• Asian Oncology Nursing
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• v.9 no.2
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• pp.77-85
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• 2009

Purpose: The purpose of this study was to identify symptom cluster experienced by patients with advanced non-small cell lung cancer (NSCLC) on gefitinib treatment. In addition, this study assessed the patterns in severity of the symptom cluster and differences in quality of life (QOL) and function among subgroups by the severity of symptom cluster. Methods: This study was conducted as a secondary analysis of symptoms of 72 patients from a mother study. Factor analysis was used to identify symptom clusters measured with EORTC QLQ-C30 and LC13 symptom related items. Results: Three symptom clusters were identified: cluster 1 was comprised of fatigue, anorexia and dysphagia; cluster 2 of dyspnea, cough and insomnia; and cluster 3 of pain, constipation and nausea/vomiting. These three symptom clusters were improved one week after gefitinib administration. The group with more severe symptom clusters showed significantly lower QOL and function than the group with less severe symptom clusters. Conclusion: Since symptom clusters experienced by the patients with advanced NSCLC influenced on the QOL and function, it is important for nurses to understand and observe their symptom clusters. In addition, there is an necessity to develop nursing interventions to effectively care patients with the symptom clusters.

• Journal of Korean Clinical Nursing Research
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• v.20 no.1
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• pp.123-133
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• 2014

Purpose: The purpose of the study was to investigate symptom clusters experienced by patients on hemodialysis and to identify relations between symptom clusters and quality of life. Methods: Data were collected from 127 patients at 10 local hemodialysis clinics. Symptoms were measured using 10-item physical symptom checklist as well as the Hospital Anxiety depression Scale. Quality of life was measured with the Satisfaction with Life Scale. Data were analyzed using factor analysis, Pearson correlation, and stepwise multiple regression. Results: The most frequently reported symptoms included fatigue, itching, depression, numbness/tingling, and insomnia. Four distinct symptom clusters were identified: cluster 1 was comprised of dry mouth, headache, nausea (gastrointestinal); cluster 2 of decreased appetite, insomnia (basic need); cluster 3 of itching, numbness/tingling (sensory-comfort); and cluster 4 of fatigue, depression (mood-vitality). Among the clusters, the 'basic need' cluster and 'mood-vitality' cluster had a significant negative association with quality of life. The 'mood-vitality' cluster, explained 17.4% of the variance in quality of life. Conclusion: The results of the study indicate that comprehensive symptom assessment provides better symptom management for patients on hemodialysis. Further studies are needed to verify symptom clusters identified in this study.

• Journal of Korean Clinical Nursing Research
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• v.14 no.1
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• pp.61-70
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• 2008

Purpose: Women with gynecologic cancer often experience various physical and psychological symptoms relating to the cancer and its treatment. The purpose of this study was to identify symptom clusters. Method: A survey was conducted on 184 women with diagnoses of cervical, ovarian or endometrial cancer. Fifty symptoms were assessed for prevalence, severity and interference, and symptom clusters were identified. Cluster analysis was done using SPSS version 12.0. Results: Fatigue was identified as the most prevalent symptom (81.52%), lack of vaginal lubrication (2.26) as the most severe symptom, and lack of vaginal lubrication as the most interfering one (2.15). Identified six clusters were: Anorexia-pain cluster (loss of appetite, taste change, weight loss, appearance change, alopecia, weakness, pain), Fatigue cluster (lack of concentration, lack of memory, fatigue, dry mouth), Urinary-bowel distress cluster (urinary difficulty, constipation), Abdominal discomfort cluster (lower abdominal pain, abdominal pain, bloating), Emotional distress (sadness, anxiety-worry, nervousness, restlessness), and Menopausal cluster (sweating, hot flush, fever). Conclusion: The result of this study provides fundamental data to health care professionals in developing interventions for effective symptom management for women with gynecologic cancer by understanding identified 6 symptom clusters.

