Symptoms experience during the oral intake rehabilitation period following esophagectomy: A network analysis

Patients experience diverse symptoms during the oral intake rehabilitation period after esophagectomy, yet symptom interactions remain poorly understood. This study aimed to identify symptom clusters, core symptoms, and their relationships to inform targeted nursing interventions.

In this cross-sectional study, 252 participants completed the Anderson Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer quality of life questionnaire, specifically the esophageal-specific module (EORTC QLQ-OES18). Symptom clusters were derived via Principal Component Analysis (SPSS 26.0), and a network analysis (R4.3.1) was conducted to explore symptom centrality and interconnectedness.

Five symptom clusters emerged: reflux symptoms, unpleasant eating changes, low spirits symptoms, nerve damage symptoms, and energy deficiency symptoms. Distress (strength ​= ​4.878, betweenness ​= ​20, closeness ​= ​0.263) and trouble enjoying meals (strength ​= ​4.666, betweenness ​= ​28, closeness ​= ​0.258) were identified as core symptoms and with the highest bridge strength (distress: 3.400; trouble enjoying meals: 3.210). Patients experiencing these symptoms exhibited significantly greater weight loss (distress: 2.60 ​± ​2.52 vs. 1.68 ​± ​2.10 kg, P ​= ​0.002; trouble enjoying meals:2.42 ​± ​2.56 vs. 1.65 ​± ​2.00 kg, P ​= ​0.009).

Distress and trouble enjoying meals are not only core symptoms but also bridge symptoms. Future interventions targeting these two symptoms may be able to alleviate the overall symptoms and reduce weight loss during the oral intake rehabilitation period following esophagectomy.