{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T20:58:40Z","timestamp":1784667520539,"version":"3.55.0"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"Intramural Research Program of National Institutes of Health"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Lung cancer survivors experience multiple concurrent symptoms after cancer treatments. However, the majority of symptom research has focused on assessing and managing individual symptoms. Furthermore, little is known about the risk factors and adverse outcomes of complex symptoms in lung cancer survivors. The purpose of the study was to: (1) identify symptom profiles in lung cancer survivors; (2) determine influencing factors of the symptom profiles; and (3) examine differences in health outcomes among the symptom profiles. A cross-sectional secondary analysis of data from the Measuring Your Health (MY-Health) study was conducted with 526 lung cancer survivors. Symptom profiles were identified using latent profile analysis based on four patient-reported symptoms (pain, fatigue, sleep disturbance, and depression) with custom PROMIS\n                    <jats:sup>\u00ae<\/jats:sup>\n                    short forms. We conducted multinomial logistic regression analysis to determine influencing factors of the symptom profiles and multivariate analysis of variance to examine differences in physical function and social function among the symptom profiles. Four latent class symptom profiles were identified: (1)\n                    <jats:italic>\n                      <jats:italic>Within Normal Limits<\/jats:italic>\n                    <\/jats:italic>\n                    (Class 1), (2)\n                    <jats:italic>\n                      <jats:italic>Pain with Fatigue and Sleep Disturbance<\/jats:italic>\n                    <\/jats:italic>\n                    (Class 2), (3)\n                    <jats:italic>\n                      <jats:italic>Depression with Fatigue and Sleep disturbance<\/jats:italic>\n                    <\/jats:italic>\n                    (Class 3), and (4)\n                    <jats:italic>\n                      <jats:italic>All High Symptom Burden<\/jats:italic>\n                    <\/jats:italic>\n                    (Class 4). Age, income, employment status, and number of comorbidities were the influencing factors of the symptom profiles. There were significant differences in physical function and social function among the symptom profiles. This study found that the influencing factors of the symptom profiles in lung cancer survivors tended to be more sociodemographic in nature, rather than clinical. Researchers and healthcare providers use findings such as these when establishing symptom management strategies for lung cancer survivors by integrating demographic and socioeconomic determinants of health in conjunction with targeted clinical variables.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0309272","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T17:46:15Z","timestamp":1761932775000},"page":"e0309272","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Symptom profiles in lung cancer survivors: A latent class approach"],"prefix":"10.1371","volume":"20","author":[{"given":"Tehreem","family":"Hussain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa H.","family":"Son","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwenyth R.","family":"Wallen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2086-993X","authenticated-orcid":true,"given":"Lena J.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"pone.0309272.ref001","unstructured":"National Cancer Institute Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Lung and Bronchus Cancer. https:\/\/seer.cancer.gov\/statfacts\/html\/lungb.html"},{"issue":"4","key":"pone.0309272.ref002","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1188\/07.ONF.785-792","article-title":"Relationships among pain, fatigue, insomnia, and gender in persons with lung cancer","volume":"34","author":"AJ Hoffman","year":"2007","journal-title":"Oncol Nurs Forum"},{"issue":"3","key":"pone.0309272.ref003","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1017\/S1478951513001119","article-title":"Assessment of sleep disturbance in lung cancer patients: relationship between sleep disturbance and pain, fatigue, quality of life, and psychological distress","volume":"13","author":"M Nishiura","year":"2015","journal-title":"Palliat Support Care"},{"issue":"4","key":"pone.0309272.ref004","doi-asserted-by":"crossref","first-page":"100383","DOI":"10.1016\/j.apjon.2024.100383","article-title":"Identifying central symptom clusters and correlates in patients with lung cancer post-chemotherapy: A network analysis","volume":"11","author":"L Teng","year":"2024","journal-title":"Asia Pac J Oncol Nurs"},{"issue":"2","key":"pone.0309272.ref005","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1002\/pon.4513","article-title":"Comparison of fatigue, depression, and anxiety