Symptom clusters in patients with gynecologic cancer receiving chemotherapy

Rachel A. Pozzar, Marilyn J. Hammer, Bruce A. Cooper, Kord M. Kober, Lee May Chen, Steven M. Paul, Yvette P. Conley, Jon D. Levine, Christine Miaskowski

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: To describe ratings of symptom occurrence, severity, and distress for 38 symptoms and to identify and compare the number and types of symptom clusters identified using these ratings. Although patients with gynecologic cancer experience multiple co-occurring symptoms, little is known about how these symptoms cluster together. SAMPLE & SETTING: Eligible patients (N = 232) had gynecologic cancer and were receiving chemotherapy. METHODS & VARIABLES: Symptoms were assessed using the Memorial Symptom Assessment Scale. Symptom clusters were identified through exploratory factor analysis. Geomin-rotated factor loadings with absolute values of 0.3 or greater were considered meaningful. Factor solutions (i.e., symptom clusters) were assessed for simple structure and clinical relevance. RESULTS: Lack of energy, hair loss, and “I don’t look like myself” were the most common, severe, and distressing symptoms. Hormonal, respiratory, and weight change clusters were identified across all three dimensions. IMPLICATIONS FOR NURSING: Research that explores how symptom clusters change over time and their underlying mechanisms is warranted.

Original languageEnglish (US)
Pages (from-to)441-452
Number of pages12
JournalOncology nursing forum
Issue number4
StatePublished - Jul 2021


  • Chemotherapy
  • Ovarian neoplasms
  • Symptom clusters
  • Symptoms
  • Uterine neoplasms
  • Severity of Illness Index
  • Humans
  • Factor Analysis, Statistical
  • Syndrome
  • Genital Neoplasms, Female/drug therapy
  • Antineoplastic Agents/adverse effects
  • Female
  • Cluster Analysis

ASJC Scopus subject areas

  • Oncology(nursing)


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