Core symptoms in patients with colorectal cancer receiving chemotherapy: a network analysis

To investigate the prevalence and intensity of symptoms in patients with colorectal cancer (CRC), and to develop a symptom network model to pinpoint key symptoms and clusters within the network.

This study encompassed 330 patients receiving postoperative treatment for CRC at a tertiary hospital's oncology department in Shanghai, China, from March 2023 to March 2024. Symptom assessment was conducted using the Chinese version of the MD Anderson Symptom Assessment Scale (MDASI-C) and a specially designed CRC module. Exploratory factor analysis was utilized to identify symptom clusters, and R 4.3.1 software was employed to construct networks of symptom severity and clusters. Centrality indicators, including strength, closeness, and betweenness, were subsequently analyzed to identify core symptoms and clusters.

Among CRC symptoms, altered bowel habits were the most prevalent (n = 289, 87.6%), followed by distress (n = 250, 75.8%), pain (n = 244, 73.9%), weight loss (n = 205, 62.1%), and fatigue (n = 187, 56.7%). Three primary symptom clusters emerged: The gastrointestinal-neurological cluster, the sickness behavior cluster, and the emotional cluster (variance contribution rate, 36.8%, 19.0%, and 12.3%, respectively; cumulative, 68.1%). In the symptom severity network, numbness exhibited the highest expected influence (r_E = 1.25); in the symptom cluster network, numbness (rs = 0.60), sadness (rs = 0.56), and fatigue (rs = 0.55) were the most influential symptoms across the three clusters.

In patients with CRC undergoing chemotherapy, network analysis identified numbness (gastrointestinal-neurological cluster), sadness (emotional cluster), and fatigue (sickness behavior cluster) as core symptoms, with numbness demonstrating the highest expected influence. The gastrointestinal-neurological cluster emerged as the most central. Strong symptom correlations (e.g., fear-sadness and numbness-sleep disturbance) underscored interconnected physical and psychological burdens. These findings advocate for prioritized targeted interventions: neurotoxicity monitoring for numbness, psychological support for emotional distress, and tailored fatigue management. A multidisciplinary approach is critical to address these interconnected clusters. Future research should employ longitudinal designs to unravel temporal symptom dynamics and refine personalized care.