as factors affecting posttreatment health-related quality of life in lung cancer survivors","volume":"27","author":"JY Jung","year":"2018","journal-title":"Psychooncology"},{"issue":"2","key":"pone.0309272.ref006","doi-asserted-by":"crossref","DOI":"10.1097\/NCC.0000000000000765","article-title":"Trajectories of Self-reported Physical Functioning and Symptoms in Lung Cancer Survivors","volume":"44","author":"ME Medysky","year":"2021","journal-title":"Cancer Nurs"},{"issue":"4","key":"pone.0309272.ref007","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/NCC.0000000000000605","article-title":"A Systematic Review and Narrative Synthesis to Explore the Effectiveness of Exercise-Based Interventions in Improving Fatigue, Dyspnea, and Depression in Lung Cancer Survivors","volume":"42","author":"CL Henshall","year":"2019","journal-title":"Cancer Nurs"},{"issue":"4","key":"pone.0309272.ref008","article-title":"Symptom clusters: concept analysis and clinical implications for cancer nursing","volume":"28","author":"H-J Kim","year":"2005","journal-title":"Cancer Nurs"},{"issue":"4","key":"pone.0309272.ref009","doi-asserted-by":"crossref","DOI":"10.1093\/jnci\/djw253","article-title":"Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations","volume":"109","author":"C Miaskowski","year":"2017","journal-title":"J Natl Cancer Inst"},{"issue":"4","key":"pone.0309272.ref010","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/ANS.0000000000000423","article-title":"Advances in conceptual and methodological issues in symptom cluster research: A 20-year perspective","volume":"45","author":"CS Harris","year":"2022","journal-title":"ANS Adv Nurs Sci"},{"key":"pone.0309272.ref011","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/978-3-319-26633-6_12","article-title":"Mixture models: latent profile and latent class analysis.","volume-title":"Modern Statistical Methods for HCI","author":"D. Oberski","year":"2016"},{"issue":"4","key":"pone.0309272.ref012","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1177\/0095798420930932","article-title":"Latent Class Analysis: A Guide to Best Practice","volume":"46","author":"BE Weller","year":"2020","journal-title":"Journal of Black Psychology"},{"key":"pone.0309272.ref013","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ejon.2019.08.005","article-title":"Roles of biological and psychosocial factors in experiencing a psychoneurological symptom cluster in cancer patients","volume":"42","author":"H-J Kim","year":"2019","journal-title":"Eur J Oncol Nurs"},{"issue":"4","key":"pone.0309272.ref014","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.soncn.2016.08.004","article-title":"Cancer Symptom Cluster Management","volume":"32","author":"KL Kwekkeboom","year":"2016","journal-title":"Semin Oncol Nurs"},{"issue":"24","key":"pone.0309272.ref015","doi-asserted-by":"crossref","first-page":"4665","DOI":"10.1002\/cncr.33852","article-title":"Symptom clusters in 1330 survivors of 7 cancer types from the PROFILES registry: A network analysis","volume":"127","author":"BH de Rooij","year":"2021","journal-title":"Cancer"},{"issue":"1","key":"pone.0309272.ref016","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1136\/bmjspcare-2021-003325","article-title":"Symptom clusters in patients receiving chemotherapy: A systematic review","volume":"12","author":"CS Harris","year":"2022","journal-title":"BMJ Support Palliat Care"},{"issue":"3","key":"pone.0309272.ref017","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/00012272-199703000-00003","article-title":"The middle-range theory of unpleasant symptoms: an update","volume":"19","author":"ER Lenz","year":"1997","journal-title":"ANS Adv Nurs Sci"},{"issue":"1","key":"pone.0309272.ref018","article-title":"An Analysis and Evaluation of the Theory of Unpleasant Symptoms","volume":"40","author":"SE Lee","year":"2017","journal-title":"ANS Adv Nurs Sci"},{"key":"pone.0309272.ref019","first-page":"99","article-title":"The Measuring Your Health Study: Leveraging Community-Based Cancer Registry Recruitment to Establish a Large, Diverse Cohort of Cancer Survivors for Analyses of Measurement Equivalence and Validity of the Patient Reported Outcomes Measurement Information System (PROMIS\u00ae) Short Form Items","volume":"58","author":"RE Jensen","year":"2016","journal-title":"Psychological Test and Assessment Model"},{"issue":"11","key":"pone.0309272.ref020","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/j.jclinepi.2010.04.011","article-title":"The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008","volume":"63","author":"D Cella","year":"2010","journal-title":"J Clin Epidemiol"},{"issue":"10","key":"pone.0309272.ref021","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.1007\/s11136-014-0732-6","article-title":"Setting standards for severity of common symptoms in oncology using the PROMIS item banks and expert judgment","volume":"23","author":"D Cella","year":"2014","journal-title":"Qual Life