Identifying Core Symptoms in Breast Cancer Patients with Different Chemotherapy Phases Using Network Analysis: A...

Network analysis can identify the core symptoms reported by patients at each time point, providing a basis to develop precise symptom strategies for treatment. However, few studies have established symptom networks for breast cancer patients at various treatment stages.

The purpose of this study was to identify core symptoms that may be targeted for intervention in different chemotherapy phases for breast cancer patients.

A multicenter prospective longitudinal survey design was employed in this study. 467 breast cancer patients were recruited in the Breast Surgery Ward from November 2022 and October 2023. The Symptoms Assessment Scale for Breast Cancer Patients Receiving Chemotherapy was used to assess breast cancer patients' symptoms before chemotherapy (T0), after the first chemotherapy (T1), after three chemotherapy treatments (T2), and after the sixth chemotherapy treatment (T3). Symptom networks and node properties were explored using network analysis.

At T0, difficulty sleeping was a symptom with the highest strength (r _s=2.43) and closeness (r _c=1.51). Depression was a symptom with the highest betweenness (r _b=2.47). At T1, decreased appetite was the symptom with the highest strength centrality (r _s=2.22). Pain was the symptom with the highest closeness centrality (r _c=1.48). Headache was a symptom with the highest betweenness centrality (r _b=1.68). Fatigue was the symptom with the highest strength, closeness, and betweenness at T2 and T3 (T2: r _s=1.67; r _c=2.11; r _b=2.30. T3: r _s=1.96; r _c=2.68; r _b=2.15). Except for betweenness centrality at T1, all other centrality measures showed CS coefficients above 0.25, indicating that the symptom networks were substantially stable.

The core symptoms that need to be targeted for intervention in various chemotherapy stages of breast cancer patients differ. Difficulty sleeping and depression should be addressed at T0; decreased appetite and pain were the core symptoms at T1; and fatigue was the most central symptom at T2 and T3 and should be controlled as a priority.