Symptom clustering and assessment of functional status in patients with colorectal cancer

INTRODUCTION AND AIM: Colorectal cancer is the third most common cancer worldwide, accounting for approximately 10% of all cancer cases, and is the second leading cause of cancer-related deaths worldwide. Cancer patients receiving treatment experience multiple distressing symptoms throughout the course of the illness and treatment. The clusters of symptoms perceived by the patient and described as two or more acute or chronic symptoms occurring simultaneously adversely impact the physiological, psychological, and social aspects of patients' lives, significantly affecting their quality of life. The aim of this research is to identify symptom clusters in patients with colorectal cancer and to assess the impact of these symptoms on the functional status of the patients. MATERIAL AND METHOD: A descriptive and cross-sectional study has been conducted with the participation of 115 patients who agreed to participate and received inpatient or outpatient treatment at the Medical Oncology Department, Palliative Care Center, and Chemotherapy Unit of Sakarya Training and Research Hospital. The data collection tools included a Patient Information Form, Memorial Symptom Assessment Scale, and Functional Assessment of Cancer Therapy-Colorectal scale. The data obtained in the study have been analyzed using the SPSS statistical program (SPSS-25). In the study, frequency and percentage analysis, Cronbach's alpha internal consistency test, Pearson correlation test, independent samples t-test, Kruskal-Wallis analysis of variance, and cluster analysis (Ward Method) methods have been applied. FINDINGS: The average age of the patients was 60.75±12.08, with 55,7% being male and 44,3% female. 77,4% had colon cancer, 47,8% had been diagnosed with cancer for 12 months or more, 53% had no metastasis to other organs, 52,2% received chemotherapy and surgery as treatment, 74,8% did not have colostomy, and 58,7% had first-degree relatives with cancer. The average scores for the psychological symptom sub-dimensions of sensitivity, feeling sad, and feeling angry, as well as the physical symptom sub-dimensions of energy loss, fatigue, pain, and dry mouth, have been found to be significantly higher among patients (p<0,05). "In our symptom clustering study, it has been determined that gastrointestinal symptoms (dry mouth, nausea, vomiting, difficulty swallowing, diarrhea, constipation, bloating), respiratory system symptoms (difficulty breathing, cough), and emotional symptoms (sensitivity, feeling sad, feeling drowsy/disoriented) were most commonly observed in the Frequency, Distress, and Severity clusters. When examining the impact of symptoms on functional status, it has been indicated that as the distress, severity, and frequency of physical symptoms increased, the functional status has been adversely affected (p <0,05). CONCLUSION: When examining the correlation values of Memorial Symptom Assessment Scale sub-dimensions in our study, it has been found that the correlation coefficients of Functional Assessment of Cancer Therapy-Colorectal subheadings were all significantly associated, and the relationships between the sub-dimensions were positive (p<0,01) (Table 8). In cluster analyses, it has been identified that patients with colorectal cancer experience various symptoms together, and it has been observed that gastrointestinal system, respiratory system, and emotional symptoms are more frequently and severely present in the clusters of distress, frequency, and severity. As a result, it can be stated that the functional status of patients is adversely affected as the frequency, severity, and distress levels of reported symptoms increase. To enhance patients' functional status and quality of life, it is recommended to plan and implement nursing interventions in symptom management in the clinical setting, aiming to prevent the occurrence of symptoms and detect them early when they arise.