Analysis on the evolution trajectory of symptom clusters and its influencing factors in lung cancer patients during the first chemotherapy cycle_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QUAN Yumeng ¹ , WANG Yan ² , WU Yue ¹ , ZHU Zitian ¹ , LIANG Yuqi ¹ , PENG Shilin ¹ , WANG Jie ² ,  LIANG Tao ¹ ,  SUN Xin ³

1. School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China;
2. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China;
3. Department of Medical Management, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China;

Corresponding?author：

LIANG Tao, Email: liangtao1@hotmail.com; SUN Xin, Email: sunxin9097@163.com

Keywords：

Lung cancer; chemotherapy; symptom clusters; latent class mixed model; trajectory analysis; influencing factors

DOI：

10.7507/1007-4848.202606015

Video：

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Objective To explore the dynamic evolution trajectory of symptom clusters and the influencing factors among lung cancer patients during their first chemotherapy cycle, so as to provide evidence for precise and stratified symptom management. Methods A convenience sampling method was adopted. Incident lung cancer patients were recruited from the Cancer Hospital, Chinese Academy of Medical Sciences between December 2025 and April 2026. Longitudinal surveys were conducted at 1 day before the first chemotherapy, and on days 1, 3, 5 and 7 after chemotherapy using the general information questionnaire, the Chinese version of the M. D. Anderson Symptom Inventory-Lung Cancer Module (MDASI-LC), and the Charlson Comorbidity Index (CCI). Exploratory factor analysis was used to identify the composition of symptom clusters at different time points. Latent class mixed models (LCMM) were applied to fit the developmental trajectories of symptom clusters. The least absolute shrinkage and selection operator (LASSO) regression was used for variable screening, followed by multivariate logistic regression to analyze the influencing factors of each trajectory class. Results A total of 133 patients were enrolled, including 97 males and 36 females, aged 37-78 (62.54±9.27) years. Five symptom clusters were identified: respiratory symptom cluster, cough-expectoration symptom cluster, chemotherapy-related symptom cluster, gastrointestinal symptom cluster and psychological symptom cluster. All symptom clusters exhibited significant dynamic changes throughout the first chemotherapy cycle (P<0.05). Trajectory analysis revealed 2 to 3 trajectory subtypes for symptom clusters with marked heterogeneity. Most symptom clusters peaked on days 3 to 5 after chemotherapy. Multivariate logistic regression analysis, with the low-level trajectory group as reference, showed that pathological type (P<0.001) and medical insurance type [OR=0.022, 95%CI (0.000, 0.976), P=0.049] were associated with membership of respiratory symptom cluster trajectories; household per capita monthly income [OR=3.102, 95%CI (1.183, 8.129), P=0.021] and chemotherapy regimen [OR=0.306, 95%CI (0.098, 0.959), P=0.042] were associated with membership of cough-expectoration symptom cluster trajectories; smoking