Longitudinal study on core symptoms and nursing strategies for patients with colorectal cancer undergoing postoperative chemotherapy

doi:10.3761/j.issn.0254-1769.2025.11.005

Abstract

Abstract:

Objective To explore the changes in symptom clusters and core symptoms at different stages in colorectal cancer patients undergoing postoperative chemotherapy，and to provide a reference for developing precise symptom management strategies in clinical practice. Methods 300 colorectal cancer patients who underwent postoperative chemotherapy at 2 tertiary hospitals in Tianjin from August 2023 to May 2024 were conveniently selected as the study subjects. General information questionnaires and the Chinese version of the MD Anderson Symptom Inventory for Colorectal Cancer were used to survey patients during the first chemotherapy cycle（T1） and the third chemotherapy cycle（T2）. Exploratory factor analysis was used to extract symptom clusters；R language was used to construct symptom networks. Results 300 questionnaires were distributed and collected at T1，and 264 questionnaires were distributed and collected at T2，with a recovery rate of 88.00%. Colorectal cancer patients undergoing postoperative chemotherapy had 5 symptom clusters at T1，and 4 symptom clusters at T2. In the symptom network，distress was the symptom with the highest strength（r_s=1.188），closeness centrality（r_c=0.004），and betweenness centrality（r_b=36） at T1. Distress was the symptom with the highest strength（r_s=1.397），while decreased appetite had the highest closeness centrality（r_c=0.004） and betweenness centrality（r_b=39） at T2. Conclusion The symptom clusters in colorectal cancer patients undergoing postoperative chemotherapy remain stable over time. Distress is a stable core symptom during chemotherapy，while decreased appetite is a bridging symptom in the mid-chemotherapy phase. Healthcare providers should prioritize interventions for decreased appetite while addressing emotional symptoms to improve the efficiency of symptom management.

Key words: Colorectal Cancer, Symptom Clusters, Chemotherapy, Core Symptoms, Network Analysis, Nursing Care

摘要：

目的探讨结直肠癌术后化疗患者不同时期症状群及核心症状的变化，为制订精准的症状管理方案提供参考。方法采用便利抽样法，选取2023年8月—2024年5月在天津市2所三级甲等医院住院治疗的300例结直肠癌术后化疗患者作为调查对象，采用一般资料调查表、中文版安德森症状评估量表结直肠癌模块在第1化疗周期（T1）和第3化疗周期（T2）进行调查。使用探索性因子分析法提取症状群并运用R语言构建症状网络分析中心性指标。结果 T1时发放并回收调查问卷300份，T2时发放调查问卷300份，回收264份，有效问卷回收率为88.00%。结直肠癌术后化疗患者T1时存在5个症状群，T2时存在4个症状群。在症状网络中，T1时苦恼是强度（r_s=1.188）、紧密中心性（r_c=0.004）和中介中心性（r_b=36）最大的症状；T2时苦恼是强度（r_s=1.397）最大的症状，食欲下降是紧密中心性（r_c=0.004）和中介中心性（r_b=39）最大的症状。结论结直肠癌术后化疗患者的症状群持续稳定存在；苦恼既是结直肠癌术后患者化疗期稳定存在的核心症状又是化疗初期的桥梁症状，食欲下降是化疗中期的桥梁症状。医护人员在干预苦恼的同时还要优先干预食欲下降，提高症状管理效率。

关键词: 结直肠癌, 症状群, 化疗, 核心症状, 网络分析, 护理

ZHENG Cunfeng, WANG Zheng, LIU Haijing, GAO Jie, QIN Ya, ZHANG Qing. Longitudinal study on core symptoms and nursing strategies for patients with colorectal cancer undergoing postoperative chemotherapy[J]. Chinese Journal of Nursing, 2025, 60(11): 1309-1315.

郑存风, 王峥, 刘海静, 高杰, 秦娅, 张清. 结直肠癌术后化疗患者核心症状的纵向研究及护理对策[J]. 中华护理杂志, 2025, 60(11): 1309-1315.

Figures/Tables 5

Table 1 General information of the survey subjects（n=264）

Table 2 Incidence and severity of symptoms at different stages for postoperative chemotherapy patients with colorectal cancer（n=264）

Table 3 The results of factor analysis at different stages for postoperative chemotherapy patients with colorectal cancer（n=264）

Table 4 The severity of symptoms clusters for postoperative chemotherapy patients with colorectal cancer at different stages[n=264，score，M（P25，P75）]

Figure 1 Symptom network diagrams of postoperative chemotherapy patients with colorectal cancer at different stages

