ArticleBMC medical research methodology2008
The changing causal foundations of cancer-related symptom clustering during the final month of palliative care: a longitudinal study.
Article in BMC medical research methodology, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Applications of causal and structural equation modeling in epidemiology: a systematic and critical review.BMC medical research methodology · 2026Pooled it
- Supporting gut health with medicinal cannabis in people with advanced cancer: potential benefits and challenges.British journal of cancer · 2024Review
- Systematic symptom and problem assessment at admission to the palliative care ward - perspectives and prognostic impacts.BMC palliative care · 2020Article
- Comparing two approaches for studying symptom clusters: factor analysis and structural equation modeling.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2014Article
- Symptom Clusters in Cancer Patients With Bone Metastases: Subanalysis of Patients Reporting Exclusively Non-zero ESAS Scores.World journal of oncology · 2011Article
- Symptom clusters and quality of life in older adult breast cancer survivors.Oncology nursing forum · 2011Article
- Temporal changes in the causal foundations of palliative care symptoms.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2010Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSymptoms tend to occur in what have been called symptom clusters. Early symptom cluster research was imprecise regarding the causal foundations of the coordinations between specific symptoms, and was silent on whether the relationships between symptoms remained stable over time. This study develops a causal model of the relationships between symptoms in cancer palliative care patients as they approach death, and investigates the changing associations among the symptoms and between those symptoms and well-being.
methodsComplete symptom assessment scores were obtained for 82 individuals from an existing palliative care database. The data included assessments of pain, anxiety, nausea, shortness of breath, drowsiness, loss of appetite, tiredness, depression and well-being, all collected using the Edmonton Symptom Assessment System (ESAS). Relationships between the symptoms and well-being were investigated using a structural equation model.
resultsThe model fit acceptably and explained between 26% and 83% of the variation in appetite, tiredness, depression, and well-being. Drowsiness displayed consistent effects on appetite, tiredness and well-being. In contrast, anxiety's effect on well-being shifted importantly, with a direct effect and an indirect effect through tiredness at one month, being replaced by an effect working exclusively through depression at one week.
conclusionSome of the causal forces explaining the variations in, and relationships among, palliative care patients' symptoms changed over the final month of life. This illustrates how investigating the causal foundations of symptom correlation or clustering can provide more detailed understandings that may contribute to improved control of patient comfort, quality of life, and quality of death.
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