amount [OR=1.039, 95%CI (1.003, 1.075), P=0.011] and clinical stage [OR=0.209, 95%CI (0.045, 0.977), P=0.047] were associated with membership of gastrointestinal symptom cluster trajectories; CCI [OR=0.342, 95%CI (0.131, 0.897), P=0.029] was associated with membership of psychological symptom cluster trajectories. Conclusion Symptom clusters in lung cancer patients demonstrate obvious dynamic evolutionary characteristics and individual heterogeneity during the first chemotherapy cycle. Days 3 to 5 post-chemotherapy serve as the critical window for symptom monitoring and intervention. Medical staff should implement individualized stratified management in consideration of patients’ pathological type, economic status, comorbidity burden and treatment regimen to realize precise early warning and timely intervention of symptoms.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1): 47-53.
3.	Fang Y, Li Z, Chen H, et al. Burden of lung cancer along with attributable risk factors in China from 1990 to 2019, and projections until 2030[J]. J Cancer Res Clin Oncol, 2023, 149(7): 3209-3218.
4.	國家衛生健康委辦公廳. 原發性肺癌診療指南(2022年版)[J]. 協和醫學雜志, 2022, 13(4): 549-570.General Office of National Health Commission of the People's Republic of China. Clinical practice guideline for primary lung cancer (2022 version)[J]. Med J Peking Union Med Coll Hosp, 2022, 13(4): 549-570.
5.	Rouanet P, Rullier E, Lelong B, et al. Tailored treatment strategy for locally advanced rectal carcinoma based on the tumor response to induction chemotherapy: preliminary results of the French phase Ⅱ multicenter GRECCAR4 trial[J]. Dis Colon Rectum, 2017, 60(7): 653-663.
6.	Mogavero MP, DelRosso LM, Fanfulla F, et al. Sleep disorders and cancer: state of the art and future perspectives[J/OL]. Sleep Med Rev, 2021, 56: 101409. DOI: 10.1016/j.smrv.2020.101409.
7.	Dodd MJ, Miaskowski C, Paul SM. Symptom clusters and their effect on the functional status of patients with cancer[J]. Oncol Nurs Forum, 2001, 28(3): 465-470.
8.	Donnelly S, Walsh D. The symptoms of advanced cancer[J]. Semin Oncol, 1995, 22(2 Suppl 3): 67-72.
9.	Portenoy RK, Thaler HT, Kornblith AB, et al. Symptom prevalence, characteristics and distress in a cancer population[J]. Qual Life Res, 1994, 3(3): 183-189.
10.	李芙蘭, 謝海霞, 于天爽, 等. 肺癌患者化療期間癥狀群的范圍綜述[J]. 中華護理雜志, 2024, 59(18): 2283-2289.Li FL, Xie HX, Yu TS, et al. Symptom clusters in lung cancer patients during chemotherapy: a scoping review[J]. Chin J Nurs, 2024, 59(18): 2283-2289.
11.	Russell J, Wong ML, Mackin L, et al. Stability of symptom clusters in patients with lung cancer receiving chemotherapy[J]. J Pain Symptom Manage, 2019, 57(5): 909-922.
12.	劉麗峰, 崔嘉, 王海楠, 等. 肺癌術后患者癥狀群對恐懼疾病進展的影響[J]. 護理學雜志, 2024, 39(6): 37-41.Liu LF, Cui J, Wang HN, et al. Impact of symptom clusters on fear of disease progression in postoperative lung cancer patients[J]. J Nurs Sci, 2024, 39(6): 37-41.
13.	Li Y, Wang Q, Liu C, et al. Symptom clusters and their impact on quality of life among Chinese patients with lung cancer: a cross-sectional study[J/OL]. Eur J Oncol Nurs, 2023, 67: 102465. DOI: 10.1016/j.ejon.2023.102465.