References 18

[1]	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3):229-263.
[2]	Wang K, Diao M, Yang ZX, et al. Identification of core symptom cluster in patients with digestive cancer:a network analysis[J]. Cancer Nurs, 2025, 48(1):E55-E63.
[3]	冯芳茗, 张伟英, 何佳倩, 等. 消化道癌症患者化疗期间症状群及影响因素分析[J]. 解放军护理杂志, 2020, 37(9):13-17.
	Feng FM, Zhang WY, He JQ, et al. Symptom clusters and influencing factors for patients with gastrointestinal cancer during chemotherapy[J]. Nurs J Chin PLA, 2020, 37(9):13-17.
[4]	叶艳欣, 秦岚, 骆佳慧, 等. 肺癌患者化疗相关症状群的发生现状及影响因素分析[J]. 中华护理杂志, 2023, 58(18):2230-2238. DOI
	Ye YX, Qin L, Luo JH, et al. Study on status and influencing factors of chemotherapy related symptom cluster among lung cancer patients[J]. Chin J Nurs, 2023, 58(18):2230-2238. DOI
[5]	胡月. 胃癌术后化疗患者症状群与生活质量的纵向研究[D]. 南京: 南京中医药大学, 2018.
	Hu Y. Longitudinal study on symptom groups and quality of life of patients with postoperative chemotherapy for gastric cancer[D]. Nanjing: Nanjing University of Chinese Medicine, 2018.
[6]	Li X, Zou YL, Zhang ZY, et al. Chemotherapy-related symptom networks in distinct subgroups of Chinese patients with gastric cancer[J]. Asia Pac J Oncol Nurs, 2023, 11(3):100366.
[7]	Teng LP, Zhou Z, Yang YT, et al. Identifying central symptom clusters and correlates in patients with lung cancer post-chemotherapy:a network analysis[J]. Asia Pac J Oncol Nurs, 2024, 11(4):100383.
[8]	国家卫生健康委员会医政司,中华医学会肿瘤学分会. 国家卫健委中国结直肠癌诊疗规范(2023版)[J]. 中国实用外科杂志, 2023, 43(6):602-630.
	Hospital Authority of National Health Commission of the Peo-ple’s Republic of China;Chinese Society of Oncology. Chinese Medical Association Chinese protocol of diagnosis and treatment of colorectal ancer of the National Health Commission(2023 edition)[J]. Chin J Pract Surg, 2023, 43(6):602-630.
[9]	Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy:a tutorial paper[J]. Behav Res Methods, 2018, 50(1):195-212. DOI PMID
[10]	Wang XS, Wang Y, Guo H, et al. Chinese version of the M. D. Anderson Symptom Inventory:validation and application of symptom measurement in cancer patients[J]. Cancer, 2004, 101(8):1890-1901.
[11]	顾铭. 安德森症状评估量表大肠癌模块的编制及应用研究[D]. 上海: 上海中医药大学, 2019.
	Gu M. Development and application of Anderson Symptom Assessment Scale for colorectal cancer module[D]. Shanghai: Shanghai University of Traditional Chinese Medicine, 2019.
[12]	Kim E, Jahan T, Aouizerat BE, et al. Changes in symptom clusters in patients undergoing radiation therapy[J]. Support Care Cancer, 2009, 17(11):1383-1391. DOI PMID
[13]	苏晓雨, 王青青, 刘风侠. 肿瘤患者症状群生物学机制的研究进展[J]. 癌症进展, 2022, 20(6):555-558,572.
	Su XY, Wang QQ, Liu FX. Research progress on biological mechanism of symptom group in tumor patients[J]. Oncol Prog, 2022, 20(6):555-558,572.
[14]	褚彦香, 王颖, 熊欢. 分级管理方案在乳腺癌患者化疗所致恶心呕吐中的应用[J]. 中华护理杂志, 2019, 54(12):1815-1819. DOI
	Chu YX, Wang Y, Xiong H. Clinical practice of grading management scheme for chemotherapy induced nausea and vomiting in breastcancer patients[J]. Chin J Nurs, 2019, 54(12):1815-1819.
[15]	刘美子, 安然, 吴子童, 等. 头颈部肿瘤患者核心症状及症状群的网络分析与护理对策[J]. 中华护理杂志, 2024, 59(7):828-834. DOI
	Liu MZ, An R, Wu ZT, et al. A network analysis and nursing implications of core symptoms and symptom clusters in head and neck cancer patients[J]. Chin J Nurs, 2024, 59(7):828-834. DOI
[16]	Wei ZH, Ren L, Wang XM, et al. Network of depression and anxiety symptoms in patients with epilepsy[J]. Epilepsy Res, 2021, 175:106696.
[17]	邹炎铃, 李易, 张紫嫣, 等. 基于体质特征的胃癌化疗患者核心症状及影响因素研究[J]. 中华护理杂志, 2024, 59(18):2238-2243. DOI
	Zou YL, Li Y, Zhang ZY, et al. Examining core symptoms and influencing factors of patients with gastric cancer undergoing chemotherapy:the role of Traditional Chinese Medicine constitutional traits[J]. Chin J Nurs, 2024, 59(18):2238-2243.
[18]	Rha SY, Park M, Lee J. Stability of symptom clusters and sentinel symptoms during the first two cycles of adjuvant chemo-therapy[J]. Support Care Cancer, 2019, 27(5):1687-1695.