• Christine Miaskowski, Bruce A Cooper, Steven M Paul, Marylin Dodd, Kathryn Lee, Bradley E Aouizerat, Claudia West, Maria Cho, and Alice Bank.
• Department of Physiological Nursing, University of California, San Francisco, USA. chris.miaskowski@nursing.ucsf.edu
• Oncol Nurs Forum. 2006 Sep 1;33(5):E79-89.

Purpose/ObjectivesTo identify subgroups of outpatients with cancer based on their experiences with the symptoms of fatigue, sleep disturbance, depression, and pain; to explore whether patients in the subgroups differed on selected demographic, disease, and treatment characteristics; and to determine whether patients in the subgroups differed on two important patient outcomes: functional status and quality of life (QOL).DesignDescriptive, correlational study.SettingFour outpatient oncology practices in northern California.Sample191 outpatients with cancer receiving active treatment.MethodsPatients completed a demographic questionnaire, Karnofsky Performance Status scale, Lee Fatigue Scale, General Sleep Disturbance Scale, Center for Epidemiological Studies Depression Scale, Multidimensional Quality-of-Life Scale Cancer, and a numeric rating scale of worst pain intensity. Medical records were reviewed for disease and treatment information. Cluster analysis was used to identify patient subgroups based on patients symptom experiences. Differences in demographic, disease, and treatment characteristics as well as in outcomes were evaluated using analysis of variance and chi square analysis.Main Research VariablesSubgroup membership, fatigue, sleep disturbance, depression, pain, functional status, and QOL.FindingsFour relatively distinct patient subgroups were identified based on patients experiences with four highly prevalent and related symptoms.ConclusionsThe subgroup of patients who reported low levels of all four symptoms reported the best functional status and QOL.Implications For NursingThe findings from this study need to be replicated before definitive clinical practice recommendations can be made. Until that time, clinicians need to assess patients for the occurrence of multiple symptoms that may place them at increased risk for poorer outcomes.

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