The core symptom in multiple myeloma patients undergoing chemotherapy: a network analysis

Abstract

Background: During chemotherapy for multiple myeloma, symptoms include those related to the disease, as well as adverse effects of the treatment. Few studies have explored the relationships between these symptoms. Network analysis could identify the core symptom in the symptom network.

Objective: The aim of this study was to explore the core symptom in multiple myeloma patients undergoing chemotherapy.

Methods: This was a cross-sectional study in which sequential sampling was used to recruit 177 participants from Hunan, China. Demographic and clinical characteristics were surveyed using a self-developed instrument. The symptoms of chemotherapy-treated multiple myeloma, including pain, fatigue, worry, nausea, and vomiting, were measured using a questionnaire with good reliability and validity. The mean ± SD, frequency, and percentages were used as descriptive statistics. Network analysis was used to estimate the correlation between symptoms.

Results: The results showed that 70% of multiple myeloma patients using chemotherapy exhibited pain. In the network analysis, worrying was the dominant symptom, and the strongest relationship was between nausea and vomiting in chemotherapy-treated multiple myeloma patients' symptoms.

Conclusion: Worrying is the core symptom of multiple myeloma patients. Interventions could be most effective if there is a symptom management focus on worrying when providing care to chemotherapy-treated multiple myeloma patients. Nausea combined with vomiting could be better managed, which would decrease the cost of health care. Understanding the relationship between the symptoms of multiple myeloma patients undergoing chemotherapy is beneficial for precise symptom management.

Implications for practice: Nurses and health care teams should be a priority to intervene in the worrying for chemotherapy-treated multiple myeloma patients to maximize the effectiveness of an intervention. Except, nausea and vomiting should be managed together in a clinical setting.

Keywords: Chemotherapy; Core symptom; Multiple myeloma; Network analysis.

Fig. 1

Network of symptoms. P1, difficulty concentrating; P2, pain; P3, lack of energy; P4, cough; P5, feeling nervous; P6, dry mouth; P7, nausea; P8, feeling drowsy; P9, numbness/tingling in hands/feet; P10, difficulty sleeping; P11, feeling bloated; P12, problems with urination; P13, vomiting; P14, shortness of breath; P15, diarrhoea; P16, feeling sad; P17, sweats; P18, worrying; P19, problems with sexual interest or activity; P20, itching; P21, lack of appetite; P22, dizziness; P23, difficulty swallowing; P24, feeling irritable; P25, mouth sores; P26, change in the way food tastes; P27, weight loss; P28, hair loss; P29, constipation; P30, swelling of arms or legs; P31, “I don’t look like myself”; P32, changes in skin

Fig. 2

Estimated strength centrality. P1, difficulty concentrating; P2, pain; P3, lack of energy; P4, cough; P5, feeling nervous; P6, dry mouth; P7, nausea; P8, feeling drowsy; P9, numbness/tingling in hands/feet; P10, difficulty sleeping; P11, feeling bloated; P12, problems with urination; P13, vomiting; P14, shortness of breath; P15, diarrhoea; P16, feeling sad; P17, sweats; P18, worrying; P19, problems with sexual interest or activity; P20, itching; P21, lack of appetite; P22, dizziness; P23, difficulty swallowing; P24, feeling irritable; P25, mouth sores; P26, change in the way food tastes; P27, weight loss; P28, hair loss; P29, constipation; P30, swelling of arms or legs; P31, “I don’t look like myself”; P32, changes in skin

Fig. 3

Centrality stability (CS) coefficient of strength using the case-dropping bootstrap method. The x-axis represents the percentage of the original sample used for every step. The y-axis represents the average of correlation between strength centrality of the primary network and strength centrality of the re-estimated network after excluding the increasing percentage of cases. The lines represent the correlation of strength. The area indicates the 95% CI