14.	傅郭妹芝, 蘇文敏, 章立楠, 等. 肺癌患者化療期間癥狀群的動態研究[J]. 浙江臨床醫學, 2022, 24(11): 1658-1661.Fu GMZ, Su WM, Zhang LN, et al. Dynamic study of symptom clusters in lung cancer patients during chemotherapy[J]. Zhejiang Clin Med J, 2022, 24(11): 1658-1661.
15.	王紫艷. 肺癌患者化療期間癥狀群動態變化與中醫五態人格的相關性研究[D]. 湖南中醫藥大學, 2022.Wang ZY. Study on the correlation between the dynamic change of symptom group and five-pattern personality of Chinese medicine in lung cancer patients during chemotherapy[D]. Hunan University of Chinese Medicine, 2022.
16.	游雅芬. 老年肺癌患者化療期間癥狀群發展軌跡及影響因素研究[D]. 贛南醫科大學, 2025.You YF. Trajectories of symptom clusters development during chemotherapy in elderly lung cancer patients and study of influencing factors[D]. Gannan Medical University, 2025.
17.	岳好潤, 劉萌, 李嘉寧, 等. 免疫治療期間肺癌患者癥狀群對生活質量的影響[J]. 中華腫瘤防治雜志, 2023, 30(17): 1046-1054.Yue HR, Liu M, Li JN, et al. Impact of symptom clusters during immunotherapy on quality of life in lung cancer patients[J]. Chin J Cancer Prev Treat, 2023, 30(17): 1046-1054.
18.	Giesinger JM, Wintner LM, Zabernigg A, et al. Assessing quality of life on the day of chemotherapy administration underestimates patients' true symptom burden[J/OL]. BMC Cancer, 2014, 14(1): 758. DOI: 10.1186/1471-2407-14-758.
19.	Mendoza TR, Wang XS, Lu C, et al. Measuring the symptom burden of lung cancer: the validity and utility of the lung cancer module of the MD Anderson Symptom Inventory[J]. Oncologist, 2011, 16(2): 217-227.
20.	張立力, 臧瑜. MD安德森癥狀評估量表肺癌模塊的修訂和考評[J]. 腫瘤, 2013, 33(5): 434-438.Zhang LL, Zang Y. Revision and evaluation of the lung cancer module of the MD Anderson Symptom Inventory[J]. Tumor, 2013, 33(5): 434-438.
21.	Charlson ME, Carrozzino D, Guidi J, et al. Charlson comorbidity index: a critical review of clinimetric properties[J]. Psychother Psychosom, 2022, 91(1): 8-35.
22.	Wang D, Fu J. Symptom clusters and quality of life in China patients with lung cancer undergoing chemotherapy[J]. Afr Health Sci, 2014, 14(1): 49-55.
23.	李楠楠, 陳芬榮, 朱惠瑛, 等. 肺癌患者化療前后癥狀群的調查研究[J]. 解放軍護理雜志, 2017, 34(23): 34-38.Li NN, Chen FR, Zhu HY, et al. Investigation on symptom clusters in lung cancer patients before and after chemotherapy[J]. J PLA Nurs, 2017, 34(23): 34-38.
24.	Ju X, Bai J, She Y, et al. Symptom cluster trajectories and sentinel symptoms during the first cycle of chemotherapy in patients with lung cancer[J/OL]. Eur J Oncol Nurs, 2023, 63: 102282. DOI: 10.1016/j.ejon.2023.102282.
25.	Choi YY, Akter J, Lee J. Symptom clusters among lung cancer patients: a scoping review[J]. Korean J Adult Nurs, 2024, 36(4): 271-297.
26.	Hendriks LEL, Remon J, Faivre-Finn C, et al. Non-small-cell lung cancer[J/OL]. Nat Rev Dis Primers, 2024, 10(1): 71. DOI: 10.1038/s41572-024-00551-9.
27.	Rudin CM, Brambilla E, Faivre-Finn C, et al. Small-cell lung cancer[J/OL]. Nat Rev Dis Primers, 2021, 7(1): 3. DOI: 10.1038/s41572-020-00235-0.
28.	Saetan P, Chaiviboontham S, Pokpalagon P, et al. The effects of the respiratory rehabilitation program on perceived self-efficacy and dyspnea in patients with lung cancer[J]. Asian Nurs Res, 2020, 14(5): 277-285.
29.	Viola R, Kiteley C, Lloyd NS, et al. The management of dyspnea in cancer patients: a systematic review[J]. Support Care Cancer, 2008, 16(4): 329-337.
