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Cho, Kwon, Kim, Kim, and Ryu: Identification and Validation of Symptom Clusters in Patients with Hepatocellular Carcinoma
Original Article
Journal of Korean Academy of Nursing

Journal of Korean Academy of Nursing 2009; 39(5): 683-692.

Published online: 31 October 2009

DOI: https://doi.org/10.4040/jkan.2009.39.5.683

Identification and Validation of Symptom Clusters in Patients with Hepatocellular Carcinoma

Myung Sook Cho1, In Gak Kwon1, Hee Sun Kim2, Kyunghee Kim3, Eunjung Ryu4

1Associate Professor, Department of Clinical Nursing Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Unit Manager, Department of Nursing, Samsung Medical Center, Seoul, Korea.

3Professor, Department of Nursing, Chung-Ang University, Seoul, Korea.

4Professor, Department of Nursing, Konkuk University, Chungju, Korea.

Address reprint requests to: Kwon, In Gak. Department of Clinical Nursing Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: 82-2-3410-2904, Fax: 82-2-3410-6616, ingak.kwon@samsung.com

Received 4 March 2009       Accepted 17 September 2009

Copyright © 2009 Korean Society of Nursing Science

Abstract

Purpose

The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma.

Methods

This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters.

Results

Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression.

Conclusion

Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.

Keywords: Symptom, Cluster, Hepatocellular carcinoma

Figures and Tables

Table 1
Characteristics of Participants (N=194)
jkan-39-683-i001

*Missing value excluded; †Multiple response.

TACE=transcatheter arterial chemoembolization; RFA=radiofrequency ablation; ECOG PS=Eastern Cooperative Oncology Group Performance Status.

Table 2
Symptom Prevalence and Severity (N=194)
jkan-39-683-i002

*Symptom severity was computed by averaging the symptom severity scores of those who had one or more symptoms.

Table 3
Factor Matrix for the Four-factor Model (N=194)
jkan-39-683-i003
Table 4
Correlations Matrix among Factors (N=194)
jkan-39-683-i004
Table 5
Symptom Scores of Factors by Performance Status and Liver Function (N=194)
jkan-39-683-i005

ECOG=Eastern Cooperative Oncology Group Performance Status.

Table 6
Symptom Scores of Factors by Anxiety and Depression (N=194)
jkan-39-683-i006

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