Symptom network analysis during radiotherapy in gastrointestinal cancers: A longitudinal study primarily involving esophageal cancer patients.

Objective: To investigate longitudinally the core symptom clusters and their association with quality of life in patients undergoing radiotherapy for gastrointestinal cancers, with the aim of reducing symptom burden and enhancing quality of life. Methods: A longitudinal study was conducted among 130 conveniently selected patients receiving radiotherapy for gastrointestinal cancers. Symptom occurrence and quality of life were assessed using a general information questionnaire, the M.D. Anderson Symptom Inventory-Gastrointestinal Cancer Module, and the Quality of Life Scale at three time points: 7 days before radiotherapy (T0), the 15th radiotherapy session (T1), and 30 days after completion of radiotherapy (T2). Results: Network analysis revealed that loss of appetite exhibited the highest centrality strength at T0 (r S ​= ​1.293) and T2 (r S ​= ​1.180), and the highest betweenness at T0 (r B ​= ​50), while fatigue demonstrated the highest strength at T1 (r S ​= ​1.215). Statistically significant differences were observed in quality of life scores across all dimensions-excluding shortness of breath and constipation-at different time points (P ​< ​0.05). Core symptom cluster severity scores were negatively associated with quality of life scores at all time points (P ​< ​0.01). Conclusions: The emotion-energy deficiency cluster was identified as the core symptom cluster, with its severity negatively associated with quality of life. Continuous interventions targeting this cluster are essential to enhance the precision and effectiveness of symptom management and thereby improve patients' quality of life.