• Ellen Bjerkeset, Kari Röhrl, and Inger Schou-Bredal.
• Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Postboks 4956 Nydalen, 0424, Oslo, Norway. uxelbj@ous-hf.no.
• Breast Cancer Res. Treat. 2020 Feb 1; 180 (1): 63-71.

PurposeBreast cancer survivors may experience pain, fatigue, or psychological distress as a result of the treatment. These symptoms may co-occur and form a cluster. However little is known about symptom clusters (SCs) in long-term breast cancer survivors. This study aimed to identify subgroups of breast cancer survivors with the SC of pain, fatigue, and psychological distress, and to examine sociodemographic and clinical characteristics associated with this SC.MethodsData were obtained from a nationwide survey of breast cancer survivors (N = 834). Exhaustive enumeration of possible combination of the three binary variables (pain, fatigue, psychological distress) was conducted. They were identified using the recommended threshold for the Hospital Anxiety and Depression Scale, the Fatigue Questionnaire, and a score of one or more on a numeric rating scale for pain. The SC was defined to include all the three variables, all other combinations were defined as no SC. Logistic regression analyses were conducted to examine the association between sociodemographic and clinical variables and the SC.ResultsOf the 834 survivors, 13% had the SC. Younger age (OR 2.3, 95% CI 1.3-4.1, p = 0.003), lymphedema (OR 1.9, 95% CI 1.1-3.2, p = 0.02), working part-time (OR 2.9, 95% CI 1.6-5.3, p < 0.001), or being disabled (OR 4.1, 95% CI 2.2-7.8, p < 0.001) were all associated with the SC.ConclusionThirteen percent of the survivors experienced the SC. It appears that premenstrual women are at greater risk, than postmenopausal women. Having this SC might have an impact on the survivors' ability to work.

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