Trajectories of Symptom Clusters, Performance Status, and Quality of Life During Concurrent Chemoradiotherapy in Patients With High-Grade Brain Cancers

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Symptom clusters must be identified in patients with high-grade brain cancers for effective symptom management during cancer-related therapy.


The aims of this study were to identify symptom clusters in patients with high-grade brain cancers and to determine the relationship of each cluster with the performance status and quality of life (QOL) during concurrent chemoradiotherapy (CCRT).


Symptoms were assessed using the Memorial Symptom Assessment Scale, and the performance status was evaluated using the Karnofsky Performance Scale. Quality of life was assessed using the Functional Assessment of Cancer Therapy–General. This prospective longitudinal survey was conducted before CCRT and at 2 to 3 weeks and 4 to 6 weeks after the initiation of CCRT.


A total of 51 patients with newly diagnosed primary malignant brain cancer were included. Six symptom clusters were identified, and 2 symptom clusters were present at each time point (ie, “negative emotion” and “neurocognitive” clusters before CCRT, “negative emotion and decreased vitality” and “gastrointestinal and decreased sensory” clusters at 2–3 weeks, and “body image and decreased vitality” and “gastrointestinal” clusters at 4–6 weeks). The symptom clusters at each time point demonstrated a significant relationship with the performance status or QOL.


Differences were observed in symptom clusters in patients with high-grade brain cancers during CCRT. In addition, the symptom clusters were correlated with the performance status and QOL of patients, and these effects could change during CCRT.

Implications for Practice:

The results of this study will provide suggestions for interventions to treat or prevent symptom clusters in patients with high-grade brain cancer during CCRT.

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