Abstract
Patients with advanced cancer often experience multiple concurrent symptoms. To explore
this symptom clustering and its associated parameters, we prospectively surveyed 427
consecutive patients on admission to the Palliative Care Unit. There were 222 males
(52.0%) and 205 females (48.0%), with a median age of 66 years (range: 27e93 years).
The main tumor sites were lung (19.9%), liver (18.0%), and colorectum (11.0%). The
median survival was 13 days (1e418 days). Symptoms were assessed using a face-valid
Symptom Reporting Form. We identified five symptom clusters by exploratory factor analysis.
Clusters were named ‘‘loss of energy,’’ ‘‘poor intake,’’ ‘‘autonomic dysfunction,’’
‘‘aerodigestive impairment,’’ and ‘‘pain complex.’’ We used nonhierarchical cluster analysis
to divide the 394 patients with complete data into six groups. Each group was characterized
by a particular pattern that was composed of different symptom clusters. Survival, functional
performance, bone metastasis, and fluid accumulation were significantly associated with
symptom clustering in six groups of patients. The severity of psychological distress also related
to their physical deterioration. These data suggest that different underlying mechanisms
associate with symptom clustering. Further elucidation of these processes may assist in
symptom management. J Pain Symptom Manage 2010;39:655e662. 2010 U.S.
Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.