Exploring the Dynamics of Postoperative Radiotherapy Symptom Networks in Oral Cancer Patients: A Cross-Lagged Panel Network Analysis.

Abstract

Patients experience adverse reactions during oral cancer treatment, necessitating more precise symptom management. Establishing causal relationships among symptoms using cross-sectional data has proven challenging. This longitudinal study aimed to employ CLPN analysis to construct symptom networks in oral cancer patients at four radiotherapy time points to identify predictive relationships and intervention opportunities. From March to October 2024, 246 patients were followed. Throughout postoperative radiotherapy, prevalence and symptom severity were assessed using the M. D. Anderson Symptom Inventory Head and Neck Cancer Module: T0 (pre-radiotherapy), T1 (10 sessions), T2 (20 sessions), and T3 (30 sessions). CLPNs were constructed from longitudinal data using R to identify crucial network nodes and explore predictive and interactive effects among symptoms. The analysis revealed that pain and vomiting exhibited the highest out-EI (outgoing expected influence) from T0 to T1. Distress had a sustained impact throughout the radiotherapy, with Distress at T1 predicting sleep disturbance, fatigue, and drowsiness at T2. T2 mouth or throat sores predicted T3 pain, problems with teeth or gums, and difficulty in swallowing or chewing. The CLPNs from T0-T1 and T2-T3 CLPNs showed medium to high stability based on the centrality stability coefficients of out-EI. Throughout the radiotherapy period, fatigue and drowsiness had the highest ingoing expected influence (in-EI). This study reveals the development of core symptoms in postoperative oral cancer patients under multidimensional symptom distress during radiotherapy. It elucidates inter-symptom relationships over time, providing valuable insights for the precise timing of interventions and tailored preventive programs.