To identify the distribution characteristics, dynamic changes, and sentinel symptoms of symptom clusters in colorectal cancer patients undergoing post-operative adjuvant chemotherapy.
Approach:
Study Design: A prospective longitudinal study design with convenience sampling of 220 colorectal cancer patients receiving their first post-operative chemotherapy.
Data Collection: Utilized the M.D. Anderson Symptom Inventory-Gastrointestinal Cancer Module (MDASI-GI) to assess symptoms after the 1st, 2nd, and 3rd chemotherapy cycles.
Data Analysis: Employed exploratory factor analysis, generalized estimating equations for longitudinal changes, and the Apriori algorithm for identifying sentinel symptoms.
Key Findings:
Symptom burden increased from an average of 8.32 symptoms at T1 to 13.3 at T3.
Fatigue, decreased appetite, and disturbed sleep were the most prevalent symptoms, reaching 96.7% by T3.
Symptom cluster structure evolved from three clusters at T1 to four clusters at T2 and T3, with a new fatigue-pain cluster emerging.
All symptom severities increased significantly over time (P<0.001), with fatigue and constipation showing the most pronounced progression.
Seven sentinel symptoms were identified across three time points: taste changes (T1), nausea and diarrhea (T2), abdominal bloating (T3), disturbed sleep (T2), distress and sadness (T3).
Interpretation:
Colorectal cancer patients undergoing post-operative chemotherapy experience cumulative increases in symptom burden, with evolving symptom cluster structures throughout treatment.
Limitations:
Loss-to-follow-up rate of 12.50% may affect the generalizability of the findings, particularly as the study was conducted at a single tertiary hospital.
Conclusion:
The identified sentinel symptoms may inform symptom management strategies, though further intervention studies are needed to validate their clinical utility.
