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Updated: Sep 11, 2026
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Network temperature and stability of symptom clusters in colorectal cancer patients undergoing adjuvant chemotherapy:
Chenxi Cao1,2, Shiyu Liu1, Shengnan Shan2
1Department of Oncology, The First Affiliated Hospital of Soochow University, Soochow University, No.188 Shizi Street, Suzhou, 215006, China.
Purpose:
Postoperative colorectal cancer patients receiving adjuvant chemotherapy often experience a high symptom burden that compromises quality of life, yet evidence on the stage-specific stability of symptom clusters remains limited. We applied network temperature to characterize temporal changes in the configurational stability of symptom states during chemotherapy and to examine whether these patterns differed among symptom clusters.
Methods:
This prospective longitudinal observational study was conducted at three chemotherapy stages. Symptoms with prevalence of at least 20% at all assessments were included in multigroup Ising network models. Symptom clusters were identified using the Spinglass community detection algorithm. Temperature estimates and their 95% confidence intervals were obtained using 1000 patient-level nonparametric bootstrap resamples.
Results:
Among 380 patients, three clusters emerged: emotional distress, somatic-gastrointestinal, and fatigue-neuropathy. Overall relative network temperature decreased across chemotherapy stages. The fatigue-neuropathy cluster showed a marked reduction in temperature from the initial reference level (T1 = 1.00; T2 = 0.60 [0.49-0.74]; T3 = 0.45 [0.36-0.55]), whereas the emotional distress cluster showed an increasing temperature trajectory over time (T1 = 1.00; T2 = 1.06 [0.96-1.19]; T3 = 1.12 [1.01-1.25]).
Conclusion:
Among colorectal cancer patients receiving adjuvant chemotherapy, overall symptom-network temperature decreased across stages, indicating a more constrained distribution of symptom-state configurations. The fatigue-neuropathy cluster showed progressive concentration of symptom-state configurations, whereas the emotional distress cluster maintained greater configurational variability throughout chemotherapy. These findings highlight the importance of longitudinal, cluster-informed symptom assessment during chemotherapy.