Symptom Clusters in Patients With Colorectal Cancer and Diabetes Over Time

Objectives: To examine symptoms and symptom clusters in patients with colorectal cancer (CRC) with or without diabetes at three key periods (0–6 months, 12–18 months, and 24–30 months) post–initial chemotherapy.

Sample & Setting: Patients with CRC from a cancer center in the midwestern United States between January 2007 and December 2017.

Methods & Variables: Eight of the most common symptoms (fatigue, gastrointestinal issues, depression, anxiety, peripheral neuropathy, physical function, cognition, and sleep disturbance) reported by patients with CRC and patients with diabetes were extracted from electronic health records. Exploratory factor analysis was used to identify symptom clusters, which were assessed for patterns and clinical relevance.

Results: Gastrointestinal issues and fatigue were the most prevalent symptoms in patients with CRC at each period. Across the three periods, patients with CRC and diabetes had more symptom clusters (n = 7) compared to patients with CRC without diabetes (n = 4). No stable symptom clusters were identified for either group.

Implications for Nursing: Oncology clinicians must recognize that patients with CRC and diabetes may present with exacerbated symptoms or symptom clusters. Ongoing assessment and monitoring of patients with CRC and diabetes for symptoms and symptom clusters is important because they may be at an increased risk for higher symptom burden.