Longitudinal Study of Symptom Cluster Trajectories and Sentinel Symptoms in Patients With Cervical Cancer After Surgery and During the First Chemotherapy Cycle

Patients with cervical cancer often experience multiple concurrent symptoms that may cluster and change during treatment. Understanding symptom cluster trajectories and identifying sentinel symptoms may support early symptom management.

The aim is to investigate postoperative and first-cycle chemotherapy symptoms in patients with cervical cancer, analyze symptom cluster trajectories, and identify sentinel symptoms.

A prospective longitudinal study collected data at 5 time points: postoperative day 5 (T1), before the first chemotherapy (T2), and 1, 2, and 3 weeks after chemotherapy (T3-T5). Symptoms were assessed using the Symptom Assessment of Cancer Therapy-Cervix and Symptom Onset Timing Questionnaire. Latent class growth analysis identified symptom clusters and trajectories, and the Apriori algorithm detected sentinel symptoms.

Among 152 patients, 4 symptom clusters were identified. Hair loss did not cluster with other symptoms. Cluster 1 (gastrointestinal-genitourinary symptoms) showed a low-level, low-fluctuation downward trajectory. Cluster 2 (abdominal bloating-vaginal bleeding-poor appetite-weight loss-numbness) demonstrated a moderate-level downward trajectory with greater severity early after surgery. Cluster 3 (pain-fatigue) showed a high-level, high-fluctuation trajectory, with pain identified as the sentinel symptom. Cluster 4 (nervousness-depression-anxiety) showed a high-level trajectory with a slight increase over time, with nervousness identified as the sentinel symptom. No sentinel symptoms were identified in clusters 1 or 2.

Distinct symptom cluster trajectories were observed after surgery and early chemotherapy. Sentinel symptoms within key clusters may provide targets for early intervention.

Monitoring symptom cluster trajectories and sentinel symptoms may support timely, cluster-based symptom management.