• Korean Journal of Adult Nursing
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• v.21 no.6
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• pp.705-717
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• 2009

Purpose: The purpose of this study was to identify symptom clusters in patients with breast cancer and to investigate the associations among them with functional status and quality of life (QOL). Methods: A convenient sample of 303 patients was recruited from an oncology-specialized hospital. Results: Two distinct clusters were identified: A gastrointestinal- fatigue cluster and a pain cluster. Each cluster significantly influenced functional status and QOL. Based on these two clusters, we identified subgroups of symptom clusters using K-means cluster analysis. Three relatively distinct patient subgroups were identified in each cluster: mild, moderate, and severe group. Disease-related factors (i.e., stage, metastasis, type of surgery, current chemotherapy, and anti-hormone therapy) were associated with these subgroups of symptom clusters. There were significant differences in functional status and QOL among the three subgroups. The subgroup of patients who reported high levels of symptom clusters reported poorer functional status and QOL. Conclusion: Clinicians can anticipate that breast cancer patients with advanced stage, metastasis, and who receive mastectomy, and chemotherapy will have more intense gastrointestinal-fatigue or pain symptoms. In order to enhance functional status and QOL for patients with breast cancer, collective management for symptoms in a cluster may be beneficial.

• Korean Journal of Adult Nursing
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• v.23 no.5
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• pp.434-445
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• 2011

Purpose: This study was conducted to identify the impact of the symptom cluster of pain, fatigue, sleep disturbance, depression on the quality of life (QOL) among breast cancer patients receiving chemotherapy. Methods: One hundred and thirteen patients were recruited from five hospitals in Korea. The instruments used in this study were the fatigue, depression, sleep disturbance, pain and the quality of life scale for patients with breast cancer. The influence of the symptom cluster on patients' QOL was analyzed by using multiple regression. Results: Most patients reported a moderate level of pain, fatigue, sleep disturbance and depression. Eighty percent of patients reported three of the four symptoms. Among the four symptoms, there was no correlation between pain and sleep disturbance. Quality of life was negative correlated with the four symptoms in the cluster. Symptom cluster of pain, fatigue, and depression accounted for 51.2% of variance in QOL. Conclusion: The findings supported that there is a symptom cluster that negatively influences quality of life and needs to be addressed as we are caring for patients and are promoting quality of life.

• Journal of Korean Academy of Nursing
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• v.39 no.5
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• pp.683-692
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• 2009

Purpose: The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma. Methods: This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters. Results: Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression. Conclusion: Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.

• Journal of Korean Clinical Nursing Research
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• v.23 no.1
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• pp.20-29
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• 2017

Purpose: The purpose of this study was to investigate symptoms experienced by patients who reported fever at the emergency room (ER) and to identify any existing cluster of symptom related to fever. Methods: The study used a retrospective and descriptive design with secondary data analysis. Data were abstracted from 665 medical records of patients with fever who visited ER from September 1, 2015 to August 31, 2016 at a tertiary hospital. Results: The most frequently reported symptoms included cold (43.9%), myalgia (24.1%), headache (16.2%), general weakness (15.3%), respiratory symptoms (12.3%), gastrointestinal (GI) symptoms (12.0%), mental change (4.5%), sweating(1.8%), and warmth (0.9%). Analysis of the symptoms related to fever revealed seven symptom clusters; Cluster 1 (n=190) included cold (100%) and myalgia (28.9%); Cluster 2 (n=37), headache (100%) and myalgia (32.4%); Cluster 3 (n=33), GI symptoms (100%), general weakness, headache, and cold; Cluster 4 (n=34), cold (100%), myalgia, headache, and respiratory symptoms; Cluster 5 (n=241), respiratory symptoms (10.8%); Cluster 6 (n=76): myalgia (75.0%) and general weakness, and Cluster 7 (n=54), cold (87.0%), general weakness, and respiratory symptoms. Conclusion: The results of this comprehensive symptom assessment are hoped to be helpful in developing better symptom management for ER patients with fever than before. Further research is warranted to verify the symptom clusters of this study in different clinical settings.

