cancer, chemotherapy, metastatic, palliative care, symptom cluster



  1. Kim, Hee Sun PhD, RN
  2. Kim, Miok PhD, RN
  3. Lee, Seon Heui PhD, RN


This study aims to investigate symptom clusters and the physiological, psychological, and situational factors associated with symptom clusters in patients with metastatic cancer undergoing palliative chemotherapy. Also, this research explored how severity of symptom clusters affected physical function. A total of 106 patients with metastatic cancer in South Korea participated. Three symptom clusters were identified: cluster 1 included neuropsychological symptoms (drowsiness, difficulty in remembering, sadness, distress, sleep disturbances, and fatigue), cluster 2 included pain symptoms (shortness of breath, numbness, dry mouth, and pain), and cluster 3 included gastrointestinal symptoms (nausea, vomiting, and poor appetite). Low hemoglobin level (physiological factor) was associated with the pain cluster. High anxiety and low fighting spirit (psychological factors) were associated with 3 clusters, and high depression (psychological factor) was associated with the neuropsychological cluster. Low social support (situational factor) was associated with the gastrointestinal cluster. The participants in the severe subgroups of the 3 symptom clusters experienced low physical function. Palliative nurses should understand the different symptom clusters and their possibly synergistic adverse effects on patient outcomes. Our results provide an important basis for developing palliative strategies to manage concurrent symptoms in patients with metastatic cancer undergoing chemotherapy, with the goal of improving their physical function.