Article

Symptom Clusters and Quality of Life in Older Adult Breast Cancer Survivors

Rachel A. Roiland

Susan M. Heidrich

breast neoplasms, geriatric nursing, health-related quality of life
ONF 2011, 38(6), 672-680. DOI: 10.1188/11.ONF.672-680

Purpose/Objectives: To identify symptom clusters in older adult breast cancer survivors (ages 65-97 years) and examine whether symptom clusters are related to demographic, health, and quality-of-life variables.

Design: Factor analysis to identify possible symptom clusters. The resulting clusters then were correlated with quality-of-life measures.

Setting: Phone interviews between the participants and a trained research nurse. Sample: 192 breast cancer survivors (X age = 70).

Methods: This was a secondary data analysis of the baseline measures of demographics, health history, symptom bother, and physical, mental, and existential dimensions of quality of life. Exploratory and confirmatory factor analyses were conducted as well as multiple indicator multiple cause modeling and partial correlation analyses to assess the relationships among clusters and demographic, health history, and quality-of-life measures.

Main Research Variables: Self-reported symptom bother, demographics such as age and education level, health history, and quality of life.

Findings: Seven clinically distinct symptom clusters tapping 36 different symptoms in older adult breast cancer survivors were found. These symptom clusters were significantly related to multiple dimensions of quality of life.

Conclusions: Older adult breast cancer survivors experience multiple concurrent symptoms that appear to cluster. Identifying symptom clusters helps to elucidate possible intersymptom relationships which may lead to the design of more effective symptom management interventions for older adult breast cancer survivors.

Implications for Nursing: Older adult breast cancer survivors should be assessed for a wide variety of symptoms if clinicians hope to identify and understand intersymptom relationships. Such assessment would enable more comprehensive symptom management.

