Learning Objective #1: Learners will be able to describe how important to understand symptom clustering pattern in caring cancer patients for symptom assessment and management.

Learning Objective #2: Learners will be able to describe the different pattern of symptom clustering by the treatment mode.

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This study compared symptom clustering patterns in the two treatment groups (chemotherapy group and radiation treatment group) at 2 time points after initiating cancer treatment for breast cancer. The sample included 125 breast cancer patients undergoing chemotherapy and 157 breast cancer patients undergoing radiation treatment. Data were collected at two time points after initiating treatments: for chemotherapy patients, 48 hours after the second and third chemotherapy cycle; for radiation treatment patients, last week of treatment and one month after the completion of treatment. In each group at each time point, common oncologic treatment-related symptoms were factor analyzed in order to identify symptom clusters. Instruments included: the General Fatigue Scale (fatigue); the Profile of Mood States-Short Form (Depressive mood); the Pittsburgh Sleep Quality Inventory (insomnia); and the Side Effect Checklist (16 other symptoms). Symptom clustering pattern was different in the two groups: Two distinct symptom clusters were identified at both time points for the chemotherapy group: psycho-neurological cluster; gastrointestinal cluster. On the other hand, one symptom cluster was identified in the radiation group. However, the one cluster in the radiation treatment group was very similar to the psycho-neurological cluster in the chemotherapy patients, by including most psycho-neurological symptoms. Across time points, symptom clustering in the chemotherapy group was more stable than symptom clustering in the radiation treatment group. The current study indicates that the psycho-neurological symptom cluster exists in both chemotherapy and radiation treatment patients; while upper-gastrointestinal cluster does not exist in the patients receiving radiation treatment. In caring cancer patients, clinicians need to consider the symptom clustering pattern for symptom assessment.