Many patients with cancer receive chemotherapy as part of their treatment plan. While this treatment may save or prolong lives, chemotherapy is also known to cause severe and bothersome symptoms. Several of the more prevalent and distressing symptoms are gastrointestinal (GI) in nature, and are experienced disproportionately by patients with hematologic malignancies as they tend to receive higher doses of chemotherapies. Research has shown that symptoms in cancer patients rarely occur alone;but rather co-occur or "cluster" together, and that symptom clusters negatively affect health outcomes such as mood, quality of life, and survival. While a number of studies have identified symptom clusters containing GI symptoms, the symptom measures used in these studies were severely limited, in many cases containing only four GI symptoms. None of the symptom measurement tools included the full range of GI symptoms commonly experienced by patients receiving chemotherapy. The purpose of this study is to describe GI symptom clusters in patients receiving chemotherapy for hematologic cancers using a "GI complete" symptom measure.
Specific aims are (1) To identify which GI symptoms cluster based on symptom severity, distress, and frequency ratings in patients with hematological cancers receiving chemotherapy, (2) To determine if GI symptom clusters are stable over three weeks of a cycle of chemotherapy, and (3) To determine if GI symptom clusters are related to symptom interference with daily life or QoL. A sample of 200 adult hematologic cancer patients receiving chemotherapy will be asked to complete a symptom measure modified to be "GI complete" and measures of symptom interference with life and QoL at the start of a cycle of chemotherapy. All measures will be repeated weekly on Days 7, 14, and 21. Symptom clusters will be identified at baseline using exploratory factor analysis and confirmed at Days 7, 14, and 21 using confirmatory factor analysis. Relationships between interference with life, QoL and the symptom clusters identified will be calculated as partial correlations, controlling for participant age, gender, race, and chemotherapy dose / intensity. Understanding which symptoms form stable symptom clusters would allow for targeted interventions to be developed to more efficiently address symptom management and to reduce the negative consequences associated with symptom clusters during active treatment. If stable GI symptom clusters are identified, nurses can use this information to develop more efficient interventions targeted to multi-symptom clusters, rather than individual symptoms.
Gastrointestinal (GI) symptoms are extremely prevalent in persons receiving chemotherapy, with up to 19 different GI symptoms reported. The proposed work will enhance understanding of chemotherapy-related GI symptom clusters, and will inform intervention research targeting co-occurring GI symptoms.