Supportive Care in Cancer

, Volume 18, Issue 3, pp 335–342

Exploration of symptoms clusters within cancer patients with brain metastases using the Spitzer Quality of Life Index

  • Amanda Hird
  • Jennifer Wong
  • Liying Zhang
  • May Tsao
  • Elizabeth Barnes
  • Cyril Danjoux
  • Edward Chow
Original Article

DOI: 10.1007/s00520-009-0657-8

Cite this article as:
Hird, A., Wong, J., Zhang, L. et al. Support Care Cancer (2010) 18: 335. doi:10.1007/s00520-009-0657-8

Abstract

Purpose

Advanced cancer patients can experience many concurrent symptoms. It has been suggested that certain symptoms can cluster together and have a synergistic effect on patient morbidity. The objective of this study was to explore the presence of symptom clusters in patients with brain metastases treated with whole brain radiotherapy (WBRT).

Materials and methods

Patients with brain metastases were asked to rate their symptoms and quality of life (QOL) using the Spitzer Quality of Life Index (SQLI) and a study-designed 17-item symptom questionnaire. Utilizing a principal component analysis, the SQLI and symptoms were analyzed for the presence of symptom clusters. The Cronbach’s alpha statistic was used to estimate the internal consistency and reliability of the derived clusters. Follow-up was carried out at baseline and 1, 2 and 3 months following WBRT.

Results

Between August 2005 to October 2007, 129 patients with brain metastases were enrolled. Analysis of the SQLI items revealed two clusters. Cluster 1 consisted of activity, daily living and health, while cluster 2 consisted of support and outlook. Cronbach’s alpha was 0.69 and 0.40, respectively, for the two clusters, which accounted for 64% of the total variance. Analysis of the 17 additional symptoms revealed three clusters at baseline. These clusters changed slightly over time, but certain symptoms appeared to remain together: (1) trouble concentrating and confusion, (2) memory loss and decreased alertness, (3) nausea and vomiting, (4) numbness and weakness, and (5) dizziness and headache. These clusters persisted despite WBRT.

Conclusion

Symptom clusters exist in patients with brain metastases. Although the clusters varied over time, they did not weaken or disintegrate following WBRT, suggesting the latter one may not significantly improve the QOL and symptom distress in this group.

Keywords

Brain metastasesRadiotherapySymptom cluster

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Amanda Hird
    • 1
  • Jennifer Wong
    • 1
  • Liying Zhang
    • 1
  • May Tsao
    • 1
  • Elizabeth Barnes
    • 1
  • Cyril Danjoux
    • 1
  • Edward Chow
    • 1
  1. 1.Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada