Associations between interoceptive awareness and symptom clusters in patients with lung cancer undergoing chemotherapy: A joint network analysis
- 1Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
- 2Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
Abstract
Objective: To identify symptom clusters among patients with lung cancer undergoing chemotherapy and examine associations and directional dependencies between multidimensional interoceptive awareness and these clusters.
Methods: A cross-sectional study was conducted at two campuses of a tertiary hospital in China. Interoceptive awareness and symptom burden were assessed using the Multidimensional Assessment of Interoceptive Awareness-2 and the M.D. Anderson Symptom Inventory-Lung Cancer Module. Symptom clusters were identified via exploratory factor analysis. Gaussian graphical network analysis examined associations and bridge centrality, while Bayesian network analysis explored directional probabilistic dependencies.
Results: Among 514 patients, 56.4% were aged ≥ 65 years, and 89.5% had stage III–IV disease. Four symptom clusters emerged: psychological, gastrointestinal, respiratory, and neurocognitive. Network analysis showed the psychological and respiratory clusters were most strongly associated with the Not-Worrying (weight = −0.407) and Trusting (weight = −0.430) dimensions, respectively. Not-Worrying, Trusting, and drowsiness showed the highest bridge strengths in the psychological, respiratory, and neurocognitive symptom-level networks, respectively. Bayesian analysis identified connections between interoceptive awareness dimensions and symptoms in the psychological, respiratory, and neurocognitive networks, but no cross-community connections in the gastrointestinal network. At the symptom level, Not-Worrying was linked to pain and sadness within the psychological cluster; respiratory symptoms were linked to Trusting within the respiratory cluster; and multiple interoceptive dimensions were linked to drowsiness within the neurocognitive cluster.
Conclusions: The Not-Worrying and Trusting dimensions emerged as key bridging dimensions for the psychological and respiratory clusters, respectively, while drowsiness was the key bridge symptom within the neurocognitive cluster. These findings highlight dimension-specific patterns linking interoceptive awareness to symptom clusters, offering hypotheses for future longitudinal and intervention research.
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BibTeX
@article{zhang2026associations,
title = {{Associations between interoceptive awareness and symptom clusters in patients with lung cancer undergoing chemotherapy: A joint network analysis}},
author = {Xingliang Zhang and Xueru Chen and Xinyu Wu and Jianxin Li and Teng Wang and Liping Teng},
journal = {Asia-Pacific Journal of Oncology Nursing},
year = {2026},
month = sep,
doi = {10.1016/j.apjon.2026.101036},
url = {https://doi.org/10.1016/j.apjon.2026.101036},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Associations between interoceptive awareness and symptom clusters in patients with lung cancer undergoing chemotherapy: A joint network analysis
AU - Xingliang Zhang
AU - Xueru Chen
AU - Xinyu Wu
AU - Jianxin Li
AU - Teng Wang
AU - Liping Teng
PY - 2026
DA - 2026/09/24
JO - Asia-Pacific Journal of Oncology Nursing
DO - 10.1016/j.apjon.2026.101036
UR - https://doi.org/10.1016/j.apjon.2026.101036
AB - Objective: To identify symptom clusters among patients with lung cancer undergoing chemotherapy and examine associations and directional dependencies between multidimensional interoceptive awareness and these clusters. Methods: A cross-sectional study was conducted at two campuses of a tertiary hospital in China. Interoceptive awareness and symptom burden were assessed using the Multidimensional Assessment of Interoceptive Awareness-2 and the M.D. Anderson Symptom Inventory-Lung Cancer Module. Symptom clusters were identified via exploratory factor analysis. Gaussian graphical network analysis examined associations and bridge centrality, while Bayesian network analysis explored directional probabilistic dependencies. Results: Among 514 patients, 56.4% were aged ≥ 65 years, and 89.5% had stage III–IV disease. Four symptom clusters emerged: psychological, gastrointestinal, respiratory, and neurocognitive. Network analysis showed the psychological and respiratory clusters were most strongly associated with the Not-Worrying (weight = −0.407) and Trusting (weight = −0.430) dimensions, respectively. Not-Worrying, Trusting, and drowsiness showed the highest bridge strengths in the psychological, respiratory, and neurocognitive symptom-level networks, respectively. Bayesian analysis identified connections between interoceptive awareness dimensions and symptoms in the psychological, respiratory, and neurocognitive networks, but no cross-community connections in the gastrointestinal network. At the symptom level, Not-Worrying was linked to pain and sadness within the psychological cluster; respiratory symptoms were linked to Trusting within the respiratory cluster; and multiple interoceptive dimensions were linked to drowsiness within the neurocognitive cluster. Conclusions: The Not-Worrying and Trusting dimensions emerged as key bridging dimensions for the psychological and respiratory clusters, respectively, while drowsiness was the key bridge symptom within the neurocognitive cluster. These findings highlight dimension-specific patterns linking interoceptive awareness to symptom clusters, offering hypotheses for future longitudinal and intervention research.
SN - 2347-5625
SN - 2349-6673
ER -