TY - JOUR
T1 - Symptom clusters in patients with head and neck cancer receiving concurrent chemoradiotherapy
AU - Xiao, Canhua
AU - Hanlon, Alexandra
AU - Zhang, Qiang
AU - Ang, Kian
AU - Rosenthal, David I.
AU - Nguyen-Tan, P. Felix
AU - Kim, Harold
AU - Movsas, Benjamin
AU - Bruner, Deborah Watkins
N1 - Funding Information:
The authors thank for the support from the American Nursing Foundation, the Radiation Therapy Oncology Group, and the National Cancer Institute (NCI).
PY - 2013/4
Y1 - 2013/4
N2 - Objectives: This study is to identify symptom clusters for head and neck (HNC) patients treated with concurrent chemoradiotherapy. Patients and methods: A secondary data analysis of 684 HNC patients treated on the Radiation Therapy Oncology Group (RTOG) 0129 trial comparing different RT fractionation schedules with concurrent chemotherapy was used to examine clusters. Treatment-related symptoms were measured by clinicians at three time-points during and after chemoradiotherapy using the National Cancer Institute Common Toxicity Criteria v2.0. Exploratory factor analysis was applied to identify symptom clusters, which was further verified by confirmatory factor analysis. Coefficients of congruence and alpha coefficients were employed to examine generalizability of cluster structures over different time-points and in different subgroups. Results: Two clusters were identified. The HNC specific cluster is composed of radiodermatitis, dysphagia, radiomucositis, dry mouth, pain, taste disturbance, and fatigue. The gastrointestinal (GI) cluster involves nausea, vomiting, and dehydration. With the exception of patients 65 years old or older, diagnosed with larynx cancer, or with stage III cancer, the two clusters were generalizable to different subgroups defined by age, gender, race, education, marital status, history of tobacco use, treatments, primary sites, disease stages, and tube feedings, as well as to the three symptom assessment time-points. Conclusions: The data provides preliminary support for two stable clusters in patients with HNC. These findings may serve to inform the symptom management in clinical practice. Moreover, the findings necessitate future research to examine the generalizability of identified clusters in the late symptom phase or other treatment modalities, and to understand the underlying biological mechanism.
AB - Objectives: This study is to identify symptom clusters for head and neck (HNC) patients treated with concurrent chemoradiotherapy. Patients and methods: A secondary data analysis of 684 HNC patients treated on the Radiation Therapy Oncology Group (RTOG) 0129 trial comparing different RT fractionation schedules with concurrent chemotherapy was used to examine clusters. Treatment-related symptoms were measured by clinicians at three time-points during and after chemoradiotherapy using the National Cancer Institute Common Toxicity Criteria v2.0. Exploratory factor analysis was applied to identify symptom clusters, which was further verified by confirmatory factor analysis. Coefficients of congruence and alpha coefficients were employed to examine generalizability of cluster structures over different time-points and in different subgroups. Results: Two clusters were identified. The HNC specific cluster is composed of radiodermatitis, dysphagia, radiomucositis, dry mouth, pain, taste disturbance, and fatigue. The gastrointestinal (GI) cluster involves nausea, vomiting, and dehydration. With the exception of patients 65 years old or older, diagnosed with larynx cancer, or with stage III cancer, the two clusters were generalizable to different subgroups defined by age, gender, race, education, marital status, history of tobacco use, treatments, primary sites, disease stages, and tube feedings, as well as to the three symptom assessment time-points. Conclusions: The data provides preliminary support for two stable clusters in patients with HNC. These findings may serve to inform the symptom management in clinical practice. Moreover, the findings necessitate future research to examine the generalizability of identified clusters in the late symptom phase or other treatment modalities, and to understand the underlying biological mechanism.
KW - Chemoradiotherapy
KW - Head and neck neoplasms
KW - Symptom clusters
KW - Symptoms
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U2 - 10.1016/j.oraloncology.2012.10.004
DO - 10.1016/j.oraloncology.2012.10.004
M3 - Article
C2 - 23168337
AN - SCOPUS:84875251002
SN - 1368-8375
VL - 49
SP - 360
EP - 366
JO - Oral Oncology
JF - Oral Oncology
IS - 4
ER -