Functional Impairments as Symptoms in the Symptom Cluster Analysis of Patients Newly Diagnosed With Advanced Cancer

Journal of Pain and Symptom Management - Functional Impairments as Symptoms in the Symptom Cluster Analysis of Patients Newly Diagnosed With Advanced Cancer

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Abstract

Context

Symptoms and subsequent functional impairment have been associated with the biological processes of a disease, including the interaction between the disease and treatment in a measurement model of symptoms. However, hitherto cluster analysis has primarily focused on symptoms.

Objectives

This study among patients within 100 days of diagnosis with advanced cancer explored whether self-reported physical symptoms and functional impairments formed clusters at the time of diagnosis.

Methods

We applied the cluster analysis to self-reported symptoms and activities of daily living of 111 patients newly diagnosed with advanced gastrointestinal (GI), gynecological, head and neck, and lung cancers. Based on the content, expert evaluations, the best techniques, variables were identified, yielding the best solution.

Results

The best cluster solution used a K-means algorithm and cosine similarity and yielded five clusters of physical as well as emotional symptoms and functional impairments. Cancer site formed the predominant organizing principle of composition for each cluster. The top five symptoms and functional impairments in each cluster were Cluster 1 (GI): outlook, insomnia, appearance, concentration, and eating/feeding; Cluster 2 (GI): appetite, bowel, insomnia, eating/feeding, and appearance; Cluster 3 (gynecological): nausea, insomnia, eating/feeding, concentration, and pain; Cluster 4 (head and neck): dressing, eating/feeding, bathing, toileting, and walking; and Cluster 5 (lung): cough, walking, eating/feeding, breathing, and insomnia.

Conclusion

Functional impairments in patients newly diagnosed with late-stage cancers behave as symptoms during the diagnostic phase. Health care providers need to expand their assessments to include both symptoms and functional impairments. Early recognition of the functional changes may accelerate diagnosis at an earlier cancer stage.

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Figures and tables from this article:

Fig. 1. Top five symptoms and impairments in activities of daily living listed in descending order of conditional probability in each cluster.