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已发表论文
肺癌患者放疗期间症状群及预警症状的识别：一项纵向研究
Authors Zhang J, Li S, Wu J, Yang B, Tan X, Zhang G, Zhao X
Received 27 April 2025
Accepted for publication 19 September 2025
Published 7 October 2025 Volume 2025:17 Pages 2307—2318
DOI https://doi.org/10.2147/CMAR.S536992
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Seema Singh
Jiang Zhang,1,* Song Li,2,* Jiang Wu,1,* Bingkun Yang,1 Xiangxiu Tan,2 Guilan Zhang,3 Xijuan Zhao4
1Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Peking University Cancer Hospital Yunnan, Kunming, People’s Republic of China; 2Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Peking University Cancer Hospital Yunnan, Kunming, People’s Republic of China; 3Nursing Department, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, People’s Republic of China; 4Department of Oncology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Guilan Zhang, Nursing Department, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, People’s Republic of China, Email 1289902143@qq.com Xijuan Zhao, Department of Oncology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China, Email 2051814334@qq.com
Purpose: This study longitudinally examined symptom clusters and sentinel symptoms in lung cancer patients across radiotherapy phases, providing a theoretical foundation for targeted symptom management.
Methods: In this prospective longitudinal study, 244 patients were recruited via convenience sampling from a tertiary cancer hospital in Southwest China between January and December 2024. Data were collected using the General Demographic Questionnaire and MD Anderson Symptom Inventory (including the lung cancer module). Assessments occurred at four time points: T1 (one day before radiotherapy), T2 (after 10 sessions), T3 (after 20 sessions), and T4 (at end of radiotherapy). Exploratory factor analysis identified symptom clusters from symptoms with > 20% incidence, while Apriori algorithm modeling analyzed intra-cluster associations to determine sentinel symptoms.
Results: Five symptom clusters emerged: psychological (sadness, distress, sleep disturbance), respiratory (chest tightness, shortness of breath), lung cancer-specific (coughing, expectoration), radiotherapy side-effect (dry mouth, pain, decreased appetite), and perceptual (at T1: pain, numbness, at T2: dry mouth, pain, decreased appetite, numbness, constipation, at T3 and T4: forgetfulness, somnolence, fatigue, nausea, constipation). At T1, distress, shortness of breath, and coughing were sentinel symptoms for the psychological, respiratory, and lung cancer-specific clusters, respectively. Pain was the sentinel for the radiotherapy side-effect cluster at T3, and somnolence for the perceptual cluster at T4.
Conclusion: Lung cancer patients exhibit multiple stable symptom clusters during radiotherapy, with sentinel symptoms varying by phase. These insights offer new perspectives on timed assessments and precision nursing interventions, while providing key theoretical and practical guidance for building early warning models and intelligent symptom management pathways.
Keywords: lung cancer, radiotherapy, symptom clusters, sentinel symptoms, longitudinal study
1Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Peking University Cancer Hospital Yunnan, Kunming, People’s Republic of China; 2Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Peking University Cancer Hospital Yunnan, Kunming, People’s Republic of China; 3Nursing Department, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, People’s Republic of China; 4Department of Oncology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Guilan Zhang, Nursing Department, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, People’s Republic of China, Email 1289902143@qq.com Xijuan Zhao, Department of Oncology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China, Email 2051814334@qq.com
Purpose: This study longitudinally examined symptom clusters and sentinel symptoms in lung cancer patients across radiotherapy phases, providing a theoretical foundation for targeted symptom management.
Methods: In this prospective longitudinal study, 244 patients were recruited via convenience sampling from a tertiary cancer hospital in Southwest China between January and December 2024. Data were collected using the General Demographic Questionnaire and MD Anderson Symptom Inventory (including the lung cancer module). Assessments occurred at four time points: T1 (one day before radiotherapy), T2 (after 10 sessions), T3 (after 20 sessions), and T4 (at end of radiotherapy). Exploratory factor analysis identified symptom clusters from symptoms with > 20% incidence, while Apriori algorithm modeling analyzed intra-cluster associations to determine sentinel symptoms.
Results: Five symptom clusters emerged: psychological (sadness, distress, sleep disturbance), respiratory (chest tightness, shortness of breath), lung cancer-specific (coughing, expectoration), radiotherapy side-effect (dry mouth, pain, decreased appetite), and perceptual (at T1: pain, numbness, at T2: dry mouth, pain, decreased appetite, numbness, constipation, at T3 and T4: forgetfulness, somnolence, fatigue, nausea, constipation). At T1, distress, shortness of breath, and coughing were sentinel symptoms for the psychological, respiratory, and lung cancer-specific clusters, respectively. Pain was the sentinel for the radiotherapy side-effect cluster at T3, and somnolence for the perceptual cluster at T4.
Conclusion: Lung cancer patients exhibit multiple stable symptom clusters during radiotherapy, with sentinel symptoms varying by phase. These insights offer new perspectives on timed assessments and precision nursing interventions, while providing key theoretical and practical guidance for building early warning models and intelligent symptom management pathways.
Keywords: lung cancer, radiotherapy, symptom clusters, sentinel symptoms, longitudinal study