OBJECTIVES: To examine the literature on symptom clusters and the impact of co-occurring symptoms on the physical function of patients with cancer during treatment. DATA SOURCES: Research and review articles. CONCLUSION: Unmanaged symptoms occur in what are often called symptom clusters. A focus on known and frequently present co-occurring symptoms, such as pain, fatigue, and sleep disturbance, might be the most efficient and effective way to manage specific symptoms and improve patient functioning. IMPLICATIONS FOR NURSING PRACTICE: Nurses should select assessments that identify multiple symptoms and define their co-occurrence. KEYWORDS: Physical function, patient outcomes, symptom clusters, cancer treatment SYMPTOM CLUSTERS AND PHYSICAL FUNCTION FOR PATIENTS RECEIVING CHEMOTHERAPY BARBARA A. GIVEN,CHARLES W. GIVEN,ALLA SIKORSKII, AND NIRA HADAR I N THE PAST decade, consideration of the symptom experi- ence for cancer patients focusing on single symptoms has given way to evidence that unmanaged symptoms occur in what are often called clusters or symptom combinations. 1-4 For cancer patients, assessment of a single symptom is too narrow, seldom reflects the patient’s real situation, underestimates the symptom burden that the patient is experiencing, and results in a less comprehensive approach to symptom management. Research has provided support that together multiple symptoms may have a more negative effect on patients’ quality of life than the occurrence of single symptoms. 4-6 This article examines the literature on symptom clusters and the impact of multiple co-occurring symptoms on physical func- tioning of patients with cancer during treatment. The presence of multiple co-occurring symptoms is critical to patients not only because of concern for altered comfort or distress, but also be- cause multiple symptoms often cause alteration in physical func- tion with subsequent altered quality of life. 7 Symptom burden resulting from multiple co-occurring symptoms may lead to treat- ment reductions, delays, or discontinuation, any of which could have a negative effect on the treatment’s effectiveness if patients do not receive the desired full therapeutic dose. 3 In addition, patients may be unable to carry out their daily activities often caused by lowered physical function. 3,8-10 In addition, recent re- search addresses the impact of physical activity on survivorship Barbara A. Given, RN, PhD, FAAN: Uni- versity Distinguished Professor, College of Nursing, Michigan State University, East Lansing, MI. Charles W. Given, PhD: Pro- fessor, Family Medicine, Michigan State University, East Lansing, MI. Alla Sikorskii, PhD: Assistant Professor, College of Nursing, Michigan State University, East Lansing, MI. Nira Hadar: Research Associate, Formally of Michigan State Uni- versity, East Lansing, MI; now residing in Boston, MA. Supported in part by National Cancer Institutes grant nos. NCI R01 CA79280 (Family Home Care for Cancer: A Com- munity-Based Model) and NCI R01 CA030724 (Automated Telephone Monitor- ing for Symptom Management). Address correspondence to Barbara A. Given, RN, PhD, FAAN, B515C West Fee Hall, Michigan State University, Family Care Study, East Lansing, MI 48824; e-mail: Barb.Given@hc.msu.edu © 2007 Elsevier Inc. All rights reserved. 0749-2081/07/2302-$30.00/0 doi:10.1016/j.soncn.2007.01.005 121 Seminars in Oncology Nursing, Vol 23, No 2 (May), 2007: pp 121–126