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Systematic review
Symptom clusters in patients receiving chemotherapy: A systematic review
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  1. Carolyn S. Harris1,
  2. Kord M. Kober1,
  3. Yvette P. Conley2,
  4. Anand A. Dhruva3,
  5. Marilyn J. Hammer4 and
  6. Christine A Miaskowski1,3
  1. 1 School of Nursing, University of California, San Francisco, California, USA
  2. 2 School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3 School of Medicine, University of California, San Francisco, California, USA
  4. 4 Dana Farber Cancer Institute, Boston, Massachusetts, USA
  1. Correspondence to Carolyn S. Harris, University of California San Francisco School of Nursing, San Francisco, CA 94118, USA; carolyn.harris{at}ucsf.edu

Abstract

Background and purpose Since 2001, symptom cluster research has grown considerably. However, because multiple methodological considerations remain, ongoing synthesis of the literature is needed to identify gaps in this area of symptom science. This systematic review evaluated the progress in symptom clusters research in adults receiving primary or adjuvant chemotherapy since 2016.

Methods Eligible studies were published in English between 1 January 2017 and 17 May 2021; evaluated for and identified symptom clusters ‘de novo;’ and included only adults being treated with primary or adjuvant chemotherapy. Studies were excluded if patients had advanced cancer or were receiving palliative chemotherapy; symptoms were measured after treatment; symptom clusters were pre-specified or a patient-centred analytic approach was used. For each study, symptom instrument(s); statistical methods and symptom dimension(s) used to create the clusters; whether symptoms were allowed to load on more than one factor; method used to assess for stability of symptom clusters and associations with secondary outcomes and biomarkers were extracted.

Results Twenty-three studies were included. Memorial Symptom Assessment Scale was the most common instrument and exploratory factor analysis was the most common statistical method used to identify symptom clusters. Psychological, gastrointestinal, and nutritional clusters were the most commonly identified clusters. Only the psychological cluster remained relatively stable over time. Only five studies evaluated for secondary outcomes.

Discussion While symptom cluster research has evolved, clear criteria to evaluate the stability of symptom clusters and standardised nomenclature for naming clusters are needed. Additional research is needed to evaluate the biological mechanism(s) for symptom clusters.

PROSPERO registration number CRD42021240216.

  • cancer
  • symptoms and symptom management
  • supportive care

Data availability statement

Data sharing not applicable as no data sets generated and/or analysed for this study. Not applicable.

https://doi.org/10.1136/bmjspcare-2021-003325

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    Data availability statement

    Data sharing not applicable as no data sets generated and/or analysed for this study. Not applicable.

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    Footnotes

    • Contributors CSH and CAM both contributed to conception and design; acquisition and analysis of the literature and drafted and critically revised the manuscript. KK contributed to conception and design; analysis of the literature and critically revised the manuscript. YC, AAD and MJH each contributed to the analysis of the literature and critically revised the manuscript. CSH is the guarantor of this work and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

    • Funding CSH is supported by a grant from the American Cancer Society (134336-DSCN-20-073-01-SCN) and the National Institute of Nursing Research of the National Institutes of Health (T32NR016920). CAM is an American Cancer Society Clinical Research Professor.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.