Perioperative symptoms in patients with thyroid cancer: a cross-sectional and longitudinal network analysis.

Abstract

Background: Patients with thyroid cancer experience a range of symptoms during surgical treatment. Identifying their core symptoms and understanding their dynamic changes can help improve the efficiency of clinical symptom management.

Methods: A longitudinal observational study design was used, and convenience sampling method was applied to select thyroid cancer patients who attended the Department of Thyroid and Breast Surgery in a tertiary hospital in Suzhou City from October 2024 to April 2025. A general information questionnaire and the Chinese version of the Memory Symptom Assessment Scale were used to assess the patients 1 day before surgery (T1), 1-2 days after surgery (T2) and 2 weeks after surgery (T3). The symptom severity bias correlation network was constructed through R language, and the core symptoms of T1, T2 and T3 were identified.

Results: This study finally included 248 patients with thyroid cancer. The results showed that the three symptoms with the highest strength centrality in the T1 network were lack of appetite (r_s=1.536), worrying (r_s=1.442), and feeling nervous (r_s=1.439). The three symptoms with the highest strength centrality in the T2 network were numbness/tingling in hands/feet (r_s=1.613), lack of appetite (r_s=1.433), and nausea (r_s=1.294). The three symptoms with the highest strength centrality in the T3 network were difficulty swallowing (r_s=1.778), feeling nervous (r_s=1.681), and neck discomfort (r_s=1.520). Neck discomfort (r_s2=1.281, r_s3=1.520) was the core symptom that was more stable postoperatively. In the test of network structural invariance, there were significant differences between T1 and T2 (M=0.78, P<0.001), T1 and T3 (M=0.45, P=0.009), and T2 and T3 (M=0.66, P<0.001). In terms of overall network connectivity strength, there were significant differences between T1 (GS=6.86) and T3 (GS=4.12), T2 (GS=7.66) and T3 (P<0.05), while there was no significant difference between T1 and T2 (P=0.65).

Conclusion: The study identified the core symptoms present at each stage of the perioperative period in patients with thyroid cancer, suggesting that clinical practitioners can develop efficient, targeted and precise management strategies based on the core symptoms at different times, with a view to improving the perioperative symptom experience of patients and increasing the efficiency of symptom management.

Clinical trial number: Not applicable.