Predictors of the intensity of symptoms in a cluster in patients with breast cancer.

PURPOSE: To examine the influence of selected demographic and clinical variables on the intensity of symptoms in two previously identified symptom clusters (psychoneurological and upper gastrointestinal) across the treatment trajectory for breast cancer.

DESIGN: A secondary analysis was conducted with a sample of 282 female breast-cancer patients who were receiving chemotherapy or radiation therapy in two American cancer centers. Data were collected three times across the treatment trajectory: baseline (before chemotherapy or radiation treatment) and two follow-up times after treatment initiation.

METHOD: Multiple regression analyses were done at each time point to examine the influence of selected demographic and clinical variables on the intensity of symptoms in each cluster.

FINDINGS: Baseline physical performance status was a consistent predictor of symptom intensity in the psychoneurological cluster across time whereas age and treatment modality were consistent predictors of symptom intensity in the upper gastrointestinal cluster. Poor physical performance at baseline predicted more intense psychoneurological symptoms. Younger women and women undergoing chemotherapy experienced more intense gastrointestinal symptoms. In addition, at the second follow-up treatment modality also influenced intensity of symptoms in the psychoneurological cluster and race and baseline physical performance status also influenced the intensity of symptoms in the upper gastrointestinal cluster.

CONCLUSIONS: Clinicians can anticipate that younger patients, patients with poor baseline physical performance status, and patients who receive chemotherapy will have more intense treatment-related gastrointestinal and psychoneurological symptoms during adjuvant breast cancer therapy. Further research is needed to determine whether collective management for symptoms in a cluster may be beneficial.

CLINICAL RELEVANCE: Clinicians can use findings from the present study to identify patients who need greater attention to symptom assessment and management, including anticipatory counseling of patients and families.