Jump to a section

    References

    American Cancer Society. (2009). Breast cancer facts and figures, 2009-2010. Atlanta, GA: Author.
    Barsevick, A.M., Whitmer, K., Nail, L.M., Beck, S.L., & Dudley, W. (2006). Symptom cluster research: Conceptual, design, measurement, and analysis issues. Journal of Pain and Symptom Management, 31, 85-95. doi:10.1016/j.jpainsymman.2005.05.015
    Bollen, K.A. (1989). Structural equation models with latent variable. New York, NY: John Wiley and Sons.
    Borg, C., Hallberg, I.R., & Blomqvist, K. (2006). Life satisfaction among older people (65+) with reduced self-care capacity: The relationship to social, health, and financial aspects. Journal of Clinical Nursing, 15, 607-618.
    Bowling, A., Banister, D., Sutton, S., Evans, O., & Windsor, J. (2002). A multidimensional model of the quality of life in older age. Ageing and Mental Health, 6, 335-371. doi:10.1080/1360786021000006983
    Boyle, P.A., Barnes, L.L., Buchman, A.S., & Bennett, D.A. (2009). Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic Medicine, 71, 574-579. doi:10.1097/PSY.0b013e3181a5a7c0
    Carpenter, J.S., Johnson, D.H., Wagner, L.J., & Andrykowski, M.A. (2002). Hot flashes and related outcomes in breast cancer survivors and matched comparison women [Online exclusive]. Oncology Nursing Forum, 29, E16-E25. doi:10.1188/02.ONF.E16-E25
    Chen, M., & Lin, C. (2007). Cancer symptom clusters: A validation study. Journal of Pain and Symptom Management, 34, 590-599. doi:10.1016/j.jpainsymman.2007.01.008
    Chen, M., & Tseng, H. (2006). Symptom clusters in cancer patients. Supportive Care Cancer, 14, 825-830. doi:10.1007/500520-006-0019-8
    Chow, E., Fan, G., Hadi, S., & Filipsczak, L. (2007). Symptom clusters in cancer patients with bone metastases. Supportive Care in Cancer, 15, 1035-1043. doi:10.1007/s00520007-0241-z
    Cleeland, C.S., Bennett, G.J., Dantzer, R., Dougherty, P.M., Dunn, A.J., Meyers, C.A., … Lee, B. (2003). Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer, 97, 2919-2925. doi:10.1002/cncr.11382
    Deimling, G.T., Bowman, K.F., Sterns, S., Wagner, L.J., & Kahana, B. (2006). Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psycho-Oncology, 15, 306-320. doi:10.1002/pon.955
    Dodd, M.J., Miaskowski, C., & Paul, S.M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28, 465-470.
    Fox, S.W., & Lyon, D.E. (2006). Symptom clusters and quality of life in survivors of lung cancer. Oncology Nursing Forum, 33, 931-936. doi:10.1188/06.ONF.931-936
    Fox, S.W., & Lyon, D. (2007). Symptom clusters and quality of life in survivors of ovarian cancer. Cancer Nursing, 30, 354-361.
    Gaston-Johansson, F., Fall-Dickson, J.M., Bakos, A.B., & Kennedy, M.J. (1999). Fatigue, pain, and depression in pre-autotransplant breast cancer patients. Cancer Practice, 7, 240-247.
    Given, B.A., Given, C.W., Sikorskii, A., & Hadar, N. (2007). Symptom clusters and physical function for patients receiving chemotherapy. Seminars in Oncology Nursing, 23, 121-126. doi:10.1016/j.soncn.2007.01.005
    Gleason, J.F., Case, D., Rapp, S.R., Ip, E., Naughton, M., Butler, J.M., … Shaw, E.G. (2007). Symptom clusters in patients with newly diagnosed brain tumors. Journal of Supportive Oncology, 5, 427-436.
    Gupta, P., Sturdee, D.W., Palin, S.L., Majumder, K., Fear, R., Marshall, T., & Paterson, I. (2006). Menopausal symptoms in women treated for breast cancer: The prevalence and severity of symptoms and their perceived effects on quality of life. Climateric, 9, 49-58. doi:10.1080/13697130500487224
    Hedberg, P., Gustafson, Y., & Brulin, C. (2010). Purpose in life among men and women aged 85 years and older. International Journal of Aging and Human Development, 70, 213-229. doi:10.2190/AG.70.3.c
    Heidrich, S.M. (1993). The relationship between physical health and psychological well-being in elderly women: A developmental perspective. Research in Nursing and Health, 16, 123-130.
    Heidrich, S.M. (1994). The self, health, and depression in elderly women. Western Journal of Nursing Research, 16, 544-555. doi:10.1177/ 0193945994016005007
    Heidrich, S.M. (1998). Older women's lives through time. Advances in Nursing Science, 20, 65-75.
    Heidrich, S.M., Egan, J.J., Hengudomsub, P., & Randolph, S.M. (2006). Symptoms, symptom beliefs, and quality of life of older breast cancer survivors: A comparative study. Oncology Nursing Forum, 33, 315-322. doi:10.1188/06.ONF.315-322
    Hu, L., & Bentler, P.M. (1999). Cutoff criteria of fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1-55. doi:10.1080/10705519909540118
    Irwin, M., Artin, L.H., & Oxman, M.N. (1999). Screening for depression in the older adult: Criterion validity for 10-item Center for Epidemiological Studies Depression scale (CES-D). Archives of Internal Medicine, 159, 1701-1704.
