Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Anita J. Hunter,RN, PhD, FAAN, Chair; Jane M. Georges, RN, PhD; Betty Ferrell, RN, PhD, FAAN


Cancer, disease-related symptoms, mental health, nursing, treatment related symptoms


Research to examine the co-occurrence of symptoms, both disease-related and treatment related, in cancer patients is in the early stages of investigation. As more individuals survive cancer, the prevalence and consequences of psychological and physical symptom clusters are increasing, yet they are under-reported and under treated. The current study, informed by the Theory of Unpleasant Symptoms, explores a large sample with a diverse representation of cancer diagnoses, examining the relationship between anxiety, depression, somatization, pain, and fatigue. Retrospective data analysis was conducted on the Brief Symptom Inventory 18 (BSI 18) and the Common Problem Checklist (PCL) administered to 523 cancer patients who presented for care at a National Cancer Institute designated facility between 1998 and 2002. The nine cancer diagnoses represented by the sample include breast, prostate, lymphoma, leukemia, melanoma, brain, head and neck, pancreas, and acoustic neuroma. The mean age was 57.9 ± 12.9 years, 53.4% were male, the majority self-identified as Caucasian (80.4%), 72.3% were married and 51.2% declared their medical insurance coverage as "unknown." Cluster analysis and finite mixture modeling revealed that the symptoms of anxiety, depression, somatization, pain, and fatigue clustered into two distinct groups—a large sub sample with low symptom scores and a small sub sample with high symptom scores. Women and divorced individuals were more prevalent in the high score symptom cluster. Those with head and neck cancer, lymphoma and pancreatic cancer suffered higher levels of symptoms relative to other cancer types. Logistic regression analysis revealed that common problems predictive of membership in the high score symptom cluster included problems communicating with family and friends, applying for medical insurance, concerns about hospice care and faith that is challenged. These results illustrate that distress, pain, and fatigue form a stable cluster with subgroups of either high or low acuity. Lack of social support and poor prognosis cancer type were shown to influence membership in the high acuity cluster. The data suggests that high acuity of this symptom cluster may be preceded by anticipatory crisis (end of life care), and existential crisis (finding meaning in the cancer experience).

Document Type

Dissertation: USD Users Only