Trajetórias de clusters de sintomas oncológicos ao longo de três ciclos de quimioterapia ambulatorial: estudo longitudinal
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Data
2025-04-24
Autores
Minarini, Etreo Junior Carneiro Da Silva
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Universidade Federal do Espírito Santo
Resumo
Introduction: Cancer patients undergoing chemotherapy often experience multiple simultaneous symptoms, which tend to cluster into interrelated patterns known as symptom clusters. Understanding these groupings throughout treatment may support more effective care strategies, especially in outpatient settings where continuous monitoring is essential. Objective: To analyze the trajectory and composition of symptom clusters in patients with malignant neoplasms over the first three cycles of outpatient chemotherapy, and to identify the clinical factors associated with their manifestation and evolution. Methods: This prospective cohort study was conducted with 84 adult patients diagnosed with stage I, II, or III cancer who were eligible for outpatient chemotherapy at a public hospital in the Southeastern region of Brazil. Data collection was performed using the Memorial Symptom Assessment Scale (MSAS™), applied during the first three chemotherapy cycles (QT1, QT2, and QT3). Symptom clusters were identified through hierarchical cluster analysis, using Euclidean distance and Ward’s method. To compare the medians of symptom frequency, intensity, and distress across cycles, the Kruskal-Wallis test was applied, followed by Conover-Iman post-hoc tests with Bonferroni correction. Symptom prevalence between QT1 and QT3 was compared using Wilcoxon signed-rank and sign tests. Associations between clusters and sociodemographic, clinical, and therapeutic variables were assessed using the chi-square test and Fisher’s exact test, adopting a significance level of 5% (p < 0.05). Results: The mean age of participants was 57.61 years, with a predominance of female patients diagnosed with ductal carcinoma in situ of the breast. Three clusters were identified in QT1 (emotional, chemotherapy-related, and neuropsychological), and four clusters were observed in both QT2 (autonomic, gastrointestinal, systemic physical, and psychosensory) and QT3 (sensory perceptual, physiological, psychosomatic, and emotional-physical). Statistically significant differences were found among clusters regarding symptom frequency, intensity, and distress across the three cycles (p < 0.05). Clusters 3 and 4 in QT2 and QT3 showed higher median values in all three dimensions, reflecting a greater symptom burden. An increase in symptom complexity was observed throughout the treatment, with an initial predominance of emotional symptoms followed by a diversification into sensory, functional, and psychosocial domains. Three primary clusters remained consistent from QT1 to QT3: emotional, chemotherapy-related, and neuropsychological. Although no statistically significant differences were found in the overall prevalence of symptoms between QT1 and QT3, clinical trends of increased prevalence were identified in 11 of the 15 symptoms assessed. In QT1, a significant association was observed between Cluster 2 (chemotherapy-related) and age ≥65 years (p = 0.048), as well as with the presence of comorbidities (p = 0.004). In QT3, Cluster 2 was more prevalent among female patients (p = 0.005), and Cluster 4 (emotional-physical) was also associated with the female sex (p = 0.010). Cluster 3 (neuropsychological) was associated with the presence of comorbidities (p = 0.033), chemotherapy drug class 4 (p = 0.007), and low platelet-to-lymphocyte ratio (PLR) (p = 0.004), suggesting potential links between clinical-immunological status and psychocognitive distress. Conclusions: The identification and comparison of symptom clusters highlighted the complexity of the symptom experience among patients undergoing chemotherapy, reinforcing the importance of clinical interventions guided by patterns of symptom co-occurrence. While the clusters showed relative stability between the first and third cycles, internal variations in symptom composition were noted. Associations with clinical and therapeutic variables emphasize the importance of continuous monitoring and personalized care based on the predominant symptom profiles throughout treatment.
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Pacientes ambulatoriais , Sintomas Concomitantes , Tratamento Farmacológico