Background Patients with cancer frequently experience more than one symptom. This study aimed to examine symptom clustering in patients with cancer screened for symptoms and problems using the Edmonton Symptom Assessment Scale (ESAS) and Problem Checklist.
Methods The study was a secondary analysis of the data obtained from a single arm, implementation study using web-based ESAS which screens for 9 clinical symptoms and Problem Checklist that screens for practical, information, social and emotional concerns. A network analysis was undertaken to identify problem/symptom clustering.
Results Forty-seven patients (32 females; 68%); median age of 57 years (IQR 51;69) completed baseline screening with 33 reporting at least one symptom and 38 (81%) reporting at least one problem (the total of 43 (91%) reporting either symptoms or problems). The median number of symptoms and problems was 7 (IQR 3;10.5). The most common symptoms reported included tiredness (27; 57%); reduced wellbeing (24; 51%); and drowsiness (17; 36%). The most common problems included fears and worries (23; 49%), sleep problems (23; 49%), weight problems (18; 38%) and changes in appearance (16; 34%). There were 4 main clusters of symptoms and problems: clinical, psychosocial, existential, and navigational. Work concerns mapped separately from these clusters. Two of the clusters mapped exclusively onto the Problem Checklist and contained no symptoms.
Conclusions People with cancer experience multiple and diverse symptoms and problems that can be broadly mapped into distinct clusters. Screening for symptoms only would miss two of these clusters, highlighting the need for evaluation of both symptoms and problems using ESAS and Problem Checklist.