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Context: Cancer patients experience a variety of concurrent symptoms. These symptoms occur frequently in groups or clusters. Objectives: The intention of this analysis was to examine patterns of pain-insomnia-fatigue (PIF) symptom clusters over time and their impact on patients´ global health status and functionality.
Methods: 207 patients with diagnosed malignancy and pain >3 days and average pain ≥3/10 participated in a clinical trial in 2 German university hospitals. EORTC-QLQ C30 was used for patient reported symptom assessment. Symptom assessments were scheduled at trial inclusion until 28 days post discharge. The PIF - cluster conditions were fulfilled if a patient had each of the consisting symptom intensity score above the 30 out of 100 points threshold. Results: 160 out of 207 patients (77.3%) showed a PIF - cluster at baseline. In this subpopulation 68 patients (42.5%) showed consistently stable PIF - clusters until 28 days post discharge. Thus, the PIF - cluster is a frequent and fairly stable symptom cluster in cancer patients with pain. Evaluating the impact of the PIF - cluster on global health status and on different functionality-scores the results reveal significant differences. Cracking a PIF - cluster is associated with a modest improvement of global health status, physical function and emotional function compared with a single symptom reduction. Conclusion: Cracking a symptom cluster has a superior impact on the patients´ quality of life and functionality compared to single symptom reduction. Therefore treatment strategies are needed to address clusters of symptoms more comprehensively.