Stability and Priority of Symptoms and Symptom Clusters Among Allogeneic HSCT Patients Within a 5-Year Longitudinal Study

Peter Esser; Katharina Kuba; Angela Scherwath; Christoffer Johansen; Anke Schwinn; Lena Schirmer; Frank Schulz-Kindermann; Margitta Kruse; Uwe Koch; Axel Rolf Zander; Nicolaus Kröger; Heide Götze; Anja Mehnert

doi:10.1016/j.jpainsymman.2017.07.012

Stability and Priority of Symptoms and Symptom Clusters Among Allogeneic HSCT Patients Within a 5-Year Longitudinal Study

Peter Esser, Katharina Kuba, Angela Scherwath, Christoffer Johansen, Anke Schwinn, Lena Schirmer, Frank Schulz-Kindermann, Margitta Kruse, Uwe Koch, Axel Rolf Zander, Nicolaus Kröger, Heide Götze, Anja Mehnert

Department of Clinical Medicine

10 Citations (Scopus)

Abstract

CONTEXT: Due to toxicity and invasiveness, allogeneic hematopoietic stem cell transplantation causes severe and longstanding symptom burden. Longitudinal studies on symptoms and symptom clusters (SC) would be helpful to optimize symptom control but are rare to date.

OBJECTIVES: The objective of this study was to investigate stability of symptoms, extract time stable SC, and determine their priority in symptom management.

METHODS: In this multicenter study, patients diagnosed with hematologic cancer were assessed before conditioning (T0) and three months (T1), one year (T2), and five years (T3) after transplantation. Symptoms were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Symptoms were stable when rated as present at three consecutive time points. Applying factor analysis, stable SC were composed of symptoms loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL).

RESULTS: Two hundred thirty-nine patients participated at T0, 150 (63%) at T1, 102 (43%) at T2, and 45 (19%) at T3. We identified three stable SC, composed of rest-tired-weak-dyspnea-loss of appetite (exhausted), tense-worried-irritable-depressed (affective), and nausea-vomiting (gastrointestinal). Fatigue was most persistent and also most severe and predictive for QoL, both as symptom and in cluster (exhausted).

CONCLUSION: Given its high stability, severity, and impact on QoL, fatigue should have priority in symptom management. The treatment of this symptom could be enhanced by also incorporating interventions addressing dyspnea and loss of appetite.

Original language	English
Journal	Journal of Pain and Symptom Management
Volume	54
Issue number	4
Pages (from-to)	493-500
ISSN	0885-3924
DOIs	https://doi.org/10.1016/j.jpainsymman.2017.07.012
Publication status	Published - Oct 2017

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Esser, P., Kuba, K., Scherwath, A., Johansen, C., Schwinn, A., Schirmer, L., Schulz-Kindermann, F., Kruse, M., Koch, U., Zander, A. R., Kröger, N., Götze, H., & Mehnert, A. (2017). Stability and Priority of Symptoms and Symptom Clusters Among Allogeneic HSCT Patients Within a 5-Year Longitudinal Study. Journal of Pain and Symptom Management, 54(4), 493-500. https://doi.org/10.1016/j.jpainsymman.2017.07.012

Esser, P, Kuba, K, Scherwath, A, Johansen, C, Schwinn, A, Schirmer, L, Schulz-Kindermann, F, Kruse, M, Koch, U, Zander, AR, Kröger, N, Götze, H & Mehnert, A 2017, 'Stability and Priority of Symptoms and Symptom Clusters Among Allogeneic HSCT Patients Within a 5-Year Longitudinal Study', Journal of Pain and Symptom Management, vol. 54, no. 4, pp. 493-500. https://doi.org/10.1016/j.jpainsymman.2017.07.012

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title = "Stability and Priority of Symptoms and Symptom Clusters Among Allogeneic HSCT Patients Within a 5-Year Longitudinal Study",

abstract = "CONTEXT: Due to toxicity and invasiveness, allogeneic hematopoietic stem cell transplantation causes severe and longstanding symptom burden. Longitudinal studies on symptoms and symptom clusters (SC) would be helpful to optimize symptom control but are rare to date.OBJECTIVES: The objective of this study was to investigate stability of symptoms, extract time stable SC, and determine their priority in symptom management.METHODS: In this multicenter study, patients diagnosed with hematologic cancer were assessed before conditioning (T0) and three months (T1), one year (T2), and five years (T3) after transplantation. Symptoms were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Symptoms were stable when rated as present at three consecutive time points. Applying factor analysis, stable SC were composed of symptoms loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL).RESULTS: Two hundred thirty-nine patients participated at T0, 150 (63%) at T1, 102 (43%) at T2, and 45 (19%) at T3. We identified three stable SC, composed of rest-tired-weak-dyspnea-loss of appetite (exhausted), tense-worried-irritable-depressed (affective), and nausea-vomiting (gastrointestinal). Fatigue was most persistent and also most severe and predictive for QoL, both as symptom and in cluster (exhausted).CONCLUSION: Given its high stability, severity, and impact on QoL, fatigue should have priority in symptom management. The treatment of this symptom could be enhanced by also incorporating interventions addressing dyspnea and loss of appetite.",

