Network analysis of core symptom changes in lung cancer survivors: a longitudinal study.

Purpose: To explore the dynamic changes and to identify core symptoms using network analysis in lung cancer survivors before, during, and after radiotherapy using a longitudinal approach.

Methods: This study recruited 234 lung cancer survivors from a prospective and longitudinal study in a tertiary cancer hospital of China from January 2023 to October 2024. M.D. Anderson Symptom Inventory of lung cancer module (MDASI-LC) and Hospital Anxiety and Depression Scale (HADS) were used to measured physical and psychological symptoms at the time of pre-radiotherapy, the end of radiotherapy, and 4 weeks after radiotherapy, respectively. Network analysis was performed using R software version 4.3.2 to identify the core symptoms.

Results: A total of 234 lung cancer survivors are treated with radiotherapy; participants were included with an average age of 59.2 years, predominantly male (78.2%), representing various lung cancer subtypes and stages. Before radiotherapy, poor appetite was identified as the core symptom. At the end of radiotherapy, shortness of breath emerged as the central symptom, likely driven by radiation-induced respiratory complications. Four weeks after radiotherapy, fatigue became the most significant symptom. Psychological networks revealed depressive symptoms of lack of optimism as core before radiotherapy, panic as central at the end of treatment, and tension as predominant post-radiotherapy.

Conclusions: This study highlights the dynamic evolution of core symptoms in lung cancer survivors undergoing radiotherapy. Findings underscore the importance of early interventions targeting appetite and psychological distress, as well as post-treatment strategies to address fatigue and emotional tension. Integrating physical and psychological care through symptom network analysis can guide personalized management approaches, improving patient quality of life and treatment outcomes.

Implications for cancer survivors: Integrating dynamic symptom management strategies that address evolving physical and psychological challenges, such as appetite, fatigue, and emotional tension, can significantly enhance quality of life and treatment outcomes for lung cancer survivors undergoing radiotherapy.