• Erin McKenzie, Liying Zhang, Pearl Zaki, Stephanie Chan, Vithusha Ganesh, Yasmeen Razvi, May Tsao, Elizabeth Barnes, Matthew K Hwang, Carlo DeAngelis, and Edward Chow.
• Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
• Ann Palliat Med. 2019 Apr 1; 8 (2): 140-149.

BackgroundCancer patients often present with several concurrent symptoms. There is evidence to suggest that related symptoms can cluster together in stable groups. The present study sought to identify symptom clusters in advanced cancer patients using the Edmonton Symptom Assessment System (ESAS) in a palliative outpatient radiotherapy clinic.MethodsPrincipal component analysis (PCA), exploratory factor analysis (EFA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the 9 ESAS items using ESAS scores from each patient's first visit.ResultsPCA identified three symptom clusters (cluster 1: depression, anxiety; cluster 2: nausea, dyspnea, loss of appetite; cluster 3: pain, well-being, tiredness, drowsiness). EFA identified two clusters (cluster 1: tiredness, drowsiness, loss of appetite, well-being, pain, nausea, dyspnea; cluster 2: depression, anxiety). HCA identified three symptom clusters (cluster 1: depression, anxiety, pain, well-being; cluster 2: tiredness, drowsiness, dyspnea; cluster 3: nausea, loss of appetite).ConclusionsSymptom clusters were identified using three analytical methods. The following items were always in the same cluster: depression and anxiety; nausea and appetite loss; well-being and pain; tiredness and drowsiness. Further research in symptom clusters is necessary to advance our understanding of the complex symptom interactions in advanced cancer patients and to determine the most clinically relevant symptom clusters.

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