More Is Needed to Treat Symptom Clusters in Cancer Survivors


More than half of the studies surveyed did not alleviate all 3 “cluster” symptoms of pain, fatigue, and sleep disturbances.

Cancer survivors often experience a symptom cluster of pain, fatigue, and sleep disturbances after treatment ends. Although these effects are very common, the majority of interventions from randomized controlled trials did not alleviate all 3 of these symptoms, according to a recent systematic review presented at the 2020 ONS Bridge virtual conference.

“Symptom clusters reduce survivors’ quality of life. This is why effective self-management interventions are needed to alleviate symptom clusters,” said Sameena Sheikh, RN-BC, a doctoral student at the University of Miami, while presenting her findings. “Oncology nurses need to continue to assess and advocate for effective management of symptoms.”

Sheikh analyzed 10 randomized controlled trials, that included a total of 1200 survivors: 3 used exercise to address symptom clusters, 3 used a behavioral approach, 2 used a pharmacological approach, and 2 used other therapies.

Overall, 40% of interventions were effective in managing the entire symptom cluster (pain, fatigue, and sleep disturbances), while 50% relieved 1 or 2 symptoms, and 10% failed to manage any symptoms.

The following interventions resulted in statistically significant and clinically meaningful improvement in the symptom cluster:

  • Aerobic exercise and stretching that occurred 3 times a week over 9 months
  • A behavioral-based approach, where a cognitive strategy using imagery, relaxation, and distraction was used
  • Four 1-hour sessions Valencia model of waking hypnosis with cognitive-based therapy over 3 months, with skill practice 3 times a day between sessions
  • Slow-stroke back massage, which occurred 3 times per week, 10 minutes after chemotherapy treatment, for a total of 4 weeks

“Exercise, behavioral, and massage interventions are promising treatments to manage the entire symptom cluster,” Sameena said.

The one intervention that did not have an effect on any symptoms in the cluster was daily 1-hour cranial microcurrent stimulation.

However, more research is needed in the realm of symptom cluster management, so that oncology nurses can provide better and clearer relief recommendations to their patients.

“Nurse scientists researching symptom clusters should provide clarity and consistency on specific instruments,” Sameena said.

“For sustained impact on cancer survivors’ wellbeing and quality of life, more randomized control trials of interventions are needed to be tested over a length of time to ensure reliability and stability in outcomes. This is because symptom clusters may persist and evolve through the continuum of cancer survivorship.”

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