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Symptom Clusters in Ovarian Cancer Patients With Chemotherapy After Surgery

A Longitudinal Survey

Huang, Juan MD; Gu, Liyan MD; Zhang, Lingjuan PhD; Lu, Xiaoying MD; Zhuang, Wei MD; Yang, Yan PhD(c), MS

doi: 10.1097/NCC.0000000000000252

Background: Ovarian cancer is 1 of the most common malignancies in the female reproductive system. Identification of symptom clusters in ovarian cancer patients may improve management of symptoms.

Objective: The objective of this article is to explore the changes in symptom clusters in ovarian cancer patients with adjuvant chemotherapy after surgery at different time points.

Methods: Basic details of the patients were documented and a longitudinal investigation was carried out. We used the Memorial Symptom Assessment Scale to examine 115 Chinese ovarian cancer patients’ symptom experience at 4 time points: days before chemotherapy (T1), chemotherapy cycle 1 (T2), chemotherapy cycle 3 (T3), and chemotherapy cycle 6 (T4). The exploratory factor analysis was performed to determine the numbers and components of symptom clusters.

Results: Symptom clusters varied at different time points, which were classified as pain-related symptom cluster, psychological symptom cluster, menopausal symptom cluster, gastrointestinal symptom cluster, body image symptom cluster, and peripheral neurologic symptom cluster. The gastrointestinal symptom cluster and body image symptom cluster appeared at T1 and remained consistent at T3 and T4, whereas the peripheral neurologic symptom cluster was noted at T3 and T4.

Conclusions: Clinicians should prioritize symptom management interventions with ovarian cancer patients to focus on the most severe symptom cluster: psychological symptom cluster at T1, gastrointestinal symptom cluster at T2, and body image symptom cluster at T3 and T4.

Implications for Practice: The ability to predict symptom clusters in ovarian cancer patients receiving chemotherapy may help to make optimized clinical decision in advance to alleviate patients’ symptoms and improve their life quality.

Author Affiliations: Department of Nursing, Changhai Hospital affiliated to Second Military Medical University (Drs Huang, Gu, Zhang, and Lu); Department of Nursing, Shanghai First Maternity & Infant Health Hospital affiliated to Tongji University (Dr Zhuang); Department of Nursing, Renji Hospital affiliated to Shanghai Jiaotong University, Shanghai, China (Ms Yang).

Author contributions: Juan Huang, Liyan Gu, and Xiaoying Lu contributed equally to this work and should be regarded as co-first authors.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Lingjuan Zhang, PhD, Department of Nursing, Changhai Hospital affiliated to Second Military Medical University, No. 168 Changhai Road, Shanghai 200433, China (

Accepted for publication January 22, 2015.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved