Abstract:

Objective To explore the temporal evolution of symptom networks in patients with head and neck cancer undergoing chemoradiotherapy，and to inform precise symptom management strategies.Methods A prospective longitudinal study design was adopted. A convenience sample of 330 patients undergoing chemoradiotherapy was recruited from the head and neck surgery department of a tertiary oncology hospital in Henan Province between January 2024 and August 2025. The M.D. Anderson Symptom Inventory-Head and Neck Module was used to assess symptoms at 3 time points：before chemoradiotherapy（T0），at week 3 of chemoradio-therapy（T1），and at treatment completion（T2）. Dynamic symptom network analysis was performed using R 4.5.2 software，and network stability was evaluated.Results A total of 275 patients completed all assessments and were included in the final analysis. Dry mouth had the highest incidence at T1（82.9%），and oral/throat sores had the highest incidence at T2（90.2%）. Dynamic network analysis revealed that during the T0-to-T1 phase，oral/throat sores had the most outgoing predictive edges and dry mouth had the highest out-expected influence（EI=2.365）. During the T1-to-T2 phase，difficulty swallowing/chewing emerged as the symptom with the most outgoing predictive edges and the highest out-expected influence（EI=3.506）. Lack of appetite and difficulty swallowing/chewing had the highest bridge expected influence，and the overall network connectivity strength increased. Network stability tests yielded satisfactory to acceptable results.Conclusion The symptom network in patients with head and neck cancer undergoing chemoradiotherapy exhibits temporal dynamics. These findings suggest that nurses should implement phase-specific proactive symptom monitoring and preventive targeted interventions to interrupt cross-cluster symptom propagation，thereby mitigating functional decline，and optimizing overall quality of life.

Key words: Head and Neck Cancer, Chemoradiotherapy, Symptom Management, Network Analysis, Nursing Care

摘要：

目的 探索头颈部肿瘤放化疗患者症状网络的时序演变规律，为精准症状管理提供参考。方法 采用前瞻性纵向研究设计，便利选取2024年1月—2025年8月河南省某三级甲等肿瘤专科医院行放化疗的330例头颈部肿瘤患者，采用安德森症状评估量表-头颈部模块，分别于放化疗前（T0）、放化疗第3周（T1）、放化疗结束时（T2）进行评估。应用R 4.5.2软件进行症状动态网络分析，并评估网络稳定性。结果 最终275例患者完成全部评估并纳入分析。T1口干发生率最高（82.9%），T2口腔/喉咙溃疡发生率最高（90.2%）。动态网络分析结果显示：T0至T1阶段，口腔/喉咙溃疡发出预测边最多，口干出预期影响系数最高（预期影响系数=2.365），二者共同构成早期双核心驱动症状；T1至T2阶段，吞咽/咀嚼困难取代前者成为发出预测边最多且出预期影响系数最高的症状（预期影响系数=3.506）；两阶段中食欲不振与吞咽/咀嚼困难为桥梁预期影响系数最高的症状，且网络整体连接强度呈递增趋势，网络稳定性良好。结论 头颈部肿瘤放化疗患者症状网络呈时序动态性，提示护理人员应实施分阶段前瞻性症状监测与靶向干预，阻断症状介导的跨群传播链路，以延缓功能衰退，优化患者的生活质量。

关键词: 头颈部肿瘤, 放化疗, 症状管理, 网络分析, 护理