Res"},{"issue":"12","key":"pone.0309272.ref022","doi-asserted-by":"crossref","first-page":"3355","DOI":"10.1007\/s11136-019-02261-2","article-title":"Establishing clinically-relevant terms and severity thresholds for Patient-Reported Outcomes Measurement Information System\u00ae (PROMIS\u00ae) measures of physical function, cognitive function, and sleep disturbance in people with cancer using standard setting","volume":"28","author":"NE Rothrock","year":"2019","journal-title":"Qual Life Res"},{"issue":"10","key":"pone.0309272.ref023","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1007\/s11136-015-0992-9","article-title":"Validation of the PROMIS physical function measures in a diverse US population-based cohort of cancer patients","volume":"24","author":"RE Jensen","year":"2015","journal-title":"Qual Life Res"},{"issue":"2","key":"pone.0309272.ref024","first-page":"403","article-title":"Measuring social function in diverse cancer populations: Evaluation of measurement equivalence of the Patient Reported Outcomes Measurement Information System\u00ae (PROMIS\u00ae) Ability to Participate in Social Roles and Activities short form","volume":"58","author":"EA Hahn","year":"2016","journal-title":"Psychol Test Assess Model"},{"key":"pone.0309272.ref025","volume-title":"Mplus Version 8.10","author":"LK Muth\u00e9n","year":"2023"},{"key":"pone.0309272.ref026","volume-title":"IBM SPSS Statistics for Windows, Version 29.0","author":"IBM Corp","year":"2023"},{"issue":"1","key":"pone.0309272.ref027","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s10549-020-05522-8","article-title":"Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics","volume":"180","author":"E Bjerkeset","year":"2020","journal-title":"Breast Cancer Res Treat"},{"issue":"1","key":"pone.0309272.ref028","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1188\/20.ONF.89-100","article-title":"Symptom Clusters in Breast Cancer Survivors: A Latent Class Profile Analysis","volume":"47","author":"L Lee","year":"2020","journal-title":"Oncol Nurs Forum"},{"issue":"7","key":"pone.0309272.ref029","first-page":"3487","article-title":"Symptom experiences in post-treatment cancer survivors: associations with acceptance and commitment therapy constructs","volume":"29","author":"AB Lewson","year":"2021","journal-title":"Support Care Cancer"},{"issue":"12","key":"pone.0309272.ref030","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1080\/0284186X.2021.1981550","article-title":"Symptom trajectories in breast cancer survivors: growth mixture analysis of patient-reported pain, fatigue, insomnia, breast and arm symptoms","volume":"60","author":"AWM Nielsen","year":"2021","journal-title":"Acta Oncol"},{"issue":"5","key":"pone.0309272.ref031","doi-asserted-by":"crossref","DOI":"10.1188\/06.ONF.E79-E89","article-title":"Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: a cluster analysis","volume":"33","author":"C Miaskowski","year":"2006","journal-title":"Oncol Nurs Forum"},{"issue":"2","key":"pone.0309272.ref032","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jpainsymman.2007.03.010","article-title":"The symptom experience of oncology outpatients has a different impact on quality-of-life outcomes","volume":"35","author":"D Pud","year":"2008","journal-title":"J Pain Symptom Manage"},{"issue":"12","key":"pone.0309272.ref033","first-page":"821","article-title":"Heterogeneity of pain-fatigue-sleep disturbance symptom clusters in lung cancer patients after chemotherapy: a latent profile analysis","volume":"32","author":"Z Zhou","year":"2024","journal-title":"Support Care Cancer"},{"issue":"4","key":"pone.0309272.ref034","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1586\/erp.11.56","article-title":"Symptom clusters in patients with lung cancer: a literature review","volume":"11","author":"E Chen","year":"2011","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"issue":"4","key":"pone.0309272.ref035","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1097\/NCC.0000000000000787","article-title":"Symptom Clusters Change Over Time in Patients With Lung Cancer During Perichemotherapy","volume":"44","author":"N Li","year":"2021","journal-title":"Cancer Nurs"},{"issue":"5","key":"pone.0309272.ref036","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1188\/06.ONF.931-936","article-title":"Symptom clusters and quality of life in survivors of lung cancer","volume":"33","author":"SW Fox","year":"2006","journal-title":"Oncol Nurs Forum"},{"issue":"8","key":"pone.0309272.ref037","doi-asserted-by":"crossref","first-page":"100103","DOI":"10.1016\/j.apjon.2022.100103","article-title":"Symptom clusters and their predictors in patients with lung cancer and treated with programmed cell death protein 1 immunotherapy","volume":"9","author":"G Zhang","year":"2022","journal-title":"Asia Pac J Oncol Nurs"},{"issue":"14","key":"pone.0309272.ref038","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1001\/archinternmed.2009.179","article-title":"Psychological distress in long-term survivors of