Dynamic Changes in Symptom Clusters and Symptom Networks in Patients With Multiple Myeloma: A Cross-lagged Network Analysis.

Background: Induction chemotherapy not only can effectively reduce tumor load and improve disease symptoms in patients with multiple myeloma (MM) but can also lead to toxic side effects, which increase symptom burden. Cross-lagged panel network analysis provides a novel insight into symptom influence mechanisms during multiple time periods.

Objectives: The aims of this study were to analyze the complexity and dynamic changes of symptoms experienced by patients newly diagnosed with MM in relation to the courses of chemotherapy and provide evidence for effective and precise symptom management.

Methods: A total of 175 patients newly diagnosed with MM were selected to complete the Memorial Symptom Assessment Scale-Chinese version at baseline and the first 4 courses of chemotherapy. Exploratory factor analysis was used to extract symptom clusters. Cross-lagged panel networks were constructed to identify crucial nodes in the network and explore predictive and interactive effects among symptoms.

Results: Four symptom clusters were extracted: psychological distress, disease behavior, fatigue-lack of appetite, and abdominal distension-constipation. During T0 → T1, "feeling irritable" exhibited the highest out-EI (outgoing expected influence), predicting T1 "difficulty falling asleep" and "nausea." During T1 → T2 and T2 → T3, "weight loss" predicted T2 "lack of energy" and "loss of appetite," and predicted T3 "worry," "feeling nervous," and "feeling irritable," respectively. During T3 → T4, "feeling nervous" predicted "pain," "loss of appetite," and "lack of energy" during T4.

Conclusion: "Tension" and "irritability" in the psychological symptom cluster and "weight loss" in the fatigue-related symptom cluster were "high output centrality symptoms" predicting other symptoms and the dynamic change of the whole network.

Implications for practice: Our findings provide a theoretical intervention target for nursing intervention with patients with MM.