Identification and Validation of Symptom Clusters in Patients with Hepatocellular Carcinoma

Cho, Myung Sook; Kwon, In Gak; Kim, Hee Sun; Kim, Kyunghee; Ryu, Eunjung

doi:10.4040/jkan.2009.39.5.683

J Korean Acad Nurs. 2009 Oct;39(5):683-692. Korean.
Published online Oct 31, 2009.
https://doi.org/10.4040/jkan.2009.39.5.683

Original Article

Identification and Validation of Symptom Clusters in Patients with Hepatocellular Carcinoma

Myung Sook Cho,¹ In Gak Kwon,¹ Hee Sun Kim,² Kyunghee Kim,³ and Eunjung Ryu⁴

Author information

Author notes

Copyright and License

- ¹Associate Professor, Department of Clinical Nursing Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- ²Unit Manager, Department of Nursing, Samsung Medical Center, Seoul, Korea.
- ³Professor, Department of Nursing, Chung-Ang University, Seoul, Korea.
- ⁴Professor, Department of Nursing, Konkuk University, Chungju, Korea.
Address reprint requests to: Kwon, In Gak. Department of Clinical Nursing Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: 82-2-3410-2904, Fax: 82-2-3410-6616, Email: ingak.kwon@samsung.com

Received March 04, 2009; Accepted September 17, 2009.

Abstract

Purpose

The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma.

Methods

This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters.

Results

Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression.

Conclusion

Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.

Keywords

Symptom; Cluster; Hepatocellular carcinoma

Tables

Table 1
Characteristics of Participants (N=194)

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Table 2
Symptom Prevalence and Severity (N=194)

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Table 3
Factor Matrix for the Four-factor Model (N=194)

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Table 4
Correlations Matrix among Factors (N=194)

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Table 5
Symptom Scores of Factors by Performance Status and Liver Function (N=194)

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Table 6
Symptom Scores of Factors by Anxiety and Depression (N=194)

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References

1. Armstrong TS, Cohen MZ, Eriksen LR, Hickey JV. Symptom clusters in oncology patients and implications for symptom research in people with primary brain tumors. Journal of Nursing Scholarship 2004;36:197–206.
1. Baeg SU. The choice of hepatocellular cancer treatment. Korean Journal of Hepatology 2002;8:E57–E65.
1. Barsevick AM. The elusive concept of the symptom cluster. Oncology Nursing Forum 2007;34:971–980.
1. Barsevick AM, Whitmer K, Sweeney C, Nail N. A pilot study examining energy conservation for cancer treatment related fatigue. Cancer Nursing 2002;25:333–341.
1. Bender CM, Ergun FS, Rosenzweig MQ, Cohen SM, Sereika SM. Symptom clusters in breast cancer across 3 phases of the disease. Cancer Nursing 2005;28:219–225.
1. Cancer Statistics. National Cancer Information Center. 2008 Nov 13 [Retrieved February 20, 2009].
  from http://www.cancer.go.kr/cms/index.html.
1. Chen ML, Tseng HC. Symptom clusters in cancer patients. Support Care Cancer 2006;14:825–830.
  PubMed
  
  CrossRef
1. Chun NM, Kwon JY, Noh GO, Kim SH. Symptom clusters in women with gynecologic cancer. Journal of Korean Clinical Nursing Research 2008;14:61–70.
1. Dodd MJ, Miaskowski C, Paul S. Symptom clusters and their effects on the functional status of patients with cancer. Oncology Nursing Forum 2001;28:465–470.
1. Gaston-Johansson F, Fall-Dickson JM, Nanda J, Ohly KV, Stillman S, Krumm S. The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. Cancer Nursing 2000;23:277–285.
1. Ghany M, Hoofnagle JH. Approach to the patient with liver disease. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison's principles of internal medicine. New York, NY: McGraw-Hill Companies; 2008. pp. 1918-1923.
1. Glover J, Dibble SL, Dodd MJ, Miaskowski C. Mood states of oncology outpatients: Does pain make a difference? Journal of Pain and Symptom Management 1995;10:120–128.
1. Honea N, Brant J, Beck SL. Treatment related symptom clusters. Seminars in Oncology Nursing 2007;23:142–151.
1. Hwang SS, Chang VT, Kasimis BS. A comparison of three fatigue measures in veterans with cancer. Cancer Investigation 2003;21:363–373.
1. Kim H, Lee KH, Kim JC, Chung HY, Yoo HJ, Lee J, et al. Development and validation of Korean Functional Assessment Cancer Therapy-General (FACT-G). The Korean Journal of Clinical Psychology 2003;22:215–229.
1. Kim JR. In: Gastroenterologic disease. Seoul: Ilchokak; 2000.
1. Lang CA, Conrad S, Garrett L, Battistutta D, Cooksley WG, Dunne MP, et al. Symptom prevalence and clustering of symptoms in people living with chronic hepatitis C infection. Journal of Pain and Symptom Management 2006;31:335–344.
1. Mundfrom DJ, Shaw DG, Ke TL. Minimum sample size recommendations for conducting factor analyses. International Journal of Testing 2005;5:159–168.
1. Sun V, Ferrell B, Juarez G, Wagman LD, Yen Y, Chung V. Symptom concerns and quality of life in hepatobiliary cancers. Oncology Nursing Forum 2008;35(3):E45–E52.
1. Sun VC, Sarna L. Symptom management in hepatocellular carcinoma. Clinical Journal of Oncology Nursing 2008;12:759–766.
1. Walsh D, Rybicki L. Symptom clustering in advanced cancer. Support Care Cancer 2006;14:831–836.
  PubMed
  
  CrossRef
1. Wang SY, Tsai CM, Chen BC, Lin CH, Lin CC. Symptom clusters and relationships to symptom interferences with daily life in Taiwanese lung cancer patients. Journal of Pain and Symptom Management 2008;35:258–266.
1. Yount S, Cella D, Webster K, Heffernan N, Chang CH, Odom L, et al. Assessment of patient-reported clinical outcome in pancreatic and other hepatobiliary cancers: The FACT hepatobiliary symptom index. Journal of Pain and Symptom Management 2002;24:32–44.
1. Zhu AX. Hepatocellular carcinoma: Are we making progress? Cancer Investigation 2003;21:418–428.
1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta psychiatrica Scandinavica 1983;67:361–370.
  PubMed
  
  CrossRef
1. Zubrod CG, Scheiderman MA, Frei E, Brindley C, Lennard G, Shnider B, et al. Appraisal of methods for the study of chemotherapy in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. Journal of Chronic Diseases 1960;11:7–33.