Prevalence of cancer symptom clusters in hospitalized women with breast cancer

Introduction: Women with breast cancer experience multiple symptoms that occur simultaneously during antineoplastic treatment, comprising symptom clusters. Researchers have focused on symptom clusters during chemotherapy and radiotherapy, especially in advanced disease. However, few studies have evaluated primary symptom clusters in patients with stage I and III non-metastatic breast cancer as well as how symptom clusters correspond at these stages.

Objective: To identify and compare the prevalence, intensity, and severity of cancer symptom clusters in women with non-metastatic breast cancer at stage I and stage III of the disease.

Methods: A cross-sectional study was conducted with 87 women aged >18 years old, with anatomopathological diagnosis of stage I or stage III breast cancer and undergoing any phase of antineoplastic treatment in a highly complex Oncology care center in Brazil. Symptoms were assessed using the Memorial Symptom Assessment Scale (MSAS). The bootstrap resampling method was employed to estimate the 95%CI of the prevalence ratio (PR) of MSAS symptoms, stratified by tumor stage. Cluster analysis was conducted using hierarchical and k-Means clustering.

Results: The most prevalent symptoms in stage I patients were pain (68.63%), worrying (62.75%), difficulty sleeping (62.75%), followed by fatigue (60.78%), respectively. For stage III patients, the most prevalent symptoms were pain (72%), fatigue (66.67%), worrying (63.89%), and dry mouth (50%), respectively. The prevalence of the symptom “difficulty concentrating” in stage I breast cancer patients was 1.50 times the prevalence in stage III patients (PR=1.50; p = 0.015). Similar patterns were observed for symptoms such as “shortness of breath” (PR=1.51; p<0.001), “feeling sad” (PR=1.41; p = 0.002), and “hair loss” (PR=1.60; p = 0.037).

Conclusion: Non-metastatic breast cancer patients present several symptom profiles that vary according to disease stage, exhibiting clear trends of manifestation organized into four clusters for stage I (neuropsychological, gastrointestinal, neurocognitive, and psychological clusters) and III (psycho-neurocognitive, gastrointestinal, chemotherapy-related, and neurocognitive clusters).

Corresponding author: Luís Carlos Lopes-Júnior (e-mail: lopesjr.lc@gmail.com).