The Research On Symptom Clusters In Ovarian Cancer Patients Receiving Chemotherapy Based On Network Analysis

ObjectivesTo evaluate the composition of symptom clusters in ovarian cancer patients during chemotherapy.Then,we analyzed the relationship between symptoms within clusters through network analysis to promote cluster-based symptom management for ovarian cancer patients.MethodsWith a cross-sectional design study,we recruited ovarian cancer patients through convenience sampling of three tertiary hospitals from April 2022 to January 2023.During the third cycle of postoperative chemotherapy,the Memorial Symptom Assessment Scale(Chinese version)was applied to assess symptoms’ occurrence,severity,and distress ratings in ovarian cancer patients.The data were analyzed using SPSS 26.0 and R software.We conducted exploratory factor analysis(EFA)to confirm symptom clusters in ovarian cancer patients based on symptoms’ severity and distress ratings.Then,we compared the percentage of agreement of each symptom cluster across the two dimensions.Network analysis was conducted to describe the relationship between symptoms within clusters for ovarian cancer patients.Results1.Differences in symptom clusters identified using ratings of symptom distress vs.severity in ovarian cancer patients during chemotherapyThree hundred ninety questionnaires were distributed in this study,with 375 valid questionnaires and an effective recovery rate of 96.15%.The mean number of symptoms experienced by ovarian cancer patients during the third cycle of postoperative chemotherapy was 12.96±4.51.The most prevalent symptom was hair loss(100%),the symptom with the highest occurrence ratings was diarrhea(2.31±0.61),the symptom with the highest severity ratings was weight loss(2.43±0.80),and the symptom with the highest distress ratings was swelling of arms or legs(2.23±0.60).2.Symptom clusters in ovarian cancer patients during chemotherapy(1)The EFA of the severity ratings indicated that the six-factor solution best fit the data,accounting for 74.19% of the total variance.During the third cycle of postoperative chemotherapy in ovarian cancer patients,six symptom clusters were identified and named gastrointestinal symptom cluster(i.e.,loss of appetite,change in the way food tastes,vomiting,nausea),body image symptom cluster(i.e.,changes in the skin,I do not look like myself,hair loss,weight loss),fatigue-related symptom cluster(i.e.,lack of energy,pain,feeling irritable,difficulty sleeping),peripheral neuropathy symptom cluster(i.e.,constipation,numbness/tingling in hands/feet,dry mouth),psychological symptom cluster(i.e.,feeling worrying,feeling sad,feeling nervous),and perimenopausal symptom cluster(i.e.,sweats,problems with sexual interest or activity),which explained 14.49%,14.24%,13.11%,12.90%,9.76%,9.69%of the total variance,respectively.(2)The EFA of the distress ratings indicated that the five-factor solution best fit the data,accounting for 70.01% of the total variance.During the third cycle of postoperative chemotherapy in ovarian cancer patients,five symptom clusters were identified and named peripheral neuropathy symptom cluster(i.e.,numbness/tingling in hands/feet,constipation,lack of energy,dry mouth,pain),gastrointestinal symptom cluster(i.e.,loss of appetite,vomiting,nausea,change in the way food tastes),body image symptom cluster(i.e.,changes in the skin,I do not look like myself,hair loss,weight loss),psychological symptom cluster(i.e.,feeling sad,feeling nervous,worrying,feeling irritable),and perimenopausal symptom cluster(i.e.,sweats,problems with sexual interest or activity,difficulty sleeping),which explained 16.44%,15.49%,14.05%,12.36%,11.67% of the total variance,respectively.(3)The percentage of agreement(actual number of symptoms within cluster/total number of possible symptoms within cluster×100%)was used to compare the composition of the symptom clusters identified based on the severity and distress ratings varied.Among them,gastrointestinal,body image,and psychological symptom clusters were relatively consistent,with a percentage of agreement ≥75%.In contrast,the compositions of peripheral neuropathy and perimenopausal symptom cluster were more variable,with the percentage of the agreement being 60% and 67%,respectively.The fatigue-related symptom cluster was identified only in the severity ratings and not in the distress ratings.3.Network analysis of symptom clusters in ovarian cancer patients during chemotherapyWe used Closeness,Betweenness,and Strength to analyze all symptoms comprehensively.The Closeness,Betweenness,and Strength of nausea(Closeness=0.0023,Betweenness=32,Strength=0.92),hair loss(Closeness=0.0019,Betweenness=28,Strength=0.77),feeling irritable(Closeness=0.0036,Betweenness=90,Strength=1.02),numbness/tingling in hands/feet(Closeness=0.0025,Betweenness=34,Strength=1.00),feeling nervous(Closeness=0.0037,Betweenness=100,Strength=0.94),and sweats(Closeness=0.0028,Betweenness=20,Strength=1.00)were the highest within the cluster of gastrointestinal,body image,fatigue-related,peripheral neuropathy,psychological and perimenopausal,respectively.The network’s accuracy and stability were enough.The centrality stability coefficients(CS-coefficient)of Strength,Closeness,and Betweenness were 0.67,0.60,and 0.36,respectively.Conclusions1.Ovarian cancer patients have a high incidence of symptoms in the third cycle of postoperative chemotherapy;attention should be paid to the symptom management of patients at this stage.2.We found that the severity ratings fit the data best.During the third cycle of postoperative chemotherapy in ovarian cancer patients,the cluster of gastrointestinal,body image,fatigue-related,peripheral neuropathy,psychological,and perimenopausal were identified.3.Nausea,hair loss,feeling irritable,numbness/tingling of hands/feet,feeling nervous,and sweats are the most central symptoms within the cluster of gastrointestinal,body image,fatigue-related,peripheral neuropathy,psychological and perimenopausal,respectively.The results suggest that clinical workers should pay more attention to the above symptoms of ovarian cancer patients during chemotherapy,which lays a theoretical foundation for accurate symptom management.