Nurses Study Symptom Cluster in Patients With Mucositis

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 three symptoms.

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.

All three symptoms in the cluster decreased significantly during the week, she said, and were moderately to highly correlated at each data collection period.

"I think the research is finally catching up with what happens clinically," Dr. Dodd said. "This study is significant because it is giving us more knowledge by mapping the associations of three related symptoms. There might be an important flag that comes up when a clinician comes across a cluster of symptoms that appear related."