Visual graphical analysis helps track symptom clusters in lung cancer survivors

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NEW ORLEANS—Visual graphical analysis (VGA) can improve management of lung cancer survivors by identifying individual symptom patterns, according to research presented at the Oncology Nursing Society (ONS) 37th Annual Congress.

After treatment for lung cancer, patients experience multiple, prolonged symptoms such as difficulty swallowing, dry mouth, and pain that often cooccur. Management of symptom clusters is essential to successful recovery and improved quality of life (QOL). Although research is emerging on symptom clustering in patients being treated for lung cancer, little focus is placed on survivors and their individual symptom patterns (ISPs). Increased awareness of symptoms and symptom patterns provides new information about variations over the course of treatment and enables nurses to promptly identify patterns in order to target interventions to enhance patient outcomes.

To describe individual symptom clustering and determine the impact of clusters on factors influencing QOL, researchers at Memorial Sloan-Kettering Cancer Center, New York, NY, conducted a descriptive, longitudinal study. The study addressed ONS Research Agenda priority C, Late Effects of Cancer Treatment and Long-term Survivorship Issues, and was guided by the Theory of Unpleasant Symptoms.

Symptoms were assessed in 211 lung cancer survivors, with data collected at 1 year and 2 years after treatment completion. At both points, patients completed a bothersome symptom checklist and several self-report scales, including depression, anxiety, pain, and performance status rating. Data were analyzed using bivariate testing and multivariate model-building. Researchers sorted the ISPs a priori into pattern categories that were then independently verified by a panel of experts.

During VGA, the ISP graph of each patient was printed and then examined for similar patterns. When common patterns were identified, individual graphs were sorted into identified patterns and then sorted into categories. A mean substitution was used for any missing data.

Four different ISP categories were identified in which intense elevated levels were present at baseline and symptom resolution did not occur after treatment. In three of the patterns, symptoms did not resolve until 1 month after treatment.

One year posttreatment, 40% (n=84) of respondents reported at least two co-occurring symptoms, and 21% (n=45) had at least three co-occurring symptoms. Two years after treatment, 28% (n=60) of the sample reported at least two co-occurring symptoms, and12% (n=26) had at least three co-occurring symptoms.

At both time points, respondents with co-occurring symptoms were significantly more likely to score worse on self-reported anxiety, depression, dyspnea, fatigue, pain, and performance status scales.

“Survivors of lung cancer have significant symptoms that require attentive follow up by oncology nurses. Knowledge of these symptoms and their patterns are important in order to plan intervention-based research on symptom management for survivors of lung cancer,” the researchers concluded.

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