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. 2021 Oct;37(5):151215.
doi: 10.1016/j.soncn.2021.151215. Epub 2021 Sep 3.

Symptom Clusters in Head and Neck Cancer: A Systematic Review and Conceptual Model

Asha Mathew  1 , Amit Jiwan Tirkey  2 , Hongjin Li  3 , Alana Steffen  4 , Mark B Lockwood  4 , Crystal L Patil  4 , Ardith Z Doorenbos  5
Affiliations

Symptom Clusters in Head and Neck Cancer: A Systematic Review and Conceptual Model

Asha Mathew et al. Semin Oncol Nurs. 2021 Oct.

Abstract

Objective: The two approaches to symptom-cluster research include grouping symptoms and grouping patients. The objective of this systematic review was to examine the conceptual approaches and methodologies used in symptom-cluster research in patients with head and neck cancer.

Data sources: Articles were retrieved from electronic databases (CINAHL, MEDLINE via Ovid, APA PsycINFO, Scopus, Embase, and Cochrane Central Register of Controlled Trials-CENTRAL), five grey literature portals, and Google Scholar. Seventeen studies met the eligibility criteria. Eight studies grouped symptoms to identify symptom clusters, of which two used qualitative methods. The number of symptom clusters ranged from two to five, and the number of symptoms in a cluster ranged from 2 to 11. Nine studies grouped patients based on their experiences with multiple symptoms. Cluster analysis and factor analysis were most commonly used. Despite variable names and composition of symptom clusters, synthesis revealed three prominent symptom clusters: general, head and neck cancer-specific, and gastrointestinal. Being female and quality of life were significantly associated with high symptom group or cluster severity. Biological mechanisms were sparsely examined.

Conclusion: Symptom cluster research in head and neck cancer is emerging. Consensus on nomenclature of a symptom cluster will facilitate deduction of core clinically relevant symptom clusters in head and neck cancer. Further research is required on understanding patients' subjective experiences, identifying predictors and outcomes, and underlying mechanisms for symptom clusters.

Implications for nursing practice: Identification of clinically relevant symptom clusters would enable targeted symptom assessment and management strategies, thus improving treatment efficiencies and patient outcomes.

Keywords: Cluster analysis; Factor analysis; Head and neck cancer; Symptom cluster; Systematic review.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no potential conflicts of interest.

Figures

FIG 1.
FIG 1.
PRISMA flowchart illustrating article selection process. PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analyses.
FIG 2.
FIG 2.
(A) Fatigue-related symptom pairs with evidence. (B) Dry mouth-related symptom pairs with evidence.
FIG 3.
FIG 3.
Conceptual model based on the NIH Symptom Science Model and Symptom Management Theory applied in symptom cluster research in head and neck cancers. NIH, National Institutes of Health.
See this image and copyright information in PMC

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