Symptom Clusters Related to Treatment for Prostate Cancer

Sally L. Maliski

Lorna Kwan

David Elashoff

Mark S. Litwin

symptom burden, fatigue, distress, prostate cancer
ONF 2008, 35(5), 786-793. DOI: 10.1188/08.ONF.786-793

Purpose/Objectives: To identify symptom clusters that include urinary and erectile dysfunction among men treated for prostate cancer.

Design: Secondary data analysis.

Setting: University-affiliated urology clinic.

Sample: Data collected on 402 men for a longitudinal prostate cancer quality-of-life study.

Methods: Data were collected from an eight-month time point. Four analytic approaches were applied to determine whether consistent clusters of symptoms were identifiable.

Main Research Variables: Pain, fatigue, emotional distress, and urinary, sexual, and bowel dysfunction.

Findings: Thirty-three percent of patients reported scores on three or more quality-of-life measures falling in the lowest quartile for that measure. Although composition of the clusters was not consistent, poor mental health or poor energy was a component of any cluster made up of three or more symptoms.

Conclusions: Using a four-way analytic approach enabled the authors to explore how symptom clusters measuring general and disease-specific quality of life occurred in patients who have been treated for prostate cancer. When clusters occur, fatigue and emotional distress often are included.

Implications for Nursing: Fatigue and emotional distress may be seen together or in combination with prostate cancer-specific symptoms. Nurses should be more alert to the possibility of additional treatment-related symptoms when fatigue or emotional distress is present.

