Temporal relationship between symptom cluster and quality of life in rectal cancer survivor

Abstract

Abstract Symptom cluster and quality of life are negatively associated, but the prospective inter-relationship between them were unknown,which may provide a mechanism insight for symptom cluster management. A longitudinal study was conducted among 140 patients who undergoing laparoscopic-assisted sphincter-preserving surgery for rectal cancer between 2021 to 2022. We investigated the longitudinal associations of the change of symptom cluster with the trajectories of quality of life. These patients were assessed for symptom clusters and quality of life at specific time points: 2 weeks (T1), 1 month (T2), 3 months (T3) ,and 6 months (T4) after their surgeries. In our Pearson correlation analysis, the quality of life within 6 months after surgery showed a moderate-to-strong strength correlation (r=0.27-0.66) between the quality of life within the first 6 months post-surgery. There was also a significantly negative correlation between each symptom cluster and the quality of life at all four time points. Our cross-lagged model revealed a unidirectional temporal relationship between quality of life and symptom cluster. the quality of life level at these four time points could significantly and negatively predict the severity of each symptom cluster, with no observed reverse path. Importantly, the cross-lagged path coefficient from quality of life to symptom cluster was notably greater than the coefficient from symptom cluster to quality of life. These findings provide evidence that lower quality of life precede higher symptom cluster severity in rectal cancer survivor. This temporal relationship begins early in the post-surgery period, highlighting the importance of early quality of life intervention to help patients improve their symptom clusters. Keywords:rectal neoplasm;symptom cluster;quality of life;bidirectional relationship