions: Symptom clusters in breast cancer patients receiving chemotherapy are heterogeneous and temporally dynamic. Strict symptom assessment and tailor-made interventions tailored to the phase of chemotherapy can help to reduce the burden of symptoms and improve patient-centered care. Future studies should standardize time point definitions, adopt longitudinal design and incorporate culturally representative samples to advance the science of oncology symptoms. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42025638742, identifier CRD42025638742.