SAN DIEGO--A new study may help nursing professionals become more
aware of the presence of symptom clusters in cancer patients and their possible
synergistic adverse effect on patients’ future morbidity.
Marylin Dodd, RN, PhD, FAAN, professor of physiological nursing, University
of California, San Francisco (UCSF), presented the study at the 26th Annual
Conference of the Oncology Nursing Society (abstract 106).
"The next generation of symptom management work must look at
understanding symptom clusters and their effect on patients," Dr. Dodd
said. "Historically, we’ve studied single symptoms. It has helped us
understand some symptoms, but it’s not all that helpful to clinicians when
cancer patients present with several symptoms occurring at the same time."
Based on the UCSF Symptom Management Model, the study set out to describe
the relationship of three symptoms within a symptom cluster of pain, difficulty
eating, and difficulty swallowing fluids over a 7-day period. The study
participants were 164 outpatients who had chemotherapy-induced mucositis. The
typical participant was female (93%), married (63%), white (85%), and middle
aged (59.2 years), and averaged 13.9 years of education.
When they developed mucositis, patients had an oral assessment in the clinic
using the Patients’ Oral Assessment Guide, and the patients rated the
severity of their pain, difficulty eating, and difficulty swallowing fluids
using a 0 to 10 visual analog scale.
Patients were called by telephone on days 3, 5, and 7, and again rated the
Dr. Dodd noted that the oral assessment scores averaged 13.6 at baseline,
where a normal mouth would receive a score of 8. The average pain scores ranged
from 1.8 to 4.5, difficulty eating scores from 1.4 to 3.5, and difficulty
swallowing fluids scores from 0.7 to 3.1.