author = "Peter Esser and Katharina Kuba and Angela Scherwath and Christoffer Johansen and Anke Schwinn and Lena Schirmer and Frank Schulz-Kindermann and Margitta Kruse and Uwe Koch and Zander, {Axel Rolf} and Nicolaus Kr{\"o}ger and Heide G{\"o}tze and Anja Mehnert",

year = "2017",

month = oct,

doi = "10.1016/j.jpainsymman.2017.07.012",

language = "English",

volume = "54",

pages = "493--500",

journal = "Journal of Pain and Symptom Management",

issn = "0885-3924",

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TY - JOUR

T1 - Stability and Priority of Symptoms and Symptom Clusters Among Allogeneic HSCT Patients Within a 5-Year Longitudinal Study

AU - Esser, Peter

AU - Kuba, Katharina

AU - Scherwath, Angela

AU - Johansen, Christoffer

AU - Schwinn, Anke

AU - Schirmer, Lena

AU - Schulz-Kindermann, Frank

AU - Kruse, Margitta

AU - Koch, Uwe

AU - Zander, Axel Rolf

AU - Kröger, Nicolaus

AU - Götze, Heide

AU - Mehnert, Anja

PY - 2017/10

Y1 - 2017/10

N2 - CONTEXT: Due to toxicity and invasiveness, allogeneic hematopoietic stem cell transplantation causes severe and longstanding symptom burden. Longitudinal studies on symptoms and symptom clusters (SC) would be helpful to optimize symptom control but are rare to date.OBJECTIVES: The objective of this study was to investigate stability of symptoms, extract time stable SC, and determine their priority in symptom management.METHODS: In this multicenter study, patients diagnosed with hematologic cancer were assessed before conditioning (T0) and three months (T1), one year (T2), and five years (T3) after transplantation. Symptoms were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Symptoms were stable when rated as present at three consecutive time points. Applying factor analysis, stable SC were composed of symptoms loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL).RESULTS: Two hundred thirty-nine patients participated at T0, 150 (63%) at T1, 102 (43%) at T2, and 45 (19%) at T3. We identified three stable SC, composed of rest-tired-weak-dyspnea-loss of appetite (exhausted), tense-worried-irritable-depressed (affective), and nausea-vomiting (gastrointestinal). Fatigue was most persistent and also most severe and predictive for QoL, both as symptom and in cluster (exhausted).CONCLUSION: Given its high stability, severity, and impact on QoL, fatigue should have priority in symptom management. The treatment of this symptom could be enhanced by also incorporating interventions addressing dyspnea and loss of appetite.

AB - CONTEXT: Due to toxicity and invasiveness, allogeneic hematopoietic stem cell transplantation causes severe and longstanding symptom burden. Longitudinal studies on symptoms and symptom clusters (SC) would be helpful to optimize symptom control but are rare to date.OBJECTIVES: The objective of this study was to investigate stability of symptoms, extract time stable SC, and determine their priority in symptom management.METHODS: In this multicenter study, patients diagnosed with hematologic cancer were assessed before conditioning (T0) and three months (T1), one year (T2), and five years (T3) after transplantation. Symptoms were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Symptoms were stable when rated as present at three consecutive time points. Applying factor analysis, stable SC were composed of symptoms loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL).RESULTS: Two hundred thirty-nine patients participated at T0, 150 (63%) at T1, 102 (43%) at T2, and 45 (19%) at T3. We identified three stable SC, composed of rest-tired-weak-dyspnea-loss of appetite (exhausted), tense-worried-irritable-depressed (affective), and nausea-vomiting (gastrointestinal). Fatigue was most persistent and also most severe and predictive for QoL, both as symptom and in cluster (exhausted).CONCLUSION: Given its high stability, severity, and impact on QoL, fatigue should have priority in symptom management. The treatment of this symptom could be enhanced by also incorporating interventions addressing dyspnea and loss of appetite.

U2 - 10.1016/j.jpainsymman.2017.07.012

DO - 10.1016/j.jpainsymman.2017.07.012

M3 - Journal article

C2 - 28711754

SN - 0885-3924

VL - 54

SP - 493

EP - 500

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

IS - 4

ER -

Stability and Priority of Symptoms and Symptom Clusters Among Allogeneic HSCT Patients Within a 5-Year Longitudinal Study

Abstract

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