Update on interventions focused on symptom clusters: what has been tried and what have we learned?

Curr Opin Support Palliat Care. 2013 Mar;7(1):60-6. doi: 10.1097/SPC.0b013e32835c7d88.


Purpose of review: Although clinicians and researchers acknowledge symptom clusters, the focus has been on relieving a single symptom. This review summarizes the recent literature on interventions that focus on relief of symptom clusters in patients with cancer.

Recent findings: Twelve intervention studies meeting inclusion criteria were published in 2011-2012. The timeframe was expanded to 2009-2012 and 24 studies met the criteria: 18 in early stage and 6 in advanced-stage cancer patients. Several cognitive behavioral therapy, complementary therapy, and exercise interventions demonstrated positive outcomes in relieving a variety of symptom clusters in several cancer types. Most psychoeducational interventions using traditional formats or those combined with automated clinician alerts demonstrated effectiveness in reducing a variety of clusters. Clusters that included fatigue and anxiety or depression were reduced by exercise in early stage patients and by methylphenidate in advanced-stage patients. Current NIH R01 funded studies verified the trends in the types of interventions being tested.

Summary: Few interventions have been tested and found to be effective in relieving the specific symptom clusters in early and advanced-stage cancer patients. Future research needs to expand our understanding of the mechanisms that initiate co-occurring symptoms. Mechanism-targeted interventions need to be identified and tested in homogeneous samples with specific symptom clusters. Interventions need to be replicated before guidelines can be established.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Anxiety / etiology
  • Anxiety / therapy
  • Cognitive Behavioral Therapy / trends
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / trends
  • Complementary Therapies / psychology
  • Complementary Therapies / trends
  • Depression / etiology
  • Depression / therapy
  • Exercise Therapy / psychology
  • Exercise Therapy / trends
  • Humans
  • Neoplasms / complications
  • Neoplasms / psychology*
  • Neoplasms / therapy*
  • Palliative Care / methods*
  • Palliative Care / trends
  • Syndrome


  • Antineoplastic Agents