Symptom Cluster Trajectories During Chemotherapy in Breast Cancer Outpatients  Hsin-Tien Hsu, PhD, Kuan-Chia Lin, PhD, Li-Min Wu, PhD, Chiung-Hui Juan, MSN, Ming-Feng Hou, MD, Shiow-Li Hwang, DNSc, Yi Liu, PhD, Marylin J. Dodd, PhD  Journal of Pain and Symptom Management  Volume 53, Issue 6, Pages 1017-1025 (June 2017) DOI: 10.1016/j.jpainsymman.2016.12.354 Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 1 Quadratic trajectories of two symptom clusters in the third 21-day chemotherapy cycle. Group 1: Neurocognition cluster (pain, shortness of breath, vomiting, memory problems, numbness or tingling; 38.46%). Y = 2.08 − 0.11 (days) + 0.00241 (day2) (β0 = 2.08, P < 0.001; β1 = −0.011, P < 0.001; β2 = 0.00241, P = 0.0186). Group 2: Emotion-nausea-fatigue-anorexia cluster (fatigue, nausea, disturbed sleep, distress/upset, lack of appetite, drowsiness, dry mouth, sadness; 61.54%). Y = 3.96 − 0.26 (days) + 0.00658 (day2) (β0 = 3.96, P < 0.001; β1 = −0.26, P < 0.001; β2 = 0.00658, P < 0.001). Journal of Pain and Symptom Management 2017 53, 1017-1025DOI: (10.1016/j.jpainsymman.2016.12.354) Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 2 Linear trajectories of three symptom clusters in the third 14-day chemotherapy cycle. Group 1: Neurocognition cluster (pain, shortness of breath, vomiting, memory problems, numbness or tingling; 38.46%). Y = 2.09 − 0.11 (days) (β0 = 2.09, P < 0.001; β1 = −0.11, P = 0.004). Group 2: Emotion-nausea cluster (nausea, disturbed sleep, distress/upset, drowsiness, sadness; 38.46%). Y = 3.57 − 0.20 (days) (β0 = 3.57, P < 0.001; β1 = −0.20, P < 0.001). Group 3: Fatigue-anorexia cluster (fatigue, lack of appetite, dry mouth; 23.08%). Y = 4.22–0.21 (days) (β0 = 4.22, P < 0.001; β1 = −0.21, P < 0.001). Journal of Pain and Symptom Management 2017 53, 1017-1025DOI: (10.1016/j.jpainsymman.2016.12.354) Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions