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Symptom Cluster Analyses Based on Symptom Occurrence and Severity Ratings Among Pediatric Oncology Patients During Myelosuppressive Chemotherapy

Baggott, Christina PhD, RN, CPON; Cooper, Bruce A. PhD; Marina, Neyssa MD; Matthay, Katherine K. MD; Miaskowski, Christine PhD, RN, FAAN

doi: 10.1097/NCC.0b013e31822909fd

Background: Symptom cluster research is an emerging field in symptom management. The ability to identify symptom clusters that are specific to pediatric oncology patients may lead to improved understanding of symptoms’ underlying mechanisms among patients of all ages.

Objective: The purpose of this study, in a sample of children and adolescents with cancer who underwent a cycle of myelosuppressive chemotherapy, was to compare the number and types of symptom clusters identified using patients’ ratings of symptom occurrence and symptom severity.

Methods: Children and adolescents with cancer (10–18 years of age; N = 131) completed the Memorial Symptom Assessment Scale 10–18 on the day they started a cycle of myelosuppressive chemotherapy, using a 1-week recall of experiences. Symptom data based on occurrence and severity ratings were examined using exploratory factor analysis. The defined measurement model suggested by the best exploratory factor analysis model was then examined with a latent variable analysis.

Results: Three clusters were identified when symptom occurrence ratings were evaluated, which were classified as a chemotherapy sequela cluster, mood disturbance cluster, and a neuropsychological discomfort cluster. Analysis of symptom severity ratings yielded similar cluster configurations.

Conclusions: Cluster configurations remained relatively stable between symptom occurrence and severity ratings. The evaluation of patients at a common point in the chemotherapy cycle may have contributed to these findings.

Implications for Practice: Additional uniformity in symptom clusters investigations is needed to allow appropriate comparisons among studies. The dissemination of symptom cluster research methodology through publication and presentation may promote uniformity in this field.

Author Affiliations: Department of Physiological Nursing (Drs Baggott and Miaskowski) and Office of Research, School of Nursing (Dr Cooper), University of California, San Francisco; Department of Pediatrics, Stanford University, Palo Alto, California (Dr Marina); and Department of Pediatrics, University of California, San Francisco (Dr Matthay).

This research was supported by National Institute of Nursing Research (NR010600). Dr Baggott received funding from an American Cancer Society Doctoral Degree Scholarship in Cancer Nursing, the Betty Irene Moore Doctoral Fellowship in Nursing, and an Oncology Nursing Foundation Doctoral Scholarship in Nursing. Drs Baggott and Miaskowski are supported by a P30 Training Grant; Dr Miaskowski is funded by the American Cancer Society as a clinical research professor.

The authors declare no conflicts of interest.

Correspondence: Christina Baggott, PhD, RN, CPON, Department of Physiological Nursing; University of California San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610 (

Accepted for publication June 13, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.