    Jim, H.S., & Andersen, B.L. (2007). Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. British Journal of Health Psychology, 12, 363-381. doi:10.1348/135910706X128278
    Kim, H.J., McGuire, D.B., Tulman, L., & Barsevick, A.M. (2005). Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nursing, 28, 270-282.
    Kohout, F.J., Berkman, L.F., Evans, D.A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. Journal of Aging and Health, 5, 179-193. doi:10.1177/089826439300500202
    Kornblith, A.B., & Ligibel, J. (2003). Psychosocial and sexual functioning of survivors of breast cancer. Seminars in Oncology, 3, 799-813. doi:10.1053/j.seminoncol.2003.08.025
    Low, G., & Molzahn, A.E. (2007). Predictors of quality of life in old age: A cross-validation study. Research in Nursing and Health, 30, 141-150. doi:10.1002/nur.20178
    Manning-Walsh, J. (2005a). Psychospiritual well-being and symptom distress in women with breast cancer [Online exclusive]. Oncology Nursing Forum, 32, E56-E62. doi:10.1188/05.ONF.E56-E62
    Manning-Walsh, J. (2005b). Spiritual struggle: Effect on quality of life and life satisfaction in women with breast cancer. Journal of Holistic Nursing, 23, 120-140. doi:10.1177/0898010104272019
    Miaskowski, C., & Aouizerat, B.E. (2007). Is there a biological basis for the clustering of symptoms? Seminars in Oncology Nursing, 23, 99-105. doi:10.1016/j.soncn.2007.01.008
    Miaskowski, C., Dodd, M., & Lee, K. (2004). Symptom clusters: The new frontier in symptom management research. Journal of the National Cancer Institute. Monographs, 32, 17-21. doi:10.1093/jncimonographs/lgh023
    Mirabeau-Beale, K.L., Kornblith, A.B., Penson, R.T., Lee, H., Goodman, A., Campos, S.M., … Matulonis, U.A. (2009). Comparison of the quality of life and advanced stage ovarian cancer survivors. Gynecologic Oncology, 114, 353-359. doi:10.1016/j.ygyno.2009.05.009
    National Cancer Insitute. (2010). SEER stat fact sheet: Breast. Retrieved from http://seer.cancer.gov/statfacts/html/breast.html
    Olson, K., Hayduk, L., Cree, M., Cui, Y., Quan, H., Hanson, J., … Strasser, F. (2008). The changing causal foundations of cancer-related symptom clustering during the final month of palliative care: A longitudinal study. BioMed Central Medical Research Methodology, 8, 36-47. doi:10.1186/1471-2288-8-36
    Radloff, L. (1977). The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. doi:10.1177/014662167700100306
    Rand, K.L., Otte, J.L., Flockhart, D., Hayes, D., Storniolo, A.M., Stearns, V., … Carpenter, J.S. (2010). Modeling hot flashes and quality of life in breast cancer survivors. Climacteric. Advance online publication. doi:10.3109/13697131003717070
    Rich, T.A. (2007). Symptom clusters in cancer patients and their relations to EGFR ligand modulation of the circadian axis. Journal of Supportive Oncology, 5, 167-174.
    Ryff, C.D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57, 1069-1081. doi:10.1037/0022-3514.57.6.1069
    Sarna, L., & Brecht, M. (1997). Dimensions of symptom distress in women with advanced lung cancer: A factor analysis. Heart and Lung, 26, 23-30. doi:10.1016/S0147-9563(97)90006-6
    Schlenk, E.A., Erlen, J.A., Dunbar-Jacob, J., McDowell, J., Engberg, S., Sereika, S.M., … Bernier, M.J. (1998). Health-related quality of life in chronic disorders: A comparison across studies using the MOS SF-36. Quality of Life Research, 7, 57-65. doi:10.1023/A:1008836922089
    Schultz, P.N., Klein, M.J., Beck, M.L., Stava, C., & Sellin, R.V. (2005). Breast cancer: Relationship between menopausal symptoms, physiologic health effect of cancer treatment and physical contestants on quality of life in long-term survivors. Journal of Clinical Nursing, 14, 204-211. doi:10.1111/j.1365-2702.2004.01030.x
    Stanton, A.L., Danoff-Burg, S., & Huggins, M.E. (2002). The first year after breast cancer diagnosis: Hope and coping strategies as predictors of adjustment. Psycho-Oncology, 11, 93-102. doi:10.1002/pon.574
    Stanton, A.L., Simonelli, L.E., Fowler, J., Maxwell, G.L., & Andersen, B.L. (2008). Physical sequelae and depressive symptoms in gynecologic cancer survivors: Meaning in life as a mediator. Annals of Behavioral Medicine, 35, 275-284. doi:10.1007/s12160-008-9029-8.
    Wang, S., Tsai, C., Chen, B., Lin, C., & Lin, C. (2008). Symptom clusters and relationships to symptom interference with daily life in Taiwanese lung cancer patients. Journal of Pain and Symptom Management, 35, 258-266. doi:10.1016/j.jpainsymman.2007.03.017
    Ware, J.E., Jr., & Sherbourne, C.D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473-483.
    Woods, C.M., Otlmanns, T.F., & Turkheimer, E. (2009). Illustration of MIMIC-model DIF testing with the Schedule for Nonadaptive and Adaptive Personality. Journal of Psychopathology and Behavioral Assessment, 31, 320-330. doi:10.1007/s10862-008-9118-9