Symptom clusters and network analysis of patients with intermediate and advanced liver cancer treated with targeted immunotherapy

Affiliations
  • 1Wuxi Medical College, Jiangnan University, 1800 Lihu Avenue, Wuxi, Jiangsu, 214122, China.
  • 2The Third Affiliated Hospital of Naval Military Medical University, No. 700, Moyu North Road, Jiading District, Shanghai, 201805, China.
  • 3Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 720 Xianxia Road, Changning District, Shanghai, 200336, China.
  • 4Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Changning District, Shanghai, 200336, China.
  • 5The Third Affiliated Hospital of Naval Military Medical University, No. 700, Moyu North Road, Jiading District, Shanghai, 201805, China. 790961222@qq.com.
  • 6The Third Affiliated Hospital of Naval Military Medical University, No. 700, Moyu North Road, Jiading District, Shanghai, 201805, China. heyalun74@gmail.com.

Published on:

Abstract

BACKGROUND

This study aims to identify symptom clusters in patients with intermediate and advanced liver cancer receiving targeted immunotherapy, focusing on core and bridge symptoms to establish a foundation for precise symptom management.

METHODS

This study used a cross-sectional survey and utilized convenience sampling from May 2023 to January 2024 at a third-class hospital in Shanghai, China. The severity of symptoms in liver cancer patients during treatment was evaluated using the Memorial Symptom Assessment Scale. Network analysis was employed to depict the interrelation of symptom clusters and identify core and bridge symptoms.

RESULTS

The symptoms were classified by severity into five clusters: oral, gastrointestinal, fatigue-related, body image, and pain-sleep. Within the symptom network, the core symptoms were pain, “I don’t look like myself,” and nausea, while the critical bridge symptoms included pain, itching, and feeling bloated. The strongest connections were observed between nausea and vomiting, followed by taste changes and dry mouth, as well as weight loss and “I don’t look like myself.”

CONCLUSION

In patients receiving targeted immunotherapy for intermediate and advanced liver cancer, multiple symptoms can emerge simultaneously, forming interconnected clusters. By identifying and intervening in core and bridge symptoms, personalized management strategies can be developed to relieve other symptoms and disrupt connections between symptom clusters, thereby enhancing symptom management efficacy. This study has significant clinical and research implications, offering new insights to improve patients’ quality of life and treatment outcomes.