Symptom Clusters in Elderly Patients With Lung Cancer

Audrey G. Gift

Anita Jablonski

Manfred Stommel

C. William Given

ONF 2004, 31(2), 203-212. DOI: 10.1188/04.ONF.203-212

Purpose/Objectives: To identify the number, type, and combination (cluster) of symptoms experienced by patients with lung cancer.

Design: A secondary analysis of data collected as part of a larger study.

Setting: 24 sites that included community hospitals, medical clinics, oncology clinics, and radiation-oncology clinics.

Sample: 220 patients newly diagnosed with lung cancer, ranging in age from 65-89 years (XM = 72 years, SD = 5.02), 38% with early-stage and 62% with late-stage lung cancer.

Methods: Subject self-report.

Findings: Factor analysis found that the symptoms of fatigue, nausea, weakness, appetite loss, weight loss, altered taste, and vomiting form a cluster. Initial staging of cancer, the number of comorbid conditions, and being treated with chemotherapy emerged as significant predictors of the symptoms reported. Few differences were noted between men and women. Correlation was found among the numbers of symptoms reported, symptom severity, and limitations attributed to symptoms.

Conclusions: Patients with lung cancer report multiple distressing symptoms related to symptom severity and limitations.

Implications for Nursing: Assessment of multiple symptoms is recommended in patients with lung cancer.

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    American Cancer Society. (2004). Cancer facts and figures 2004. Retrieved January 26, 2004, from

    Brown, M.L., Carrieri, V., Janson-Bjerklie, S., & Dodd, M.J. (1986). Lung cancer and dyspnea: The patient's perception. Oncology Nursing Forum, 13(5), 19-24.

    Claessens, M.T., Lynn, J., Zhong, Z., Desbiens, N.A., Phillips, R.S., Wu, A.W., et al. (2000). Dying with lung cancer or chronic obstructive pulmonary disease: Insights from SUPPORT. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Journal of the American Geriatrics Society, 48(5 Suppl.), S146-S153.

    Cooley, M.E. (2000). Symptoms in adults with lung cancer: A systematic research review. Journal of Pain and Symptom Management, 19, 137-153.

    Degner, L.F., & Sloan, J.A. (1995). Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer. Journal of Pain and Symptom Management, 10, 423-431.

    DeMaria, L.C., & Cohen, H.J. (1987). Characteristics of lung cancer in elderly patients. Journal of Gerontology, 42, 540-545.

    Dodd, M.J., Miaskowski, C., & Paul, S.M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28, 465-470.

    Given, B.A., & Given, C.W. (September 1993-June 1998). Family home care: A community-based model (Grant #R01 NR/CA01915). Funded by the U.S. Department of Health and Human Services, the National Center for Nursing Research, and the Association of Health Care Policy and Research.

    Given, C.W., Given, B., Azzouz, F., Stommel, M., & Kozachik, S. (2000). Comparison of changes in physical functioning of elderly patients with new diagnoses of cancer. Medical Care, 38, 482-493.

    Given, C.W., Stommel, M., Given, B., Osuch, J., Kurtz, M.E., & Kurtz, J.C. (1993). The influence of cancer patients' symptoms and functional status on patients' depression and family caregivers' reaction and depression. Health Psychology, 12, 277-285.

    Hopwood, P., & Stephens, R.J. (1995). Symptoms at presentation for treatment in patients with lung cancer: Implications for the evaluation of palliative treatment. British Journal of Cancer, 71, 633-636.

    Hutchinson, S.A., & Wilson, H.S. (1998). The Theory of Unpleasant Symptoms and Alzheimer's disease. Scholarly Inquiry for Nursing Practice, 12, 143-158.

    Kurtz, M.E., Kurtz, J.C., Stommel, M., Given, C.W., & Given, B.A. (2000). Symptomology and loss of physical functioning among geriatric patients with lung cancer. Journal of Pain and Symptom Management, 19, 249-256.

    Lenz, E.R., Pugh, L.C., Milligan, R.A, Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-27.

    Lenz, E.R., Suppe, F., Gift, A.G., Pugh, L.C., & Milligan, R.A. (1995). Collaborative development of middle-range nursing theories: Toward a theory of unpleasant symptoms. Advances in Nursing Science, 17(3), 1-13.

    McCarthy, E.P., Phillips, R.S., Zhong, Z., Drews, R.E., & Lynn, J. (2000). Dying with cancer: Patients' function, symptoms, and care preferences as death approaches. Journal of the American Geriatrics Society, 4(5 Suppl.), S110-S121.

    McCorkle, R., & Quint-Benoliel, J. (1983). Symptom distress, current concerns and mood disturbance after diagnosis of life-threatening disease. Social Science Medicine, 17, 431-438.

    Nunnally, J.C., & Bernstein, I.H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.

    Portenoy, R.K., Thaler, H.T., Kornblith, A.B., Lepore, J.M., Friedlander-Klar, H., Kiyasu, E., et al. (1994). The Memorial Symptom Assessment Scale: An instrument for the evaluation of symptom prevalence, characteristics and distress. European Journal of Cancer, 30A, 1326-1336.

    Sarna, L. (1993). Correlates of symptom distress in women with lung cancer. Cancer Practice, 1, 21-28.

    Sarna, L. (1998). Effectiveness of structured nursing assessment of symptoms distress in advanced lung cancer. Oncology Nursing Society, 25, 1041-1048.

    Sarna, L., & Brecht, M.L. (1997). Dimensions of symptom distress in women with advanced lung cancer: A factor analysis. Heart and Lung, 26, 23-30.

    Vainio, A., & Auvinen, A. (1996). Prevalence of symptoms among patients with advanced cancer: An international collaborative study. Journal of Pain and Symptom Management, 12, 3-10.

    Ware, J.E., & Davies, A.R. (1995). Monitoring health outcomes from the patient's point of view: A primer. Kenilworth, NJ: Integrated Therapeutics Group.

    Ware, J.E., Snow, K.K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston: Health Institute, New England Medical Center.

    Ware, J.E., Jr., & Sherbourne, C.D. (1992). The MOS 36-Item Short-Form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473-481.

    Wyatt, G.K., Friedman, L.L., Given, C.W., Given, B.A., & Beckrow, K.C. (1999). Complementary therapy use among older cancer patients. Cancer Practice, 7, 136-144.