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. 2022 Mar;12(1):10-21.
doi: 10.1136/bmjspcare-2021-003325. Epub 2021 Dec 17.

Symptom clusters in patients receiving chemotherapy: A systematic review

Carolyn S Harris  1 , Kord M Kober  2 , Yvette P Conley  3 , Anand A Dhruva  4 , Marilyn J Hammer  5 , Christine A Miaskowski  2   4
Affiliations

Symptom clusters in patients receiving chemotherapy: A systematic review

Carolyn S Harris et al. BMJ Support Palliat Care. 2022 Mar.

Abstract

Background and purpose: Since 2001, symptom cluster research has grown considerably. However, because multiple methodological considerations remain, ongoing synthesis of the literature is needed to identify gaps in this area of symptom science. This systematic review evaluated the progress in symptom clusters research in adults receiving primary or adjuvant chemotherapy since 2016.

Methods: Eligible studies were published in English between 1 January 2017 and 17 May 2021; evaluated for and identified symptom clusters 'de novo;' and included only adults being treated with primary or adjuvant chemotherapy. Studies were excluded if patients had advanced cancer or were receiving palliative chemotherapy; symptoms were measured after treatment; symptom clusters were pre-specified or a patient-centred analytic approach was used. For each study, symptom instrument(s); statistical methods and symptom dimension(s) used to create the clusters; whether symptoms were allowed to load on more than one factor; method used to assess for stability of symptom clusters and associations with secondary outcomes and biomarkers were extracted.

Results: Twenty-three studies were included. Memorial Symptom Assessment Scale was the most common instrument and exploratory factor analysis was the most common statistical method used to identify symptom clusters. Psychological, gastrointestinal, and nutritional clusters were the most commonly identified clusters. Only the psychological cluster remained relatively stable over time. Only five studies evaluated for secondary outcomes.

Discussion: While symptom cluster research has evolved, clear criteria to evaluate the stability of symptom clusters and standardised nomenclature for naming clusters are needed. Additional research is needed to evaluate the biological mechanism(s) for symptom clusters.

Prospero registration number: CRD42021240216.

Keywords: cancer; supportive care; symptoms and symptom management.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram to determine the final selection of studies that evaluated for symptom clusters in patients receiving adjuvant chemotherapy, 2017–2021. From Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71
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References

    1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209–49. doi:10.3322/caac.21660 - DOI - PubMed
    1. Miaskowski C, Cooper BA, Melisko M, et al. Disease and treatment characteristics do not predict symptom occurrence profiles in oncology outpatients receiving chemotherapy. Cancer 2014;120(15):2371–8. doi:10.1002/cncr.28699 - DOI - PMC - PubMed
    1. Kim JE, Dodd MJ, Aouizerat BE, et al. A review of the prevalence and impact of multiple symptoms in oncology patients. J Pain Symptom Manage 2009;37(4):715–36. doi:10.1016/j.jpainsymman.2008.04.018 - DOI - PMC - PubMed
    1. Mazor M, Paul SM, Chesney MA, et al. Perceived stress is associated with a higher symptom burden in cancer survivors. Cancer 2019;125(24):4509–4515. doi:10.1002/cncr.32477 - DOI - PMC - PubMed
    1. Dodd M, Cho M, Cooper B, et al. The effect of symptom clusters on functional status and quality of life in women with breast cancer. Eur J Oncol Nurs 2010;14(2):101–10. doi:10.1016/j.ejon.2009.09.005 - DOI - PMC - PubMed

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