ONS Connections: Symptom clusters identified in patients with head and neck cancer after chemotherapy

PHOENIX—Two clusters of symptoms, one specific to head and neck cancer (HNC) and one related to gastrointestinal symptoms, were identified in patients with HNC. The research was presented at the Oncology Nursing Society (ONS) Connections: Advancing Care Through Science conference.

Symptoms that are related to each other are grouped together as a cluster, and, when compared with single symptoms, a cluster has synergistic effects on the quality of life of patients. Though patients with HNC have multiple concurrent treatment-related symptoms, no published studies had examined symptom clusters in HNC patients. This study sought to identify symptom clusters and how those clusters are generalizable over time and in different patient subsets for HNC patients after chemotherapy.

This study analyzed data from 684 HNC patients who had received combined chemoradiation to identify clusters. Clinicians measured symptoms at three time points. The time points were T1, at the end of the first cycle of chemotherapy; T2, at the end of the second cycle of chemotherapy; and T3, three months after the start of radiotherapy. Symptoms were measured with the National Cancer Institute Common Toxicity Criteria v2.0. Also, symptom clusters were identified by exploratory factor analysis, which was verified by confirmatory factor analysis.

The research team identified two clusters, the HNC-specific cluster and the gastrointestinal cluster. The HNC-specific cluster was made up of radiodermatitis, dysphagia, radiomucositis, dry mouth, pain, taste disturbance, and fatigue. The gastrointestinal cluster was composed of nausea, vomiting, and dehydration.

When the analysis made exceptions for patients age 65 years and older, those diagnosed with larynx cancer, or those with stage III cancer, the two clusters were generalizable to different subgroups. These subgroups were defined by age, gender, race, education, marriage, histories of tobacco use, treatments, primary sites, disease stages, and tube feedings, along with the three symptom assessment time points.

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