Prospective Longitudinal Evaluation of a Symptom Cluster in Breast Cancer  Stacy D. Sanford, PhD, Jennifer L. Beaumont, MS, Zeeshan Butt, PhD, Jerry J. Sweet, PhD, David Cella, PhD, Lynne I. Wagner, PhD  Journal of Pain and Symptom Management  Volume 47, Issue 4, Pages 721-730 (April 2014) DOI: 10.1016/j.jpainsymman.2013.05.010 Copyright © 2014 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 1 Lower scores on the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) perceived cognitive impairment (PCI) indicate more severe fatigue or PCI; lower scores on the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale-Depression (HADS-D) indicate less severe sleep quality and depression. Symptom cluster index (SCI) group differences are significant on all four measures (P < 0.0001). There was a significant change over time, with all symptoms worsening during chemotherapy (P < 0.01) with the exception of sleep quality, which demonstrated a nonsignificant trend (P = 0.08). There was not a significant difference in trends between groups (group × time interaction) for any of the measures. Journal of Pain and Symptom Management 2014 47, 721-730DOI: (10.1016/j.jpainsymman.2013.05.010) Copyright © 2014 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 2 The Hospital Anxiety and Depression Scale-Anxiety (HADS-A) scores over time by symptom cluster index (SCI) group. Higher scores on the HADS-A subscale indicate more severe anxiety. Scores between groups are different (P < 0.0001); the change over time was significant (P = 0.04), improving during chemotherapy; there was not a significant difference in trends between groups (group × time interaction; P = 0.34). Journal of Pain and Symptom Management 2014 47, 721-730DOI: (10.1016/j.jpainsymman.2013.05.010) Copyright © 2014 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 3 The Functional Assessment of Cancer Therapy-General (FACT-G) scores over time by symptom cluster index (SCI) group. Lower scores on the FACT-G indicate worse health-related quality of life. There was a significant difference between SCI groups (P < 0.0001), and scores were lower during chemotherapy (P < 0.001); however, there was no significant difference in trends between SCI groups (group × time interaction). Journal of Pain and Symptom Management 2014 47, 721-730DOI: (10.1016/j.jpainsymman.2013.05.010) Copyright © 2014 U.S. Cancer Pain Relief Committee Terms and Conditions