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An update in symptom clusters using the Edmonton Symptom Assessment System in a palliative radiotherapy clinic

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Abstract

Purpose

To identify symptom clusters in advanced cancer patients attending a palliative radiotherapy clinic using the Edmonton Symptom Assessment System (ESAS).

Methods

Principal component analysis (PCA), exploratory factor analysis (EFA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the nine ESAS items using scores from each patient’s first visit.

Results

ESAS scores from 182 patients were analyzed. The PCA identified three symptom clusters (cluster 1: depression-anxiety-well-being, cluster 2: pain-tiredness-drowsiness, cluster 3: nausea-dyspnea-loss of appetite). The EFA identified two clusters (cluster 1: tiredness-drowsiness-loss of appetite-well-being-pain-nausea-dyspnea, cluster 2: depression-anxiety). The HCA identified three clusters similar to the PCA with an exception of the loss of appetite item being classified under cluster 1 rather than 3. Two to three symptom clusters were identified using three analytical methods, with similar patterns reported in the literature. Particular groups of items co-occurred consistently across all three analyses: depression and anxiety; nausea and dyspnea; as well as pain, tiredness, and drowsiness.

Conclusion

Three similar symptom clusters were identified in our patient population using the PCA and HCA; whereas, the EFA produced two clusters: one physical and one psychological cluster. Given the implications of symptom clusters in the management of quality of life, clinicians should be aware of these clusters to aid in the palliative treatment of patients.

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Acknowledgements

We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.

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Authors and Affiliations

  1. Rapid Response Radiotherapy Program, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada

    Vithusha Ganesh, Liying Zhang, Stephanie Chan, Bo Angela Wan, Leah Drost, May Tsao, Cyril Danjoux, Elizabeth Barnes, Rachel McDonald, Leigha Rowbottom, Pearl Zaki, Ronald Chow, Matthew K. Hwang, Carlo DeAngelis, Nicholas Lao & Edward Chow

  2. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Edward Chow

Authors
  1. Vithusha Ganesh
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  2. Liying Zhang
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  3. Stephanie Chan
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  4. Bo Angela Wan
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  5. Leah Drost
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  6. May Tsao
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  7. Cyril Danjoux
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  8. Elizabeth Barnes
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  9. Rachel McDonald
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  10. Leigha Rowbottom
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  11. Pearl Zaki
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  12. Ronald Chow
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  13. Matthew K. Hwang
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  14. Carlo DeAngelis
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  15. Nicholas Lao
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  16. Edward Chow
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Corresponding author

Correspondence to Edward Chow.

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The authors declare that there is no conflict of interest.

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Ganesh, V., Zhang, L., Chan, S. et al. An update in symptom clusters using the Edmonton Symptom Assessment System in a palliative radiotherapy clinic. Support Care Cancer 25, 3321–3327 (2017). https://doi.org/10.1007/s00520-017-3749-x

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  • DOI: https://doi.org/10.1007/s00520-017-3749-x

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