The symptom cluster and core symptoms of early recovery in patients after esophageal cancer surgery: A network analysis

Abstract

Background Patients with esophageal cancer, one month after surgery, undergo a transitional period before discharge, which may trigger a range of emotional and physical adjustments, including physical and psychological symptoms. Although current research examines individual symptoms in isolation, it is crucial to comprehend the relationships between symptoms and the core symptoms for effective symptom management. Objective Our study aims to describe symptoms in patients in the early stages of postoperative recovery from esophageal cancer, identify symptom clusters, and explore core symptoms and the relationship between symptoms. Methods This study was a cross-sectional investigation utilizing convenience sampling to select 281 postoperative esophageal cancer patients from two hospitals in Henan Province, China. A self-administered general information questionnaire and Anderson's Gastrointestinal Tumour Symptom Evaluation Scale were employed to survey the symptoms. Symptom clusters were extracted via exploratory factor analysis, and a symptom network was constructed using R. Network analysis was used to estimate correlations among symptoms. Results Our study identified difficulty swallowing(86.8%), pain (86.8%), and feeling of sad(83.3%) as the most prevalent symptoms. Four symptom clusters were extracted: the eating-related symptom cluster, the fatigue and sleep symptom cluster, the difficulty swallowing and psychological symptom cluster, and the digestive reconstruction symptom cluster. In the symptom network, feeling of sad (rs = 0.979) and fatigue (rs = 0.845) had the largest value of strength centrality. Conclusion Multiple symptoms and symptom clusters are apparent in patients in the early stages of postoperative recovery from esophageal cancer. Feeling of sad and fatigue are the core symptoms in patients in the early stages of postoperative recovery from esophageal cancer. Healthcare professionals can design accurate interventions based on these core symptoms, reducing the role of sadness and fatigue in the symptom network and improving patients' quality of life.