Liu Hanxue, Zhang Xiaoju, Qiu Jiajia, Lu Zhenqi, Chen Chong
Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Asia Pac J Oncol Nurs. 2025 Apr 29;12:100710. doi: 10.1016/j.apjon.2025.100710. eCollection 2025 Dec.
Patients experience diverse symptoms during the oral intake rehabilitation period after esophagectomy, yet symptom interactions remain poorly understood. This study aimed to identify symptom clusters, core symptoms, and their relationships to inform targeted nursing interventions.
In this cross-sectional study, 252 participants completed the Anderson Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer quality of life questionnaire, specifically the esophageal-specific module (EORTC QLQ-OES18). Symptom clusters were derived via Principal Component Analysis (SPSS 26.0), and a network analysis (R4.3.1) was conducted to explore symptom centrality and interconnectedness.
Five symptom clusters emerged: reflux symptoms, unpleasant eating changes, low spirits symptoms, nerve damage symptoms, and energy deficiency symptoms. Distress (strength = 4.878, betweenness = 20, closeness = 0.263) and trouble enjoying meals (strength = 4.666, betweenness = 28, closeness = 0.258) were identified as core symptoms and with the highest bridge strength (distress: 3.400; trouble enjoying meals: 3.210). Patients experiencing these symptoms exhibited significantly greater weight loss (distress: 2.60 ± 2.52 vs. 1.68 ± 2.10 kg, = 0.002; trouble enjoying meals:2.42 ± 2.56 vs. 1.65 ± 2.00 kg, = 0.009).
Distress and trouble enjoying meals are not only core symptoms but also bridge symptoms. Future interventions targeting these two symptoms may be able to alleviate the overall symptoms and reduce weight loss during the oral intake rehabilitation period following esophagectomy.
食管癌切除术后经口摄入康复期间，患者会经历多种不同症状，但症状之间的相互作用仍知之甚少。本研究旨在识别症状群、核心症状及其关系，为有针对性的护理干预提供依据。
在这项横断面研究中，252名参与者完成了安德森症状评估量表和欧洲癌症研究与治疗组织生活质量问卷，特别是食管特异性模块（EORTC QLQ-OES18）。通过主成分分析（SPSS 26.0）得出症状群，并进行网络分析（R4.3.1）以探索症状的中心性和相互关联性。
出现了五个症状群：反流症状、不愉快的饮食变化、情绪低落症状、神经损伤症状和能量不足症状。痛苦（强度=4.878，中间中心性=20，紧密中心性=0.263）和用餐愉悦困难（强度=4.666，中间中心性=28，紧密中心性=0.258）被确定为核心症状，且具有最高的桥梁强度（痛苦：3.400；用餐愉悦困难：3.210）。出现这些症状的患者体重减轻明显更多（痛苦：2.60±2.52 vs. 1.68±2.10千克，P=0.002；用餐愉悦困难：2.42±2.56 vs. 1.65±2.00千克，P=0.009）。
痛苦和用餐愉悦困难不仅是核心症状，也是桥梁症状。未来针对这两种症状的干预措施可能能够缓解总体症状，并减少食管癌切除术后经口摄入康复期间的体重减轻。