• Journal of Korean Academy of Nursing
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• v.45 no.3
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• pp.378-387
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• 2015

Purpose: Acute myocardial infarction (AMI) leads to death if the patient does not receive emergency treatment. Thus it is very important to recognize the symptoms in the early stage. The purpose of this study was to identify clusters of symptoms that represent AMI in Koreans. Methods: The study used a retrospective, descriptive design with secondary data analysis. Data were abstracted from 725 medical records of AMI patients admitted from June 1, 2006 to August 15, 2014 at a university hospital. Results: Analysis of the AMI symptoms revealed five symptom clusters; Cluster 1 (n=140): middle chest pain (100%), shortness of breath, and cold sweating, Cluster 2 (n=256): substernal pain (100%), cold sweating, and shortness of breath, Cluster 3 (n=47): substernal pain (95.7%), left arm pain, shortness of breath, cold sweating, left shoulder pain, right arm pain, and the lower neck pain, Cluster 4 (n=212): shortness of breath (28.3%), left chest pain, and upper abdominal pain, and Cluster 5 (n=70): cold sweating (100%), left chest pain, shortness of breath, left shoulder pain, and upper abdominal pain. Length of hospital stay and mortality rate were significantly different according to symptom clusters (F=2.52, p =.040; F=3.62, p =.006, respectively). Conclusion: Symptom clusters of AMI from this study can be used for AMI patients in order to recognize their symptoms at an early stage. The study findings should be considered when developing educational prevention programs for Koreans with AMI.

• Asian Oncology Nursing
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• v.12 no.1
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• pp.84-91
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• 2012

Purpose: The purpose of this study was to identify relationships between quality of sleep, symptom cluster, depression, environmental disorder, and quality of life among hospitalized cancer patients. Methods: The subjects were 114 patients who underwent chemotherapy for colon cancer, gastric cancer, gynecologic cancer and breast cancer. They were recruited from the cancer center of a university hospital. Data were collected from August 4th to 30th, 2011. The questionnaires included the Korean sleep scale A (quality of sleep), MDASI-K (symptom cluster), the environmental sleep disturbing scale, Zung's depression scale, and the Korean version of EORTC QLQ-C30. The collected data was analyzed by t-test, ANOVA, multiple regression analysis using the SPSS 19.0 program. Results: Functional QOL was negatively associated with symptom QOL (r=-.798, p<.001). Symptom cluster, depression, & spouse (46.3%) were the most powerful predictors for functional QOL (46.3%) and symptom QOL (53.4%). Conclusion: It is evident that oncology nurses need to evaluate two dimensions of quality of life for cancer patients, for example, functional and symptom QOL. We recommend nurses develop specific protocols for relieving physical symptoms and alleviating depression, and furthermore test the effectiveness of them.

• Journal of Hospice and Palliative Care
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• v.16 no.3
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• pp.139-144
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• 2013

Advanced cancer patients tend to present multiple concurrent symptoms which are often moderate or severe in intensity. To date, the majority of studies have focused on either a single symptom, such as pain, fatigue, or depression or associated symptoms. While this approach has advanced understanding of some symptoms, it has offered clinicians not much guidance for treating several multiple concurrent symptoms in cancer patients. So in recent years, a few symptom management studies attempted a new approach of focusing on symptom clusters instead of individual symptoms. A symptom cluster is defined as two or more concurrent symptoms that are related to each other. If we better understand symptom clusters, interrelations of symptoms, and their common mechanisms in advanced cancer patients, clinicians can more effectively control multiple, concurrent symptoms and reduce drug side effects. And clinicians can also predict any other symptoms, functional performance, and the relationship between symptom clusters and survival in advanced cancer patients. At present, there is inconsistency in symptom clusters due to many unexplained mechanisms and various means to assess and analyze symptoms. Still, with further study, the approach to symptom clusters rather than individual symptoms could more effectively control symptoms and improve patients' quality of life.