Symptom cluster in patients with resected pancreatic cancer during adjuvant chemotherapy: A cross-sectional study

This study aimed to characterize symptom profiles and identify symptom clusters based on the dimensions of occurrence, severity, and distress in postoperative patients with pancreatic cancer undergoing adjuvant chemotherapy.

This cross-sectional study recruited postoperative patients with pancreatic cancer undergoing adjuvant chemotherapy at a tertiary hospital in Jiangsu Province, China, between January and March 2025. Baseline demographic and clinical data were collected one day before the chemotherapy initiation. Nutritional status was assessed using the Nutritional Risk Screening 2002 (NRS-2002). On Day 7 after the chemotherapy initiation, symptom burden and functional status were assessed using the Memorial Symptom Assessment Scale (MSAS) and the Karnofsky Performance Status (KPS) scale, respectively. Symptom clusters were identified through exploratory factor analysis (EFA), and performed separately for each dimension (occurrence, severity, and distress).

A total of 194 patients with a mean of 15.01 ​± ​4.50 symptoms were included in the final analysis. The most prevalent symptom was "Feeling drowsy" (85.8%), while "Feeling nervous" exhibited the highest severity (2.10 ​± ​1.54) and distress (2.10 ​± ​1.56) scores. Five symptom clusters were consistently identified among the three assessment dimensions (occurrence, severity, and distress): gastrointestinal, psychological, neuromuscular, physiological fatigue depletion, and body image disturbance. The inter-dimensional consistency rates for these clusters were 86%, 80%, 75%, 60%, and 67%, respectively.

This study demonstrates that postoperative patients with pancreatic cancer undergoing adjuvant chemotherapy experience a significant multidimensional symptom burden. Three symptom clusters (gastrointestinal, psychological, neuromuscular) showed high inter-dimensional consistency (≥ 75%), warranting prioritized intervention. Lower-consistency clusters (physiological energy depletion, body image disturbance) require multidimensional assessment for precise management. Three-dimensional assessment can improve personalized care and optimizes patient outcomes.