Abstract:

Objective To identify the core symptoms of cancer-related cognitive impairment（CRCI） in lung cancer patients and their complex relationships with various dimensions of quality of life based on a symptom network model，so as to provide a basis for precise nursing interventions. Methods A cross-sectional study was conducted. A convenience sample of 348 lung cancer patients was recruited from 3 tertiary hospitals in Chongqing，China，between April and December 2024. Cognitive function was assessed using the telephone interview for cognitive status-modified（TICS-M） and the functional assessment of cancer therapy-cognitive function（FACT-Cog）. Quality of life was assessed using the European organisation for research and treatment of cancer quality of life questionnaire （EORTC QLQ-C30）. The R software was used to construct a partial correlation network model depicting the relationships between CRCI symptoms and QoL dimensions. Node strength，closeness，betweenness，and predictability were analyzed to identify core symptoms and key association pathways. Results A total of 326 lung cancer patients were included. Symptom network analysis revealed that the top 3 edge weights were between physical function and role function（weight=0.35），between impact on QoL and other’s perception of cognitive functioning（weight=0.34），and between perceived cognitive impairments and other’s perception of cognitive functioning（weight=0.33）. The strongest negative edge connection was between social function and impact on QoL. Perceived cognitive impairments had the highest strength（r_s=1.28），closeness（r_c=0.007 4），betweenness（r_b=18），and predictability（65.7%），identifying it as the core symptom of CRCI in lung cancer patients. The network demonstrated good accuracy and stability，indicating a reliable model. Conclusion The symptom network model reveals the complex interactive mechanisms between CRCI symptoms and QoL dimensions in lung cancer patients. Perceived cognitive impairments is identified as the core intervention target. It is recommended that nursing staff prioritize designing intervention strategies targeting this core symptom and pay attention to its strong associations with dimensions such as physical functioning and social functioning to synergistically improve patients’ overall quality of life.

Key words: Symptom Network, Cancer-Related Cognitive Impairment, Lung Neoplasms, Quality of Life, Nursing Care

摘要：

目的 基于症状网络模型，识别肺癌患者癌症相关认知障碍的核心症状及其与生活质量各维度的复杂关系，为精准护理干预提供依据。 方法 采用横断面研究设计，于2024年4—12月便利抽取重庆市3所三级甲等医院348例肺癌患者作为调查对象。使用认知功能电话问卷修订版和癌症治疗功能评估-认知功能分量表评估认知功能，使用欧洲癌症患者生活质量问卷评估生活质量。运用R软件构建癌症相关认知障碍症状与生活质量各维度的症状网络模型，分析节点强度、紧密度、中介度及可预测性等指标，识别核心症状及关键关联路径。 结果 共纳入肺癌患者326例。症状网络分析显示，边缘权重排前3的分别是躯体功能和角色功能、对生活质量的影响和他人察觉的认知问题以及感知认知障碍和他人察觉的认知问题，权重依次为0.35、0.34和0.33。最强的负性边连接是社会功能和对生活质量的影响。感知认知障碍具有最高的强度（r_s=1.28）、紧密度（r_c=0.007 4）、中介度（r_b=18）及可预测性（65.7%），是肺癌患者癌症相关认知障碍的核心症状。经检验，网络的准确性和稳定性较好，网络模型可靠。 结论 症状网络模型揭示了肺癌患者癌症相关认知障碍症状与生活质量各维度的复杂交互机制，感知认知障碍为核心干预靶点。建议护理人员优先针对该核心症状设计干预策略，并关注其与躯体功能、社会功能等维度的强关联，以协同改善患者整体生活质量。

关键词: 症状网络, 癌症相关认知障碍, 肺癌, 生活质量, 护理