A longitudinal analysis evaluated the subgrouping of patients with cancer by similar symptom experiences and also found that patients’ symptom experiences changed with time over the course of treatment. The analysis was conducted by Sena Chae, PhD, RN, of the College of Nursing at the University of Iowa in Iowa City, and colleagues. Results were reported in the journal Oncology Nursing Forum.

Patients with cancer may experience clusters of co-occurring symptoms, which can affect function and quality of life. To provide the most suitable and effective interventions for managing symptoms in accordance with National Institute of Nursing Research goals, “there is a need to identify subgroups of patients based on symptom experiences over time,” Dr Chae and colleagues explained in their report.

In this analysis, the researchers had 2 main goals. One was to identify descriptions in the literature of patient subgroups based on similar symptom experiences and patients’ symptom changes over time. The other was to describe the methodologies of longitudinal studies in which patients were categorized by similar experiences of symptoms.

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The researchers conducted literature searches of the PubMed, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases for articles dated from database inception through January 2019. They searched for combinations of multiple terms related to signs and symptoms, cancer, patterns, and time, among other similar terms. Inclusion criteria included the studies involved patients of any age with cancer diagnoses and needed to describe patient subgroupings by experiences with established symptom clusters.

Eleven studies were included in the analysis, all of which had been published after 2010. The number of symptoms examined within the studies ranged from 2 to 30. Pain and sleep disturbance were the most commonly evaluated symptoms. In studies focused on primary cancer sites, the most common sites were the breast (36%) and the lung (18%).

Overall, 91% of the studies reported that symptom experiences changed over the course of treatment trajectories in patients with cancer. Symptom clusters varied by cancer diagnosis, patient age, and treatment; and symptom patterns over time varied by patient subgroups. Numbers of patient subgroupings identified in studies also varied, ranging from 2 to 5.

In terms of methodologies, the researchers found that most studies (73%) clustered patients using latent-variable modeling approaches. Also, each of the included studies had prospectively obtained data on symptoms through surveys, rather than through routinely collected health data.

“Clinicians can be informed which patients have a high risk of severe symptom burden over time compared to other groups of patients and can plan treatments and symptom management based on this knowledge,” Dr Chae and colleagues stated in their report. They also concluded that there is variability in the literature regarding methodologies, in addition to a lack of consensus on how to categorize patients based on similar experiences of symptoms.


Chae S, Cherwin C, Street WN, Moorhead S, Brown G, Gilbertson-White S. Longitudinal subgrouping of patients with cancer based on symptom experiences: an integrative review. Oncol Nurs Forum. 2022;49(4):E17-E30. doi:10.1188/22.ONF.E17-E30