# Study on the network of postoperative symptoms and its influencing factors in esophageal cancer patients

## TL;DR

This study explores the network of symptoms experienced by esophageal cancer patients after surgery to improve symptom management and patient recovery.

## Contribution

The study introduces network analysis to identify core and bridging symptoms in postoperative esophageal cancer patients.

## Key findings

- Fatigue is identified as the strongest core symptom in postoperative esophageal cancer patients.
- A choking sensation is the most significant bridging symptom in the symptom network.
- Factors like age, tumor stage, and surgical method significantly influence postoperative symptoms.

## Abstract

Esophageal cancer(EC) is a common and highly invasive malignant tumor of the digestive tract, for which surgery remains a key treatment modality. Postoperative patients frequently experience multiple coexisting physical and psychological symptoms. These symptoms are interrelated, forming a complex network that can substantially affect rehabilitation and health-related quality of life. Current symptom management often relies on traditional classification methods, which may be insufficient to elucidate the intrinsic relationships and core mechanisms among symptoms. Network analysis offers a new approach for identifying core symptoms, bridging symptoms, and key influencing factors. This study employs such methods to explore the relationships among postoperative symptoms in esophageal cancer, with the aim of providing evidence to support precise interventions and to enhance the effectiveness of symptom management.

To construct a symptom network for post-operative esophageal cancer patients, identify core and bridging symptoms, and explore influencing factors, thereby providing references for precise and efficient symptom management.

A convenience sampling method was used to select 263 patients with esophageal cancer undergoing surgery for investigation, and general information questionnaires and esophageal cancer perioperative symptom assessment scales were used. Univariate analysis and multivariate linear regression analysis were used to identify the influencing factors: bridge symptoms between core symptoms and symptom clusters were identified based on network analysis.

After surgery, esophageal cancer patients exhibited three symptom clusters: eating-related symptoms, pain and fatigue-related symptoms, and somatic-psychological symptoms, with a cumulative variance contribution rate of 67.841%. In the symptom network, fatigue (strength centrality,rs = 2.10) was the strongest core symptom, while a choking sensation (rs = 0.10) had the highest bridge strength among the bridge symptoms. The univariate analysis of results showed that gender, educational level, marital status, employment status, medical payment method, per capita monthly household income, pathological type, tumor location, disease duration, and whether postoperative or pre-discharge gastrointestinal nutrition tubes were used were not statistically significant (P>0.05). However, age, presence or absence of other chronic diseases, surgical method, treatment method, postoperative hospital stay, and tumor stage were statistically significant (P<0.05).

Fatigue is the primary symptom for esophageal cancer patients post-surgery; Healthcare providers can use symptom network analysis to promptly identify core symptoms, bridge symptoms, and influencing factors, thereby formulating precise and effective intervention measures to improve symptom management efficiency and reduce the postoperative symptom burden on esophageal cancer patients.