Symptom Clusters in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Systematic Review

BACKGROUND: Breast cancer patients experience various adverse symptoms during adjuvant chemotherapy. These adverse symptoms often form symptom clusters and have a negative impact on patients. AIMS: To summarise common symptom clusters in different dimensions and their longitudinal changes among breast cancer patients receiving adjuvant chemotherapy. DESIGN: A systematic review. DATA SOURCES: Ten electronic databases were searched from 2001 to January 2024, and the search was last updated on 16 August 2024. METHODS: Two reviewers independently assessed the eligibility of each study and extracted data. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers was used to evaluate the quality of included studies. The findings were synthesised narratively. This systematic review has been registered (CRD42022370210). RESULTS: Nine studies with a total of 1454 participants were included. The common symptom clusters in breast cancer patients receiving adjuvant chemotherapy were the gastrointestinal symptom cluster (nausea-lack of appetite), the fatigue-pain-sleep disturbance symptom cluster and the psychological symptom cluster (worry-sadness-nervousness-distress-feeling irritable-difficult concentrating). The severity dimension was the most frequently utilised in identifying symptom clusters, with the number and concurrence of symptom clusters showing variation over time. CONCLUSIONS: This study summarised common symptom clusters in breast cancer patients receiving adjuvant chemotherapy and revealed their changes from symptom dimensions and the chemotherapy process. These findings support further exploration of symptom cluster changes and underlying mechanisms, facilitating the design of targeted management strategies, including appropriate interventions and measurement dimensions in clinical nursing, to ultimately reduce patients' symptom burden. IMPACT: Common symptom clusters have been identified in breast cancer patients receiving adjuvant chemotherapy. Clinical nursing in oncology can prioritise these symptom clusters and provide patients with targeted management strategies. REPORTING METHODS: PRISMA guidelines and SWiM guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.