Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 4;33(6):532.
doi: 10.1007/s00520-025-09600-9.

Core symptoms in patients with colorectal cancer receiving chemotherapy: a network analysis

Jie Zhang #  1   2 , Qianyun He #  2 , Mei Wang #  2 , Xiaonan Lv  1   2 , Dongliang Mao  2 , Jian Li  3 , Daqiao Zhu  4 , Lei Huang  5   6
Affiliations

Core symptoms in patients with colorectal cancer receiving chemotherapy: a network analysis

Jie Zhang et al. Support Care Cancer. .

Abstract

Objective: To investigate the prevalence and intensity of symptoms in patients with colorectal cancer (CRC), and to develop a symptom network model to pinpoint key symptoms and clusters within the network.

Methods: This study encompassed 330 patients receiving postoperative treatment for CRC at a tertiary hospital's oncology department in Shanghai, China, from March 2023 to March 2024. Symptom assessment was conducted using the Chinese version of the MD Anderson Symptom Assessment Scale (MDASI-C) and a specially designed CRC module. Exploratory factor analysis was utilized to identify symptom clusters, and R 4.3.1 software was employed to construct networks of symptom severity and clusters. Centrality indicators, including strength, closeness, and betweenness, were subsequently analyzed to identify core symptoms and clusters.

Results: Among CRC symptoms, altered bowel habits were the most prevalent (n = 289, 87.6%), followed by distress (n = 250, 75.8%), pain (n = 244, 73.9%), weight loss (n = 205, 62.1%), and fatigue (n = 187, 56.7%). Three primary symptom clusters emerged: The gastrointestinal-neurological cluster, the sickness behavior cluster, and the emotional cluster (variance contribution rate, 36.8%, 19.0%, and 12.3%, respectively; cumulative, 68.1%). In the symptom severity network, numbness exhibited the highest expected influence (rE = 1.25); in the symptom cluster network, numbness (rs = 0.60), sadness (rs = 0.56), and fatigue (rs = 0.55) were the most influential symptoms across the three clusters.

Conclusion: In patients with CRC undergoing chemotherapy, network analysis identified numbness (gastrointestinal-neurological cluster), sadness (emotional cluster), and fatigue (sickness behavior cluster) as core symptoms, with numbness demonstrating the highest expected influence. The gastrointestinal-neurological cluster emerged as the most central. Strong symptom correlations (e.g., fear-sadness and numbness-sleep disturbance) underscored interconnected physical and psychological burdens. These findings advocate for prioritized targeted interventions: neurotoxicity monitoring for numbness, psychological support for emotional distress, and tailored fatigue management. A multidisciplinary approach is critical to address these interconnected clusters. Future research should employ longitudinal designs to unravel temporal symptom dynamics and refine personalized care.

Keywords: Chemotherapy; Colorectal cancer; Core symptom clusters; Network analysis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical consideration: Studies involving human participants were approved by the Ethics Committee of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. All patients provided written informed consent to participate in the study. Our study was conducted in accordance with the Declaration of Helsinki. Disclosures: The authors declare no competing interests. Competing interests: The authors declare no competing interests.

Similar articles

See all similar articles

References

    1. Bray F et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229–263 - DOI - PubMed
    1. Biller LH, Schrag D (2021) Diagnosis and treatment of metastatic colorectal cancer: a review. JAMA 325(7):669–685 - DOI - PubMed
    1. Tsai C-H et al (2021) Integrated medicine for chemotherapy-induced peripheral neuropathy. Int J Mol Sci 22(17):9257 - DOI - PubMed - PMC
    1. Huang J et al (2023) Prevalence of hand-foot syndrome following chemotherapy for colorectal cancer: a systematic review and meta-analysis. Int J Color Dis 8(1). https://doi.org/10.1007/s00384-023-04345-5
    1. Han S et al (2023) Exploring core mental health symptoms among persons living with HIV: a network analysis. Front Psychiatry 14. https://doi.org/10.3389/fpsyt.2023.1081867

Substances

LinkOut - more resources