The Influence of Multiple Chronic Conditions on Symptom Clusters in People With Solid Tumor Cancers

Abstract

Background: People with cancer who also have multiple chronic conditions (MCCs) experience co-occurring symptoms known as symptom clusters.

Objective: To describe MCC and symptom clusters in people with cancer and to evaluate the relationships between MCCs and symptom severity, symptom interference with daily life, and quality of life (QoL).

Methods: Weekly over a 3-week chemotherapy cycle, 182 adults with solid tumor cancer receiving chemotherapy completed measures of symptom severity, symptom interference with daily life, and QoL. Medical records reviewed to count number of MCCs in addition to cancer. Exploratory factor analysis was performed to identify symptom clusters. The relationships between the number of MCCs and the outcomes (symptom severity and symptom interference with daily life and QoL) at each time point were examined using the χ2 test. Longitudinal changes in outcomes were examined graphically.

Results: The number of MCCs ranged from 0 to 9, but most participants (62.1%) had 2 or fewer MCCs. Obesity was the most prevalent chronic condition. Four symptom clusters were identified: nutrition, neurocognitive, abdominal discomfort, and respiratory clusters. At each time point, no significant differences were found for MCCs and any outcome. However, symptom severity in all the symptom clusters, symptom interference with daily life, and QoL demonstrated a worsening in the week following chemotherapy.

Conclusion: A majority of our sample had 2 or fewer MCCs, and MCCs did contribute to patient outcomes. Rather, timing of chemotherapy cycle had the greatest influence of patient outcomes.

Implications for practice: Additional support on day 7 of chemotherapy treatment is needed for people with MCCs.

Figure 1.

Consolidated Standards of Reporting Trials (CONSORT) flow diagram

Figure 2.

Percentages of participants in levels of severity of the nutrition cluster symptoms, by MCC category. The nutrition cluster symptoms include nausea, lack of appetite, changes in the way food taste, diarrhea, feeling drowsy, and lack of energy over which the average score is calculated. Bars show the percentages of participants in levels of severity within each comorbidity level. Composite scores were categorized as “no severity” (score of 0), “mild severity” (scores >0 to 1), and “greater than mild severity” (scores > 1). No MCC = 0; low MCC = 1–2; high MCC = 3 or more.

Figure 3.

Percentages of participants in levels of severity of the neuro-cognitive cluster symptoms, by MCC category. The neuro-cognitive cluster symptoms include difficulty concentrating, feeling nervous, difficulty sleeping, worrying, and feeling irritable over which the average score is calculated. Bars show the percentages of participants in levels of severity within each comorbidity level. Composite scores were categorized as “no severity” (score of 0), “mild severity” (scores >0 to 1), and “greater than mild severity” (scores > 1). No MCC=0; low MCC = 1–2; high MCC = 3 or more.

Figure 4.

Percentages of participants in levels of severity of the abdominal cluster symptoms, by MCC category. The abdominal cluster symptoms include feeling bloated, passing gas, and feeling irritable over which the average score is calculated. Bars show the percentages of participants in levels of severity within each comorbidity level. Composite scores were categorized as “no severity” (score of 0), “mild severity” (scores >0 to 1), and “greater than mild severity” (scores > 1). No MCC = 0; low MCC = 1–2; high MCC = 3 or more.

Figure 5.

Percentages of participants in levels of severity of the respiratory cluster symptoms, by MCC category and day. The breathing cluster symptoms include coughing and shortness of breath over which the average score is calculated. Bars show the percentages of participants in levels of severity within each comorbidity level and day. Composite scores were categorized as “no severity” (score of 0), “mild severity” (scores >0 to 1), and “greater than mild severity” (scores > 1). No MCC = 0 MCC; low MCC = 1–2 MCC; high MCC = 3 or more MCC.

Figure 6.

Percentages of participants in levels of symptoms interference with daily life, by MCC category and day. Bars show the percentages of participants in levels of symptom interference within each comorbidity level and day. Symptom interference with daily life was categorized as “no symptom interference” (score of 0), “mild symptom interference” (scores >0 to 2.9), and “greater than mild symptom interference” (scores 3 to 10). No MCC = 0 MCC; low MCC = 1–2 MCC; high MCC = 3 or more MCC.

Figure 7.

Percentages of participants in levels of QoL interference, by MCC category and day. Bars show the percentages of participants in levels of interference with QoL within each comorbidity level and day. QoL interference was categorized as “no QoL interference” (scores ≥4.5), “mild QoL interference” (scores 3.5 to <4.5), and “greater than mild QoL interference” (score <3.5). No MCC = 0 comorbidities; low MCC = 1–2 MCC; high MCC = 3 or more MCC.