Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy

Claire J. Han, Kerryn Reding, Bruce A. Cooper, Steven M. Paul, Yvette P. Conley, Marilyn Hammer, Kord M. Kober, Jon D. Levine, Christine Miaskowski

Research output: Contribution to journalArticlepeer-review


Context: Limited evidence suggests that patients with gastrointestinal (GI) cancers receiving chemotherapy (CTX) experience an average of 13 co-occurring symptoms. An alternative to counting symptoms is to evaluate for symptom clusters. Objectives: In a sample of patients with GI cancers receiving CTX (n = 399), we evaluated the occurrence, severity, and distress of 38 symptoms in the week before patients' second or third cycle of CTX (Time 1 [T1]), approximately one week after CTX (Time 2 [T2]), and approximately two weeks after CTX (Time 3 [T3]); evaluated for differences in the number and types of symptom clusters at each of these three assessments using ratings of occurrence, severity, and distress; and evaluated for changes in symptom clusters over time. Methods: Modified version of the Memorial Symptom Assessment Scale collected data on 38 common symptoms. Exploratory factor analyses were used to create the symptom clusters. Results: Five distinct symptom clusters were identified across the three symptom dimensions and the three assessments (i.e., psychological, CTX-related, weight change, GI, and epithelial). Psychological, CTX-related, and weight change clusters were relatively stable across all three symptom dimensions and time. Across all three symptom dimensions, GI cluster was identified only at T1 and epithelial cluster was identified at T2 and T3. Conclusion: The number and types of symptom clusters appear to be relatively stable over time and across the symptom dimensions. Ongoing assessment and management of these clusters is warranted across the entire course of CTX. The underlying mechanism for these clusters warrants investigation.

Original languageEnglish (US)
Pages (from-to)989-1001.e10
JournalJournal of Pain and Symptom Management
Issue number6
StatePublished - Dec 2019


  • Symptoms
  • chemotherapy
  • distress
  • gastrointestinal cancer
  • occurrence
  • severity
  • symptom clusters

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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