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    Barsevick, A. M. (2007a). The concept of symptom cluster. Seminars in Oncology Nursing, 23(2), 89-98.
    Barsevick, A. M. (2007b). The elusive concept of the symptom cluster. Oncology Nursing Forum, 34(5), 971-980.
    Barsevick, A. M., Dudley, W. N., & Beck, S. L. (2006). Cancer-related fatigue, depressive symptoms, and functional status: A mediation model. Nursing Research, 55(5), 366-372.
    Bender, C. M., Ergyn, F. S., Rosenzweig, M. Q., Cohen, S. M., & Sereika, S. M. (2005). Symptom cluster in breast cancer across 3 phases of the disease. Cancer Nursing, 28(3), 219-225.
    Blesch, K. S., Paice, J. A., Wickham, R., Harte, N., Schnoor, D. K., Purl, S., et al. (1991). Correlates of fatigue in people with breast or lung cancer. Oncology Nursing Forum, 18(1), 81-87.
    Bower, J. E., Ganz, P. A., Desmond, K. A., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18(4), 743-753.
    Chen, M. L., & Lin, C. C. (2007). Cancer symptom clusters: A validation study. Journal of Pain and Symptom Management, 34(6), 590-599.
    Chow, E., Fan, G., Hadi, S., & Filipczak, L. (2007). Symptom clusters in cancer patients with bone metastases. Supportive Care in Cancer, 15(9), 1035-1043.
    Cleeland, C. S., Bennett, G. J., Dantzer, R., Dougherty, P. M., Dunn, A. J., Meyers, C. A., et al. (2003). Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer, 97(11), 2919-2925.
    Crowe, H., & Costello, A. J. (2003). Prostate cancer: Perspectives on quality of life and impact of treatment on patients and their partners. Urologic Nursing, 23(4), 279-285.
    Dodd, M. J., Miaskowski, C., & Lee, K. A. (2004). Occurrence of symptom clusters. Journal of the National Cancer Institute. Monographs, 32, 76-78.
    Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001). Symptoms clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28(3), 465-470.
    Fox, S. W., & Lyon, D. (2007). Symptoms clusters and quality of life in survivors of ovarian cancer. Cancer Nursing, 30(5), 354-361.
    Fox, S. W., Lyon, D., & Farace, E. (2007). Symptoms clusters in patients with high-grade glioma. Journal of Nursing Scholarship, 39(1), 61-67.
    Galbraith, M. E., Arechiga, A., Ramirez, J. M., & Pedro, L. W. (2005). Prostate cancer survivors' and partners' self-reports of health-related quality of life, treatment symptoms, and marital satisfaction 2.5-5.5 years after treatment. Oncology Nursing Forum, 32(2), E30-E41. Retrieved July 22, 2008, from
    Galbraith, M. E., Ramirez, J. M., & Pedro, L. W. (2001). Quality of life, health outcomes and identity for patients with prostate cancer in five different groups. Oncology Nursing Forum, 28(3), 551-560.
    Gaston-Johansson, T., Fall-Dickson, J. M., Bakos, A. B., & Kennedy, M. J. (1999). Fatigue, pain, and depression in pre-autotransplant breast cancer patients. Cancer Practice, 7(5), 240-247.
    Gift, A. G. (2007). Symptom clusters related to specific cancers. Seminars in Oncology Nursing, 23(2), 136-141.
    Gift, A. G., Jablonski, A., Stommel, M., & Given, C. W. (2004). Symptom clusters in elderly patients with lung cancer. Oncology Nursing Forum, 31(2), 202-212.
    Gift, A. G., Stommel, M., Jablonski, A., & Given, C. W. (2003). A cluster of symptoms over time in patients with lung cancer. Nursing Research, 52(6), 393-400.
    Honea, N., Brant, J., & Beck, S. L. (2007). Treatment-related symptom clusters. Seminars in Oncology Nursing, 23(2), 242-251.
    Hu, J. C., Elkin, E. P., Pasta, D. J., Lubeck, D. P., Kattan, M. W., Carroll, P. R., et al. (2004). Predicting quality of life after radical prostatectomy: Results from CaPSURE. Journal of Urolology, 171(2, Pt. 1), 703-707.
    Kim, H. J., McGuire, D. B., Tulman, L., & Barsevick, A. M. (2005). Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nursing, 28(4), 270-282.
    Kirkova, J., & Walsh, D. (2007). Cancer symptom clusters: A dynamic construct. Supportive Care in Cancer, 15(9), 1011-1013.
    Kornblith, A. B., Herr, H. W., Ofman, U. S., Scher, H. I., & Holland, J. C. (1994). Quality of life of patients with prostate cancer and their spouses. Cancer, 73(11), 2791-2802.
    Krupski, T. L., Fink, A., Kwan, L., Maliski, S. L., Connor, S. E., Clerkin, B., et al. (2005). Health related quality-of-life in low-income, uninsured men with prostate cancer. Journal of the Poor and Underserved, 16(2), 375-390.
    Krupski, T. L., Saigal, C. S., & Litwin, M. S. (2003). Variation in continence and potency by definition. Journal of Urology, 170(4, Pt. 1), 1291-1294.
    Litwin, M. S. (2000). A prospective, longitudinal study of the short-term effects of brachytherapy vs radical prostatectomy on health-related quality of life. Prostate Cancer and Prostatic Disease, 3(1, Suppl.), S26.
    Litwin, M. S. (2003). Quality of life following definitive therapy for localized prostate cancer: Potential impact of multiple therapies. Current Opinion in Urology, 13(2), 153-156.
    Litwin, M. S., Hays, R. D., Fink, A., Ganz, P. A., Leake, B., & Brook, R. H. (1998). The UCLA Prostate Cancer Index: Development, reliability, and validity of a health-related quality of life measure. Medical Care, 36(7), 1002-1012.
    Litwin, M. S., Hays, R. D., Fink, A., Ganz, P. A., Leake, B., & Leach, G. E. (1995). Quality of life outcomes in men treated for localized prostate cancer. JAMA, 273(2), 129-135.
    Litwin, M. S., Sadetsky, N., Pasta, D. J., & Lubeck, D. P. (2004). Bowel function and bother after treatment for early stage prostate cancer: A longitudinal quality of life analysis from CaPSURE. Journal of Urology, 172(2), 515-519.
    Maliski, S. L., Kwan, L., Orecklin, J. R., Saigal, C. S., & Litwin, M. S. (2005). Predictors of fatigue after treatment for prostate cancer. Urology, 65(1), 101-108.
    Miaskowski, C., & Aouizerat, B. E. (2007). Is there a biological basis for the clustering of symptoms? Seminars in Oncology Nursing, 23(2), 99-105.
    Miaskowski, C., Dodd, M., & Lee, K. A. (2004). Symptom clusters: The new frontier in symptom management research. Journal of the National Cancer Institute. Monograph, 32, 17-21.
    Miaskowski, C., & Lee, K. A. (1999). Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: A pilot study. Journal of Pain and Symptom Management, 17(5), 320-332.
    Penson, D. F., & Litwin, M. S. (2003a). The physical burden of prostate cancer. Urologic Clinics of North America, 30(2), 305-313.
    Penson, D. F., & Litwin, M. S. (2003b). Quality of life after treatment for prostate cancer. Current Urological Reports, 4(3), 185-195.
    Petry, H., Berry, D. L., Spichiger, E., Kesselring, A., Gasser, T. C., Sulser, T., et al. (2004). Responses and experiences after radical prostatectomy: Perceptions of married couples in Switzerland. International Journal of Nursing Studies, 41(5), 507-513.
    Ryan, C. J., DeVon, H. A., Horne, R., King, K. B., Milner, K., Moser, D. K., et al. (2007). Symptom clusters in acute myocardial infarction: A secondary data analysis. Nursing Research, 56(2), 72-81.
    Sarna, L. (1993). Correlates of symptom distress in women with lung cancer. Cancer Practice, 1(1), 21-28.
    Sarna, L., & Brecht, M. L. (1997). Dimensions of symptom distress in women with advanced lung cancer: A factor analysis. Heart and Lung, 26(1), 23-30.
    Speight, J. L., Elkin, E. P., Pasta, D. J., Silva, S., Lubeck, D. P., Carroll, P. R., et al. (2004). Longitudinal assessment of changes in sexual function and bother in patients treated with external beam radiotherapy or brachytherapy, with and without neoadjuvant androgen ablation: Data from CaPSURE. Journal of Radiation Oncology, Biology, Physics, 60(4), 1066-1075.
    Weber, B. A., Roberts, B. L., Resnick, M., Deimling, G., Zauszniewski, J. A., Musil, C., et al. (2004). The effect of dyadic intervention on self-efficacy, social support, and depression for men with prostate cancer. Psycho-Oncology, 13(1), 47-60.
    Wilmoth, M. C., Coleman, E. A., Smith, S. C., & Davis, C. (2004). Fatigue, weight gain, and altered sexualtiy in patients with breast cancer: Exploration of a symptom cluster. Oncology Nursing Forum, 31(6), 1069-1075.
    American Cancer Society. (2008). Cancer facts and figures, 2008. Atlanta, GA: Author.
    Armstrong, T. S., Cohen, M. Z., Eriksen, L. R., & Hickey, J. V. (2004). Symptom clusters in oncology patients and implications for symptom research in people with primary brain tumors. Journal of Nursing Scholarship, 36(3), 197-206.