30.	Molassiotis A, Smith JA, Bennett MI, et al. Clinical expert guidelines for the management of cough in lung cancer: report of a UK task group on cough[J/OL]. Cough, 2010, 6(1): 9. DOI: 10.1186/1745-9974-6-9.
31.	Luo Y, Mao D, Zhang L, et al. Identification of symptom clusters and sentinel symptoms during the first cycle of chemotherapy in patients with lung cancer[J]. Support Care Cancer, 2024, 32(6): 385.
32.	Shin J, Hammer MJ, Cooley ME, et al. Lower income, smoking, cardiopulmonary comorbidities, and higher symptom burden influence the occurrence of cough in patients receiving chemotherapy[J/OL]. Oncol Nurs Forum, 2024, 51(4): E4-E24. DOI: 10.1188/24.ONF.E4-E24.
33.	Okamoto I, Schuette WHW, Stinchcombe TE, et al. Meta-analysis of pemetrexed plus carboplatin doublet safety profile in first-line non-squamous non-small cell lung cancer studies[J]. Curr Med Res Opin, 2017, 33(5): 937-941.
34.	Kwekkeboom KL, Tostrud L, Costanzo E, et al. The role of inflammation in the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer[J]. J Pain Symptom Manage, 2018, 55(5): 1286-1295.
35.	Chen L, Deng H, Cui H, et al. Inflammatory responses and inflammation-associated diseases in organs[J]. Oncotarget, 2017, 9(6): 7204-7218.
36.	Chen HM, Cheung DST, Lin YY, et al. Relationships of exercise timing with sleep, fatigue and rest-activity rhythms of lung cancer patients in Taiwan: an exploratory study[J/OL]. Eur J Cancer Care, 2020, 29(4): e13233. DOI: 10.1111/ecc.13233.
37.	Chang WP, Lin CC. Changes in the sleep-wake rhythm, sleep quality, mood, and quality of life of patients receiving treatment for lung cancer: a longitudinal study[J]. Chronobiol Int, 2017, 34(4): 451-461.
38.	U?ur ?, Mert H, Karada? E, et al. Symptom clusters in patients with lung cancer patients receiving chemotherapy[J]. Ad?yaman üniversitesi Sa?l?k Bilimleri Dergisi, 2022, 8(1): 17-26.
39.	楊薪瑤, 崔蕾, 劉雪, 等. 肺癌放化療消化道不良反應癥狀群管理的最佳證據總結[J]. 中華全科醫學, 2026, 24(4): 569-573.Yang XY, Cui L, Liu X, et al. Evidence summary for management of symptom clusters of gastrointestinal adverse reactions caused by radiotherapy and chemotherapy for lung cancer[J]. Chin J Gen Pract, 2026, 24(4): 569-573.
40.	Rha SY, Lee J. Stable symptom clusters and evolving symptom networks in relation to chemotherapy cycles[J]. J Pain Symptom Manage, 2021, 61(3): 544-554.
41.	Wang YZ, Xue C, Ma C, et al. Associations of the Charlson comorbidity index with depression and mortality among the US adults[J/OL]. Front Public Health, 2024, 12: 1404270. DOI: 10.3389/fpubh.2024.1404270.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1): 47-53.
3. Fang Y, Li Z, Chen H, et al. Burden of lung cancer along with attributable risk factors in China from 1990 to 2019, and projections until 2030[J]. J Cancer Res Clin Oncol, 2023, 149(7): 3209-3218.
4. 國家衛生健康委辦公廳. 原發性肺癌診療指南(2022年版)[J]. 協和醫學雜志, 2022, 13(4): 549-570.General Office of National Health Commission of the People's Republic of China. Clinical practice guideline for primary lung cancer (2022 version)[J]. Med J Peking Union Med Coll Hosp, 2022, 13(4): 549-570.
