Zhang Jie, He Qianyun, Wang Mei, Lv Xiaonan, Mao Dongliang, Li Jian, Zhu Daqiao, Huang Lei
Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Support Care Cancer. 2025 Jun 4;33(6):532. doi: 10.1007/s00520-025-09600-9.
To investigate the prevalence and intensity of symptoms in patients with colorectal cancer (CRC), and to develop a symptom network model to pinpoint key symptoms and clusters within the network.
This study encompassed 330 patients receiving postoperative treatment for CRC at a tertiary hospital's oncology department in Shanghai, China, from March 2023 to March 2024. Symptom assessment was conducted using the Chinese version of the MD Anderson Symptom Assessment Scale (MDASI-C) and a specially designed CRC module. Exploratory factor analysis was utilized to identify symptom clusters, and R 4.3.1 software was employed to construct networks of symptom severity and clusters. Centrality indicators, including strength, closeness, and betweenness, were subsequently analyzed to identify core symptoms and clusters.
Among CRC symptoms, altered bowel habits were the most prevalent (n = 289, 87.6%), followed by distress (n = 250, 75.8%), pain (n = 244, 73.9%), weight loss (n = 205, 62.1%), and fatigue (n = 187, 56.7%). Three primary symptom clusters emerged: The gastrointestinal-neurological cluster, the sickness behavior cluster, and the emotional cluster (variance contribution rate, 36.8%, 19.0%, and 12.3%, respectively; cumulative, 68.1%). In the symptom severity network, numbness exhibited the highest expected influence (r = 1.25); in the symptom cluster network, numbness (rs = 0.60), sadness (rs = 0.56), and fatigue (rs = 0.55) were the most influential symptoms across the three clusters.
In patients with CRC undergoing chemotherapy, network analysis identified numbness (gastrointestinal-neurological cluster), sadness (emotional cluster), and fatigue (sickness behavior cluster) as core symptoms, with numbness demonstrating the highest expected influence. The gastrointestinal-neurological cluster emerged as the most central. Strong symptom correlations (e.g., fear-sadness and numbness-sleep disturbance) underscored interconnected physical and psychological burdens. These findings advocate for prioritized targeted interventions: neurotoxicity monitoring for numbness, psychological support for emotional distress, and tailored fatigue management. A multidisciplinary approach is critical to address these interconnected clusters. Future research should employ longitudinal designs to unravel temporal symptom dynamics and refine personalized care.
调查结直肠癌（CRC）患者症状的患病率和严重程度，并建立症状网络模型以确定网络中的关键症状和症状群。
本研究纳入了2023年3月至2024年3月在中国上海一家三级医院肿瘤科接受CRC术后治疗的330例患者。使用中文版的MD安德森症状评估量表（MDASI-C）和专门设计的CRC模块进行症状评估。采用探索性因子分析来识别症状群，并使用R 4.3.1软件构建症状严重程度和症状群的网络。随后分析中心性指标，包括强度、接近度和中介中心性，以识别核心症状和症状群。
在CRC症状中，排便习惯改变最为常见（n = 289，87.6%），其次是苦恼（n = 250，75.8%）、疼痛（n = 244，73.9%）、体重减轻（n = 205，62.1%）和疲劳（n = 187，56.7%）。出现了三个主要症状群：胃肠-神经症状群、疾病行为症状群和情绪症状群（方差贡献率分别为36.8%、19.0%和12.3%；累积贡献率为68.1%）。在症状严重程度网络中，麻木表现出最高的预期影响（r = 1.25）；在症状群网络中，麻木（rs = 0.60）、悲伤（rs = 0.56）和疲劳（rs = 0.55）是三个症状群中最具影响力的症状。
在接受化疗的CRC患者中，网络分析确定麻木（胃肠-神经症状群）、悲伤（情绪症状群）和疲劳（疾病行为症状群）为核心症状，其中麻木的预期影响最高。胃肠-神经症状群最为核心。强烈的症状相关性（如恐惧-悲伤和麻木-睡眠障碍）突出了身体和心理负担的相互联系。这些发现主张采取优先的针对性干预措施：对麻木进行神经毒性监测、对情绪困扰提供心理支持以及进行针对性的疲劳管理。多学科方法对于解决这些相互关联的症状群至关重要。未来的研究应采用纵向设计来揭示症状的时间动态变化并完善个性化护理。
