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Symptom Clusters and Quality of Life in Cervical Cancer Patients During the Perioperative Period: A Longitudinal
Juan Yang1, Yuting Zhang1, Yaru Wu1
1School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China.
Background:
This longitudinal observational study aimed to investigate symptom clusters and quality of life (QOL) in patients with cervical cancer (CC) at multiple time points during the perioperative period. It also sought to analyze the correlation between symptom clusters and QOL, thereby providing evidence for dynamic symptom cluster management and strategies to improve patients' QOL.
Methods:
From August to December 2025, we conducted a longitudinal observational study among 183 cervical cancer patients during the perioperative period. Participants were recruited from a gynecology center within a tertiary hospital in Northwestern China. Patients completed a demographic questionnaire, the Chinese version of the MD Anderson Symptom Inventory-perioperative symptom in patients with gynecologic cancer (MDASI-PeriOp-GYN), and the Functional Assessment of Cancer Therapy-General (FACT-G). Assessments were performed on the first day of admission (T1, preoperative baseline), 1-3 days after surgery (T2), and 7-10 days after surgery (T3). Symptom clusters were extracted using exploratory factor analysis (EFA). Longitudinal trends in symptom clusters were examined using latent class mixed models (LCMM). Trends in QOL were assessed with generalized estimating equations (GEE). Correlations between symptom clusters and QOL were analyzed using Spearman correlation analysis.
Results:
Five symptom clusters were identified in cervical cancer patients during the perioperative period: pain-fatigue, psychological, hot flashes-neurological, digestive tract, and energy-deficit. The energy-deficit cluster was detected only at T2, whereas the digestive tract cluster was present at T2 and T3. LCMM analyses revealed that the pain-fatigue, psychological, and hot flashes-neurological clusters rose from T1 to T2 and subsequently declined after T2. Overall QOL followed a V-shaped trajectory: both domain and total scores declined significantly from T1 to T2, partially recovered at T3, but remained below preoperative levels. Moreover, the severity scores of all symptom clusters were negatively correlated with the total QOL score (p < 0.05).
Conclusion:
Patients undergoing cervical cancer surgery often experience various symptom clusters. High symptom severity is typically associated with lower QOL. Therefore, clinical staff should prioritize the dynamic management of symptom clusters in perioperative cervical cancer patients. This strategy can help reduce symptom burden and enhance patients' QOL.
