Network Analysis of Fatigue Symptoms in Chinese Patients with Advanced Cancer

Objective: This study was aimed at investigating the network structures of fatigue symptoms in patients with advanced cancer, with a focus on identifying the central symptom-an aspect crucial for targeted and effective fatigue symptom management.

Methods: In this cross-sectional study, patients with advanced cancer were recruited from the cancer treatment center of a tertiary hospital in China between January and December of 2022. Symptom occurrence and severity were assessed with the Cancer Fatigue Scale. Network analysis was conducted to explore the network structure and identify the core fatigue symptoms.

Results: The study included 416 patients with advanced cancer. Lack of energy (2.25 ​± ​1.24), lack of interest in anything (2.20 ​± ​1.22), and lack of self-encouragement (2.03 ​± ​1.25) were the most severe fatigue symptoms and belonged to the affective fatigue dimension. In the overall network, reluctance (  ​= ​5.622), a heavy and tired body (  ​= ​5.424), and tiring easily (  ​= ​5.319) had the highest strength values. All these core symptoms were classified within the physical fatigue dimension and remained stable before and after adjustment for covariates.

Conclusions: This study identified reluctance, a heavy and tired body, and tiring easily as the core fatigue symptoms in patients with advanced cancer, thus providing valuable insight to help clinical nurses formulate more effective symptom management strategies. Future interventions could assess the efficacy of targeting the central symptom cluster in alleviating other symptoms and patient burden.