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Symptom network analysis of fear of recurrence and burden in postoperative lung cancer: A simulation-based
Miao Liu1, Xiaoran Mi1, Muxuan Xu1
1Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli NO17, Chaoyang District, Beijing, 100021, China.
Purpose:
Fear of cancer recurrence (FCR) and self-perceived burden (SPB) are common in postoperative lung cancer patients, yet their mutual interactions and potential causal pathways remain unclear. This study aimed to explore the symptom network characteristics of FCR and SPB, and to identify potential targets for intervention.
Methods:
A total of 336 patients with postoperative lung cancer were recruited. The Fear of Progression Questionnaire-Short Form and the Self-Perceived Burden Scale were administered to assess key psychological symptoms. Gaussian graphical modelling was applied to identify central symptoms and bridging nodes that link the two syndromes. Bayesian network analysis was applied to explore potential causal pathways, followed by a simulation study to identify intervention targets within the symptom network.
Results:
In the Gaussian graphical model, "Worried about undergoing major treatments"exhibited the highest bridge centrality (1.163), serving as the main conduit between the FCR and SPB clusters. The Bayesian network identified "Worried about losing ability to pursue hobbies" and "Worried caregiver does too much" as parent nodes. Simulation analysis revealed that alleviating "Worried caregiver does too much" resulted in the greatest reduction in global network strength (from 8.68 to 4.16).
Conclusions:
SPB may exacerbate persistent FCR through interconnected key symptoms, particularly concerns about major treatments and caregiver overburden. Prioritizing interventions that target caregiver-related distress, especially reducing worries about excessive caregiver workload, may generate synergistic effects in alleviating both psychological burden and recurrence fear, providing a promising target for postoperative psychological care.
