Symptom Networks in Postsurgical Cancer Pain Across Recovery Stages

Pain is a leading cause of emergency department visits among cancer patients, often exacerbated by psychological distress. Understanding how pain and psychological symptoms interconnect at different postoperative stages may inform precision symptom management. This secondary analysis used network analysis to map symptom interconnections in cancer patients with recent (≤3 months) vs distant (>3 months) surgical histories.

Data were obtained from a prospective observational cohort. Participants were recruited from the emergency department primarily for pain-related visits. Patient-reported outcomes included pain severity and interference assessed by the Brief Pain Inventory, psychological symptoms assessed using PROMIS short forms (anxiety, depression, sleep disturbance), and pain catastrophizing assessed with the Pain Catastrophizing Scale. Network analysis was performed on patient-reported pain severity, pain interference, anxiety, depression, helplessness, and sleep disturbance. We compared networks with the Network Comparison Test and evaluated edge accuracy and centrality stability via bootstrapping.

Of the entire sample of N = 174 participants, n = 120 had prior cancer-related surgeries and were included in this evaluation. The two networks showed no significant differences in global structure or strength. At the local level, centrality invariance suggested sleep disturbance differed in strength (p = .042) and pain interference differed in betweenness (p = .031) across groups. In the recent group, helplessness was the most prominent psychological node, with sleep disturbance also influential. In the distant group, pain interference acted as a key bridge linking pain intensity and affective-cognitive symptoms. Bootstrap analyses indicated acceptable stability of centrality estimates.

Symptom networks showed pattern-level differences, highlighting helplessness and sleep disturbance as early priorities and pain interference as a later bridging target. These findings support stage-specific screening and brief interventions in nursing practice.

Early recovery requires screen or coach for helplessness and sleep disturbance; while later recovery, we prioritize pain function-focused strategies and pacing to limit cross-cluster symptom spread.