Symptom Clusters and Quality of Life in Women with Breast Cancer Receiving Adjuvant Chemotherapy


  • Warunee Phligbua RN, PhD Candidate, Faculty of Nursing, Mahidol University, Thailand
  • Kanaungnit Pongthavornkamol RN, PhD, Associate Professor, Faculty of Nursing, Mahidol University, Thailand
  • Tish Knobf RN, PhD, FAAN, Professor, School of Nursing, Yale University, USA
  • Tiraporn Junda RN, PhD, Assistant Professor, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
  • Chukiat Viwatwongkasem PhD, Associate Professor, Department of Biostatistics, Faculty of Public Health, Mahidol University, Thailand
  • Vichien Srimuninnimit MD, Assistant Professor, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand


Symptom Experiences, Symptom Clusters, Quality of Life, Breast Cancer, Chemotherapy


This prospective longitudinal study explored symptom clusters and influences on quality of life among women with stage I-IIIA breast cancer who received treatment with chemotherapy. A sample of 112 women receiving adjuvant chemotherapy for breast cancer at a university hospital in Bangkok were recruited to this study using
convenience sampling. Data were collected three times: before chemotherapy (Time 1); before receiving the second cycle of chemotherapy (Time 2), and 1-month after completion of chemotherapy (Time 3). Instruments used were a Demographic and Medical Record Form; the Modified Memorial Symptom Assessment Scale; and the Functional Assessment of Cancer Therapy-Breast. Factor analysis and multiple regression were used to identify symptom clusters and their influences on quality of life.
The results revealed that the participants with breast cancer experienced multiple symptoms concurrently. There were five symptom clusters existing at each time point: menopausal, psychologically-related self-image, and gastrointestinal-related fatigue symptom clusters tended to be stable across all three stages of data collection. “I don’t look like myself”, worrying, and feeling drowsy were found to be the strongest predictors
of quality of life across all data collection phases. Issues regarding instability of symptoms within a cluster across phases were discussed. Knowledge obtained from this study can be beneficial for nurses and other health care providers to better understand and care for multiple symptom experiences in women with breast cancer. It will also help such women to plan ahead for them to manage concurrent symptoms to promote their quality of life. However, future research is recommended to clarify the stability and extent of symptoms within various symptom clusters in women receiving chemotherapy for breast cancer.




How to Cite

Phligbua W, Pongthavornkamol K, Knobf T, Junda T, Viwatwongkasem C, Srimuninnimit V. Symptom Clusters and Quality of Life in Women with Breast Cancer Receiving Adjuvant Chemotherapy. PRIJNR [Internet]. 2013 Aug. 28 [cited 2023 Dec. 3];17(3):249-67. Available from:



Original paper