Identifying central symptoms and central symptom clusters in acute myeloid leukemia patients receiving chemotherapy: A network analysis

Abstract

Purpose. Patients with acute myeloid leukemia who are receiving chemotherapy experience multiple concurrent symptoms (i.e., symptom clusters) that interfere with activities of daily living. However, few studies have focused on revealing the relationship between these symptoms and symptom clusters. We used network analysis to identify central symptoms and central symptom clusters and analyze the relationships between them in acute myeloid leukemia patients receiving chemotherapy. Methods. A cross-sectional study was conducted among 575 acute myeloid leukemia patients receiving chemotherapy. The Chinese version of the Memorial Symptom Assessment Scale was used to assess the symptoms via convenience sampling. Exploratory factor analysis was used for symptom cluster identification. Network analysis was used to construct the symptom network and centrality indices. Results. The most common symptom was lack of energy. The most severe and distressing symptom was worrying. Three symptom clusters were identified: neuropathy, nutritional, and psychological. In the network, the central symptom was feeling sad (r_s=1.233), and the neuropathy symptom cluster was the most central symptom cluster in adult acute leukemia patients receiving chemotherapy (r_s=0.903). Conclusions. Our study demonstrated the importance of assessing centrality indices and network density as essential components of acute leukemia. Future studies should focus on constructing dynamic symptom and symptom cluster networks, analyzing centrality indices using longitudinal data to explore causality among symptoms and symptom clusters for targeting central symptoms, and developing interventions for managing central symptom clusters.