Conceptualizing problems with symptoms, function, health behavior, health-seeking skills, and financial strain in breast cancer survivors using hierarchical clustering

X Liu, Y Chen (Corresponding Author), Andy S.K. Cheng, Yingchun Zeng, S Ullah, M Feuerstein

Research output: Journal article publicationJournal articleAcademic researchpeer-review


Purpose: Determine whether a diverse set of problems experienced by breast cancer survivors (BCS) following curative treatment can be formulated into a reduced number of clusters, potentially simplifying the conceptualization of these problems. Method: Female BCS were recruited from four cancer hospitals in China. The Chinese translation of the Cancer Survivor Profile (CSPro) was used to measure 18 common problem areas, as supported by epidemiological and phenomenological research. The Functional Assessment of Cancer Therapy–Breast (FACT-B) was used to measure quality of life, as a validation of any observed groupings. Hierarchical clustering using multiple distance criteria and aggregation methods to detect patterns of problems was used. Results: A total of 1008 BCS (mean 46.51 years old) living in both urban and rural areas were investigated. Hierarchical cluster analysis identified two major clusters of problems. One set was classified as “functional limitations,” while the other cluster was labeled “multi-problems.” Those who fell into the multi-problem cluster experienced poorer quality of life. Conclusion: Eighteen non-medical problems were broken down into two major clusters: (1) limitations in higher level functions required of daily life and (2) limitations in health care–seeking skills, problems with certain symptoms, unhealthy behaviors, and financial problems related to cancer. The breakdown of problem areas into these two clusters may help identify common mechanisms. Implications for Cancer Survivors: In the future, the search for common clusters and the mechanisms for the many problems that breast cancer survivors and other cancer survivors can experience following primary treatment may improve how we help manage these problems in the future.

Original languageEnglish
JournalJournal of Cancer Survivorship
Publication statusPublished - 9 Jun 2021


  • Breast cancer survivors
  • Economic burden
  • Functional limitations
  • Health-seeking skills
  • Hierarchical cluster analysis
  • Symptom burden

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)

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