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Peer-reviewedCC BYFrontiers in oncology

Network analysis of core symptom changes in hepatocellular carcinoma survivors after transarterial chemoembolization: A longitudinal study.

  • Suping Wang1
  • Xiuyan Wang2
  • Ni Jiang2
  • Yongpei Hu3
  • Lirong Guo4
  • Long Zhang1
  • Yanzhe Liu1
  • Simin Kong2
  • Ying Zhang1,5
5 affiliations
  1. 1School of Nursing, Kunming Medical University, Kunming, Yunnan, China.
  2. 2Department of Minimally Invasive Interventional Radiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Peking University Cancer Hospital Yunnan Hospital), Kunming, Yunnan, China.
  3. 3Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Peking University Cancer Hospital Yunnan Hospital), Kunming, Yunnan, China.
  4. 4The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Peking University Cancer Hospital Yunnan Hospital), Kunming, Yunnan, China.
  5. 5Chuxiong Medical College, Chuxiong, Yunnan, China.
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Abstract

Objective

The aims of this study were to explore the longitudinal trajectories of core symptoms in survivors with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) and to analyze their associations with health-related quality of life (HRQoL) and unmet supportive care needs.Methods

This longitudinal study enrolled 271 HCC survivors undergoing TACE in China. Patient-reported outcomes were assessed at three time points-24 h (T1), 7 days (T2), and 1 month (T3) post-TACE-using four validated instruments: the MD Anderson Symptom Inventory-Chinese Version (MDASI-C), the Tumor Symptom Measure for Primary Liver Cancer (TSM-PLC), the Quality of Life Instrument for Liver Cancer (QOL-LC V2.0), and the Short Form of Survivors' Unmet Needs Scale (SF-SUNS). Exploratory factor analysis was conducted to extract discrete symptom clusters, and network analysis was used to calculate strength centrality (rs)-an index quantifying the sum of absolute edge weights connecting each symptom to all others-to identify core symptoms.Results

Five symptom clusters were identified at T1: Fatigue-Cognitive, Post-embolization, Somatic, Emotional, and Hepatobiliary-Specific. The Post-embolization cluster was present only at T1, whereas the remaining four clusters persisted at T2 and T3. However, the core symptom shifted over time: nausea at T1 (rs = 1.154), lack of appetite at T2 (rs = 1.229), and sadness at T3 (rs = 1.107). HRQoL was lowest at T1, improved at T2, and declined at T3, with all pairwise comparisons significant (all p < 0.001). Unmet needs were highest at T3, with all time-point differences significant (all p < 0.001). The largest gaps were observed in information provision, care continuity, and emotional support. Greater symptom severity was significantly associated with poorer HRQoL at all time points (all p < 0.01).Conclusions

During the first month post-TACE, the sequence of core symptoms transitioned from nausea to lack of appetite and then to sadness, suggesting time-specific supportive care strategies-including antiemetic prophylaxis, nutritional support, and psychosocial care. Routine assessment of unmet needs may help reduce symptom burden and optimize long-term HRQoL for these survivors.

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Cite

BibTeXRIS
BibTeX
@article{wang2026network,
  title = {{Network analysis of core symptom changes in hepatocellular carcinoma survivors after transarterial chemoembolization: A longitudinal study.}},
  author = {Suping Wang and Xiuyan Wang and Ni Jiang and Yongpei Hu and Lirong Guo and Long Zhang and Yanzhe Liu and Simin Kong and Ying Zhang},
  journal = {Frontiers in oncology},
  year = {2026},
  month = oct,
  doi = {10.3389/fonc.2026.1960540},
  url = {https://europepmc.org/article/MED/42903105},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Network analysis of core symptom changes in hepatocellular carcinoma survivors after transarterial chemoembolization: A longitudinal study.
AU  - Suping Wang
AU  - Xiuyan Wang
AU  - Ni Jiang
AU  - Yongpei Hu
AU  - Lirong Guo
AU  - Long Zhang
AU  - Yanzhe Liu
AU  - Simin Kong
AU  - Ying Zhang
PY  - 2026
DA  - 2026/10/06
JO  - Frontiers in oncology
DO  - 10.3389/fonc.2026.1960540
UR  - https://europepmc.org/article/MED/42903105
AB  - Objective  The aims of this study were to explore the longitudinal trajectories of core symptoms in survivors with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) and to analyze their associations with health-related quality of life (HRQoL) and unmet supportive care needs.Methods  This longitudinal study enrolled 271 HCC survivors undergoing TACE in China. Patient-reported outcomes were assessed at three time points-24 h (T1), 7 days (T2), and 1 month (T3) post-TACE-using four validated instruments: the MD Anderson Symptom Inventory-Chinese Version (MDASI-C), the Tumor Symptom Measure for Primary Liver Cancer (TSM-PLC), the Quality of Life Instrument for Liver Cancer (QOL-LC V2.0), and the Short Form of Survivors' Unmet Needs Scale (SF-SUNS). Exploratory factor analysis was conducted to extract discrete symptom clusters, and network analysis was used to calculate strength centrality (rs)-an index quantifying the sum of absolute edge weights connecting each symptom to all others-to identify core symptoms.Results  Five symptom clusters were identified at T1: Fatigue-Cognitive, Post-embolization, Somatic, Emotional, and Hepatobiliary-Specific. The Post-embolization cluster was present only at T1, whereas the remaining four clusters persisted at T2 and T3. However, the core symptom shifted over time: nausea at T1 (rs = 1.154), lack of appetite at T2 (rs = 1.229), and sadness at T3 (rs = 1.107). HRQoL was lowest at T1, improved at T2, and declined at T3, with all pairwise comparisons significant (all p < 0.001). Unmet needs were highest at T3, with all time-point differences significant (all p < 0.001). The largest gaps were observed in information provision, care continuity, and emotional support. Greater symptom severity was significantly associated with poorer HRQoL at all time points (all p < 0.01).Conclusions  During the first month post-TACE, the sequence of core symptoms transitioned from nausea to lack of appetite and then to sadness, suggesting time-specific supportive care strategies-including antiemetic prophylaxis, nutritional support, and psychosocial care. Routine assessment of unmet needs may help reduce symptom burden and optimize long-term HRQoL for these survivors.
SN  - 2234-943X
ER  -