Core preoperative symptoms and patients' symptom experiences in oral cancer: a mixed-methods study.

Abstract

Aims: Patients with oral cancer frequently experience a substantial symptom burden, especially during the preoperative phase, which is typically marked by increased anxiety, pain, and functional impairments. This study aimed to construct contemporaneous symptom networks and investigate symptom experiences of patients with preoperative oral cancer in China.

Methods: This study employed a mixed-methods design that integrated a cross-sectional study with qualitative research. Data were collected from 527 patients with oral cancer at the Department of Head and Neck Oncology in a tertiary hospital between September 2023 and May 2024 in China. The MD Anderson Symptom Inventory for Head and Neck Cancer (MDASI-H&N) was used to assess the prevalence and severity of the cancer-related symptoms. Symptom networks were constructed using the networktools, qgraph, and Bootnet packages in R, with centrality indices calculated to identify core symptoms within the network. Qualitative data were analyzed using content analysis with NVivo software to extract themes, thereby providing a comprehensive understanding of patients' symptom experiences.

Results: Distress (89.56%) and sadness (63.95%) were the most prevalent and severe symptoms, respectively. Two distinct symptom clusters emerged: the Emotional-Sleep Symptoms Cluster (Cluster 1) and Eating Disorder Symptoms Cluster (Cluster 2). Difficulty swallowing or chewing (r_s = 0.87, r_b = 102) and disturbed sleep (r_s = 0.64, r_b = 77) exhibited the highest centrality indices, indicating that these symptoms were more likely to co-occur with others within the network. Additionally, fatigue had the most significant negative impact on quality of life (r =  - 0.16).

Conclusion: This study identified core symptoms through preoperative symptom network analysis and offered valuable insights into the lived experiences of patients with oral cancer regarding their symptoms. These findings serve as a foundation for personalized targeted treatment strategies designed to improve symptom management and enhance quality of life in oral cancer care.