adult-onset cancer: results from a national survey","volume":"169","author":"KE Hoffman","year":"2009","journal-title":"Arch Intern Med"},{"issue":"3","key":"pone.0309272.ref039","article-title":"Symptom Experiences in Colorectal Cancer Survivors After Cancer Treatments: A Systematic Review and Meta-analysis","volume":"43","author":"CJ Han","year":"2020","journal-title":"Cancer Nurs"},{"key":"pone.0309272.ref040","unstructured":"Cavallo, J. Data analysis of young-onset lung cancer reveals key differences compared with the disease in older adults. The ASCO Post. 2013. Available from: https:\/\/journals.plos.org\/plosone\/s\/submission-guidelines#loc-references"},{"issue":"1","key":"pone.0309272.ref041","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1186\/s12877-023-04198-1","article-title":"Age-related differences in the occurrence, severity, and distress of symptoms in older patients at the initiation of chemotherapy","volume":"23","author":"MS Johannessen","year":"2023","journal-title":"BMC Geriatr"},{"issue":"6","key":"pone.0309272.ref042","first-page":"333","article-title":"Symptom cluster among cancer survivors from a nationally representative survey: a network analysis","volume":"32","author":"Z Zhang","year":"2024","journal-title":"Support Care Cancer"},{"issue":"4","key":"pone.0309272.ref043","doi-asserted-by":"crossref","first-page":"173","DOI":"10.32604\/or.2022.027262","article-title":"Survival and comorbidities in lung cancer patients: Evidence from administrative claims data in Germany","volume":"30","author":"D Hernandez","year":"2023","journal-title":"Oncol Res"},{"key":"pone.0309272.ref044","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.lungcan.2019.03.010","article-title":"Lung cancer survivors and employment: A systematic review","volume":"131","author":"F Vayr","year":"2019","journal-title":"Lung Cancer"},{"issue":"5","key":"pone.0309272.ref045","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1007\/s11764-021-01097-5","article-title":"Investigating how cancer-related symptoms influence work outcomes among cancer survivors: a systematic review","volume":"16","author":"CJ Tan","year":"2022","journal-title":"J Cancer Surviv"},{"issue":"4","key":"pone.0309272.ref046","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1007\/s13187-016-1024-3","article-title":"The Relationship Between Cancer Survivors\u2019 Socioeconomic Status and Reports of Follow-up Care Discussions with Providers","volume":"32","author":"LD DiMartino","year":"2017","journal-title":"J Cancer Educ"},{"issue":"3","key":"pone.0309272.ref047","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1007\/s11764-023-01347-8","article-title":"Prevalence of health behaviors among cancer survivors in the United States","volume":"18","author":"K Gregory","year":"2024","journal-title":"J Cancer Surviv"},{"issue":"5","key":"pone.0309272.ref048","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1111\/jgs.15864","article-title":"Association Between Symptom Burden and Physical Function in Older Patients with Cancer","volume":"67","author":"C Pandya","year":"2019","journal-title":"J Am Geriatr Soc"},{"issue":"3","key":"pone.0309272.ref049","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1111\/nhs.13033","article-title":"Impact of symptom burden and self-efficacy on functional status in advanced breast cancer patients: A path analysis","volume":"25","author":"B Erdemsoy Karahan","year":"2023","journal-title":"Nurs Health Sci"},{"issue":"2","key":"pone.0309272.ref050","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.3390\/curroncol30020133","article-title":"Social Wellbeing in Cancer Survivorship: A Cross-Sectional Analysis of Self-Reported Relationship Closeness and Ambivalence from a Community Sample","volume":"30","author":"C Acquati","year":"2023","journal-title":"Curr Oncol"},{"issue":"17","key":"pone.0309272.ref051","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1200\/JCO.2016.71.4410","article-title":"United States population-based estimates of patient-reported outcomes measurement information system symptom and functional status reference values for individuals with cancer","volume":"35","author":"RE Jensen","year":"2017","journal-title":"J Clin Oncol"},{"issue":"1","key":"pone.0309272.ref052","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-020-05808-x","article-title":"Psychoneurological symptom cluster in breast cancer: the role of inflammation and diet","volume":"184","author":"MA George","year":"2020","journal-title":"Breast Cancer Res Treat"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0309272","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T17:46:23Z","timestamp":1761932783000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0309272"}},"subtitle":[],"editor":[{"given":"Made Satya Nugraha","family":"Gautama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":52,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0309272","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}