Symptom clusters among the patients with carcinoma lung attending palliative care department: a retrospective analysis

Chaitanya Patil, Shrikant Atreya, Namrata Mestri


Background: There is growing interest in the symptom cluster of these symptoms rather than single symptoms and has been commonly termed as respiratory distress cluster. So, we conducted this audit review with a goal to explore the prevalence of RDS among lung cancer patients and to find association between RDS and the histological type of lung cancer.

Methods: A retrospective review of records of lung cancer patients referred to palliative care department at Tata medical center, Kolkata, India was done. The records of 6 months (July 2018 to December 2018) were reviewed and relevant details were noted down. Hospital management system of our institution was screened for all the lung cancer patients during the above said period. Demographic details and various symptoms like cough, breathlessness, fatigue and other symptoms were also noted. Histological diagnosis was also noted as per the records.

Results: We found that 20.24% had cough with fatigue, 20.24% had cough with breathlessness, 25% had fatigue with breathlessness and 13.10% had cough, fatigue and breathlessness in the present study. The proportion of fatigue was significantly higher among the small cell type (75%) when compared to non small cell type (p=0.0425) The proportion of SxCl cough with fatigue was significantly higher among the small cell carcinoma (60%) when compared to other subtypes. (p=0.0467)

Conclusions: Among symptom clusters, fatigue with breathlessness was the most common. The proportion of fatigue and fatigue with cough was significantly higher among small cell carcinomas when compared to non small cell carcinoma subtype.


Lung Cancer, Symptom clusters, NSCLC, SCLC

Full Text:



Curtis EB, Krech R, Walsh TD. Common symptoms in patients with advanced cancer. J Palliat Care. 1991;7(2):25-9.

Donnelly S, Walsh D. The symptoms of advanced cancer. Semin Oncol. 1995;22(3):67-72.

Torre LA, Siegel RL, Jemal A. Lung Cancer Statistics. Adv Exp Med Biol. 2016;893:1-19.

de Groot PM, Wu CC, Carter BW, Munden RF. The epidemiology of lung cancer. Transl lung cancer Res. 2018;7(3):220-33.

Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med. 2011;32(4):605-44.

Xing P-Y, Zhu Y-X, Wang L, Hui Z-G, Liu S-M, Ren J-S, et al. What are the clinical symptoms and physical signs for non-small cell lung cancer before diagnosis is made? A nation-wide multicenter 10-year retrospective study in China. Cancer Med. 2019;8(8):4055-69.

Bradley SH, Kennedy MPT, Neal RD. Recognising Lung Cancer in Primary Care. Adv Ther. 2019;36(1):19-30.

Molassiotis A, Lowe M, Blackhall F, Lorigan P. A qualitative exploration of a respiratory distress symptom cluster in lung cancer: cough, breathlessness and fatigue. Lung Cancer. 2011;71(1):94-102.

Walter FM, Rubin G, Bankhead C, Morris HC, Hall N, Mills K, et al. Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study. Br J Cancer. 2015;112 Suppl 1(1):S6-13.

Hammerschmidt S, Wirtz H. Lung cancer: current diagnosis and treatment. Dtsch Arztebl Int. 2009;106(49):809-20.

Wang S-Y, Tsai C-M, Chen B-C, Lin C-H, Lin C-C. Symptom Clusters and Relationships to Symptom Interference with Daily Life in Taiwanese Lung Cancer Patients. J Pain Symptom Manage. 2008;35(3):258-66.

Chan CWH, Richardson A, Richardson J. A study to assess the existence of the symptom cluster of breathlessness, fatigue and anxiety in patients with advanced lung cancer. Eur J Oncol Nurs. 2005;9(4):325-33.

Henoch I, Ploner A, Tishelman C. Increasing stringency in symptom cluster research: a methodological exploration of symptom clusters in patients with inoperable lung cancer. Oncol Nurs Forum. 2009;36(6):E282-92.

Sher T, Dy GK, Adjei AA. Small cell lung cancer. Mayo Clin Proc. 2008;83(3):355-67.

Navada S, Lai P, Schwartz AG, Kalemkerian GP. Temporal trends in small cell lung cancer: analysis of the national Surveillance, Epidemiology, and End-Results (SEER) database. J Clin Oncol. 2006;24(18): 7082.

Luciani A, Jacobsen PB, Extermann M, Foa P, Marussi D, Overcash JA, et al. Fatigue and functional dependence in older cancer patients. Am J Clin Oncol. 2008;31(5):424-30.

Sarna L, Cooley ME, Brown JK, Chernecky C, Elashoff D, Kotlerman J. Symptom severity 1 to 4 months after thoracotomy for lung cancer. Am J Crit care an Off Publ Am Assoc Crit Nurses. 2008;17(5):455-67.

Sarna L, Padilla G, Holmes C, Tashkin D, Brecht ML, Evangelista L. Quality of life of long-term survivors of non-small-cell lung cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2002;20(13):2920-9.

Hopwood P, Stephens RJ. Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. J Clin Oncol. 2000;18(4):893-903.