J Korean Acad Nurs.  2009 Oct;39(5):683-692. 10.4040/jkan.2009.39.5.683.

Identification and Validation of Symptom Clusters in Patients with Hepatocellular Carcinoma

• Cho MS
• Kwon IG
• Kim HS
• Kim K
• Ryu E

• KMID: 820245
• DOI: http://doi.org/10.4040/jkan.2009.39.5.683

Abstract

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.

Keyword

Symptom; Cluster; Hepatocellular carcinoma

MeSH Terms

Adult
Aged
Anxiety
Carcinoma, Hepatocellular/diagnosis/*psychology/secondary
Checklist
Cluster Analysis
Cross-Sectional Studies
Demography
Depression
Fatigue
Female
Humans
Liver Function Tests
Liver Neoplasms/diagnosis/*psychology
Male
Middle Aged
Severity of Illness Index

Reference

1. Armstrong TS, Cohen MZ, Eriksen LR, Hickey JV. Symptom clusters in oncology patients and implications for symptom research in people with primary brain tumors. Journal of Nursing Scholarship. 2004. 36:197–206.

2. Baeg SU. The choice of hepatocellular cancer treatment. Korean Journal of Hepatology. 2002. 8:E57–E65.

3. Barsevick AM. The elusive concept of the symptom cluster. Oncology Nursing Forum. 2007. 34:971–980.

4. Barsevick AM, Whitmer K, Sweeney C, Nail N. A pilot study examining energy conservation for cancer treatment related fatigue. Cancer Nursing. 2002. 25:333–341.

5. Bender CM, Ergun FS, Rosenzweig MQ, Cohen SM, Sereika SM. Symptom clusters in breast cancer across 3 phases of the disease. Cancer Nursing. 2005. 28:219–225.

6. Cancer Statistics. National Cancer Information Center. 2008. 11. 13. Retrieved February 20, 2009. from http://www.cancer.go.kr/cms/index.html.

7. Chen ML, Tseng HC. Symptom clusters in cancer patients. Support Care Cancer. 2006. 14:825–830.

8. Chun NM, Kwon JY, Noh GO, Kim SH. Symptom clusters in women with gynecologic cancer. Journal of Korean Clinical Nursing Research. 2008. 14:61–70.

9. Dodd MJ, Miaskowski C, Paul S. Symptom clusters and their effects on the functional status of patients with cancer. Oncology Nursing Forum. 2001. 28:465–470.

10. Gaston-Johansson F, Fall-Dickson JM, Nanda J, Ohly KV, Stillman S, Krumm S. The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. Cancer Nursing. 2000. 23:277–285.

11. Ghany M, Hoofnagle JH. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Approach to the patient with liver disease. Harrison's principles of internal medicine. 2008. New York, NY: McGraw-Hill Companies;1918–1923.

12. Glover J, Dibble SL, Dodd MJ, Miaskowski C. Mood states of oncology outpatients: Does pain make a difference? Journal of Pain and Symptom Management. 1995. 10:120–128.

13. Honea N, Brant J, Beck SL. Treatment related symptom clusters. Seminars in Oncology Nursing. 2007. 23:142–151.

14. Hwang SS, Chang VT, Kasimis BS. A comparison of three fatigue measures in veterans with cancer. Cancer Investigation. 2003. 21:363–373.

15. Kim H, Lee KH, Kim JC, Chung HY, Yoo HJ, Lee J, et al. Development and validation of Korean Functional Assessment Cancer Therapy-General (FACT-G). The Korean Journal of Clinical Psychology. 2003. 22:215–229.

16. Kim JR. Gastroenterologic disease. 2000. Seoul: Ilchokak.

17. Lang CA, Conrad S, Garrett L, Battistutta D, Cooksley WG, Dunne MP, et al. Symptom prevalence and clustering of symptoms in people living with chronic hepatitis C infection. Journal of Pain and Symptom Management. 2006. 31:335–344.

18. Mundfrom DJ, Shaw DG, Ke TL. Minimum sample size recommendations for conducting factor analyses. International Journal of Testing. 2005. 5:159–168.

19. Sun V, Ferrell B, Juarez G, Wagman LD, Yen Y, Chung V. Symptom concerns and quality of life in hepatobiliary cancers. Oncology Nursing Forum. 2008. 35(3):E45–E52.

20. Sun VC, Sarna L. Symptom management in hepatocellular carcinoma. Clinical Journal of Oncology Nursing. 2008. 12:759–766.

21. Walsh D, Rybicki L. Symptom clustering in advanced cancer. Support Care Cancer. 2006. 14:831–836.

2. Wang SY, Tsai CM, Chen BC, Lin CH, Lin CC. Symptom clusters and relationships to symptom interferences with daily life in Taiwanese lung cancer patients. Journal of Pain and Symptom Management. 2008. 35:258–266.

23. Yount S, Cella D, Webster K, Heffernan N, Chang CH, Odom L, et al. Assessment of patient-reported clinical outcome in pancreatic and other hepatobiliary cancers: The FACT hepatobiliary symptom index. Journal of Pain and Symptom Management. 2002. 24:32–44.

24. Zhu AX. Hepatocellular carcinoma: Are we making progress? Cancer Investigation. 2003. 21:418–428.

25. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta psychiatrica Scandinavica. 1983. 67:361–370.

26. Zubrod CG, Scheiderman MA, Frei E, Brindley C, Lennard G, Shnider B, et al. Appraisal of methods for the study of chemotherapy in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. Journal of Chronic Diseases. 1960. 11:7–33.