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Comparison of Groups With Different Patterns of Symptom Cluster Intensity Across the Breast Cancer Treatment Trajectory

Kim, Hee-Ju PhD, RN, OCN; McDermott, Paul A. PhD; Barsevick, Andrea M. PhD, RN, AOCN, FAAN

doi: 10.1097/NCC.0b013e31828293e0

Background: Comparing subgroups with different patterns of change in symptom intensity would assist in sorting out individuals at risk for more severe symptoms and worse functional outcomes.

Objectives: The objectives of this study were to identify and compare subgroups of breast cancer patients with different patterns of change in a psychoneurological symptom cluster intensity across the treatment trajectory.

Methods: This secondary analysis used the data from 160 breast cancer patients undergoing chemotherapy or radiation treatment. Psychoneurological symptom cluster intensity was a composite score of 5 symptoms (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) in a psychoneurological cluster at each of 3 time points (ie, at baseline and at 2 follow-ups after chemotherapy or radiation treatment).

Results: Five distinct subgroups representing different patterns of psychoneurological symptom cluster intensity during breast cancer treatment were identified: the gradually increasing pattern subgroup (group 1), the constantly low pattern subgroup (group 2), the start low with dramatic increase and decrease pattern subgroup (group 3), the constantly high pattern subgroup (group 4), and the start high with dramatic decrease and leveling pattern subgroup (group 5). Patients without previous cancer treatment experience, with higher level of education, treated with chemotherapy, and/or with more limitations at the baseline were more likely to follow the pattern group 4. Patients in group 4 had the most serious functional limitations measured at the second follow-up time point.

Conclusion: The results suggest the need to evaluate interventions for specific subgroups and to examine the causal mechanisms underlying a psychoneurological symptom cluster.

Implication: Clinicians should consider these diverse symptom experiences for assessment/management.

Author Affiliations: College of Nursing, Catholic University of Korea, Seoul, Republic of Korea (Dr Kim); Graduate School of Education, University of Pennsylvania, Philadelphia (Dr McDermott); and Department of Medical Oncology, Thomas Jefferson University (Dr Barsevick), Philadelphia, Pennsylvania.

The primary study was supported by the National Institutes of Health–National Institute of Nursing Research (R01NR04573). The present study was supported by Sigma Theta Tau International, the Oncology Nursing Society Foundation, and Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2012R1A1A1009672).

The authors have no conflicts of interest to disclose.

Correspondence: Hee-Ju Kim, PhD, RN, OCN, 505 Banpo Dong, Seo-Cho-Gu, Catholic University of Korea, College of Nursing, Seoul, Republic of Korea (

Accepted for publication December 3, 2012.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins