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The Symptom Clusters and Core Symptoms in Patients with Lung Cancer After Surgery: A Longitudinal Network Analysis
Xueqi Tian1, Yuening Dai1, Zhiyi Dong2
1Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, People's Republic of China.
Objective:
To create a symptom network for patients who have had lung cancer surgery, pinpoint the primary symptoms, and investigate the factors that influence symptom clusters.
Methods:
A longitudinal observational design was adopted in the present study. Postoperative symptoms were measured via the MD Anderson Symptom Inventory-Traditional Chinese Medical version (MDASI-TCM). Principal component analysis was performed to extract distinct symptom clusters. Multivariate logistic regression models were constructed to explore independent influencing factors of each symptom cluster. Extended Bayesian Information Criterion Graphical Lasso was then applied to identify core and bridging symptoms within the pooled symptom network.
Results:
205 patients with lung cancer who underwent surgical resection were included in this study. At 24 hours postoperatively, pain, fatigue, disturbed sleep, shortness of breath, and loss of appetite exhibited the highest prevalence among all assessed symptoms. At the three months follow-up, elevated prevalence persisted for fatigue, shortness of breath, and disturbed sleep. Five symptom clusters were identified: digestive system symptom cluster (dry mouth, bitter taste, constipation, and abdominal fullness), emotional symptom cluster (problem remembering, sad, distressed, fidgety, and disturbed sleep), cancer-related complex symptom cluster (fatigue, nausea, lack of appetite, shortness of breath, and pain), respiratory system symptom cluster (coughing, and expectoration), and autonomic nerve-related somatic symptom cluster (numbness or tingling, sweating, and palpitation). Based on the strength centrality index, the core symptoms of patients were fatigue. According to bridge strength, the bridge symptoms were lack of appetite and dry mouth. The edge weight difference test showed that the symptom group exhibited higher stability.
Conclusion:
Lung cancer patients had surgery experienced five symptom clusters. The fatigue, lack of appetite, and dry mouth should be given priority for intervention.
