Table 1.
Intervention Studies Targeting a Specific Symptom Cluster
| Authors | Design & Sample | Symptom Cluster & Eligibility | Treatment Groups | Cluster Mechanism | Treatment effect |
|---|---|---|---|---|---|
| Yorke et al.49 | Feasibility RCT N=107 adults with lung cancer (No chest XRT or chemo in the last 4 weeks, or surgery in the last 6 weeks) |
1. Breathlessness 2. Cough 3. Fatigue All symptoms present and report of being “bothered” by at least 2 of the 3 symptoms |
Symptom Cluster Intervention • Written information on symptom experience, communication and fatigue management strategies • Controlled breathing technique • Cough easing technique • Acupressure Control • Usual care (breathlessness and fatigue information booklets) |
Not specified - combined patient and clinician preferred therapies for individual symptoms and one with crossover potential (acupressure). | Within group improvement in breathlessness, cough, and fatigue Between group - no significant difference compared to usual care control |
| Chan, Richardson & Richardson,16 | RCT N=140 patients aged ≥ 16 year old with lung cancer receiving palliative XRT |
1. Breathlessness 2. Anxiety 3. Fatigue No requirement for experience of the symptom cluster (anticipated to emerge during the course of XRT) |
Symptom Cluster Intervention • Written preparatory information and discussion of the symptom experience • Advice regarding self-care strategies • Relaxation (PMR) training and practice Control • Briefing regarding the XRT procedure • Discussion of side effects focusing on skin care • Optional group session on general care before and after XRT. |
Physical or emotional stress as a common underlying etiology of all 3 symptoms. | Between group – significant difference in change in composite symptom cluster score from pre-treatment to week 6 of XRT, but not from pre-treatment to week 12. |
| Yeh et al.50 | RCT N=31 patients with breast cancer currently off treatment or receiving adjuvant therapy |
1. Pain 2. Fatigue 3. Sleep Disturbance All symptoms present in the last week and at least two rated ≥ 3 on a 0-10 severity scale. |
Auricular acupressure •Seeds taped to points targeting pain, fatigue, and sleep disturbance Control •Sham acupressure with seeds taped to points unrelated to pain, fatigue, or sleep disturbance |
Selection of acupressure points that may stimulate the brain to active reflex pathways to relieve multiple symptoms | Within group improvement in symptoms Between group - no significant difference compared to sham acupressure |
| Kwekkeboom, Abbott-Anderson & Wanta,51 | One-group pre-post feasibility trial N=30 adults receiving chemotherapy or radiation for advanced (recurrent or metastatic) cancer |
1. Pain 2. Fatigue 3. Sleep Disturbance All symptoms present in the last week and at least two symptoms (one must be pain) rated ≥ 3 on a 0-10 severity scale in the last 48 hours |
Cognitive-Behavioral Intervention • Education about symptom cluster • Patient selection of guided imagery, relaxation, and distraction strategies (used daily) |
Crossover strategies with evidence of efficacy for at least 2 of the 3 clustered symptoms. | Within group - no change in symptoms from baseline to week 2, but immediate reductions in all 3 symptoms at the time the cognitive-behavioral strategy was used. |
| Kwekkeboom, Abbott-Anderson, Cherwin, Roiland, Serlin & Ward,52 | Pilot RCT N=86 adults receiving chemotherapy or radiation for advanced (recurrent or metastatic) cancer |
1. Pain 2. Fatigue 3. Sleep Disturbance All symptoms present in the last week and at least two rated ≥ 3 on a 0-10 severity scale. |
Cognitive-Behavioral Intervention • Education about symptom cluster • Patient selection of guided imagery, relaxation, and distraction strategies (used daily) Control • Usual care (clinician recommended education and symptom management strategies) |
Crossover strategies with evidence of efficacy for at least 2 of the 3 clustered symptoms. All 3 symptoms influenced by patients' stress, perceptions of control, and expectation for outcome. |
Between group - symptom cluster severity was lower in the treatment compared to waitlist control group at week 2. |
RCT = randomized controlled trial; XRT = radiation therapy; PMR = progressive muscle relaxation