5. Rouanet P, Rullier E, Lelong B, et al. Tailored treatment strategy for locally advanced rectal carcinoma based on the tumor response to induction chemotherapy: preliminary results of the French phase Ⅱ multicenter GRECCAR4 trial[J]. Dis Colon Rectum, 2017, 60(7): 653-663.
6. Mogavero MP, DelRosso LM, Fanfulla F, et al. Sleep disorders and cancer: state of the art and future perspectives[J/OL]. Sleep Med Rev, 2021, 56: 101409. DOI: 10.1016/j.smrv.2020.101409.
7. Dodd MJ, Miaskowski C, Paul SM. Symptom clusters and their effect on the functional status of patients with cancer[J]. Oncol Nurs Forum, 2001, 28(3): 465-470.
8. Donnelly S, Walsh D. The symptoms of advanced cancer[J]. Semin Oncol, 1995, 22(2 Suppl 3): 67-72.
9. Portenoy RK, Thaler HT, Kornblith AB, et al. Symptom prevalence, characteristics and distress in a cancer population[J]. Qual Life Res, 1994, 3(3): 183-189.
10. 李芙蘭, 謝海霞, 于天爽, 等. 肺癌患者化療期間癥狀群的范圍綜述[J]. 中華護理雜志, 2024, 59(18): 2283-2289.Li FL, Xie HX, Yu TS, et al. Symptom clusters in lung cancer patients during chemotherapy: a scoping review[J]. Chin J Nurs, 2024, 59(18): 2283-2289.
11. Russell J, Wong ML, Mackin L, et al. Stability of symptom clusters in patients with lung cancer receiving chemotherapy[J]. J Pain Symptom Manage, 2019, 57(5): 909-922.
12. 劉麗峰, 崔嘉, 王海楠, 等. 肺癌術后患者癥狀群對恐懼疾病進展的影響[J]. 護理學雜志, 2024, 39(6): 37-41.Liu LF, Cui J, Wang HN, et al. Impact of symptom clusters on fear of disease progression in postoperative lung cancer patients[J]. J Nurs Sci, 2024, 39(6): 37-41.
13. Li Y, Wang Q, Liu C, et al. Symptom clusters and their impact on quality of life among Chinese patients with lung cancer: a cross-sectional study[J/OL]. Eur J Oncol Nurs, 2023, 67: 102465. DOI: 10.1016/j.ejon.2023.102465.
14. 傅郭妹芝, 蘇文敏, 章立楠, 等. 肺癌患者化療期間癥狀群的動態研究[J]. 浙江臨床醫學, 2022, 24(11): 1658-1661.Fu GMZ, Su WM, Zhang LN, et al. Dynamic study of symptom clusters in lung cancer patients during chemotherapy[J]. Zhejiang Clin Med J, 2022, 24(11): 1658-1661.
15. 王紫艷. 肺癌患者化療期間癥狀群動態變化與中醫五態人格的相關性研究[D]. 湖南中醫藥大學, 2022.Wang ZY. Study on the correlation between the dynamic change of symptom group and five-pattern personality of Chinese medicine in lung cancer patients during chemotherapy[D]. Hunan University of Chinese Medicine, 2022.
16. 游雅芬. 老年肺癌患者化療期間癥狀群發展軌跡及影響因素研究[D]. 贛南醫科大學, 2025.You YF. Trajectories of symptom clusters development during chemotherapy in elderly lung cancer patients and study of influencing factors[D]. Gannan Medical University, 2025.
17. 岳好潤, 劉萌, 李嘉寧, 等. 免疫治療期間肺癌患者癥狀群對生活質量的影響[J]. 中華腫瘤防治雜志, 2023, 30(17): 1046-1054.Yue HR, Liu M, Li JN, et al. Impact of symptom clusters during immunotherapy on quality of life in lung cancer patients[J]. Chin J Cancer Prev Treat, 2023, 30(17): 1046-1054.
18. Giesinger JM, Wintner LM, Zabernigg A, et al. Assessing quality of life on the day of chemotherapy administration underestimates patients' true symptom burden[J/OL]. BMC Cancer, 2014, 14(1): 758. DOI: 10.1186/1471-2407-14-758.
19. Mendoza TR, Wang XS, Lu C, et al. Measuring the symptom burden of lung cancer: the validity and utility of the lung cancer module of the MD Anderson Symptom Inventory[J]. Oncologist, 2011, 16(2): 217-227.
20. 張立力, 臧瑜. MD安德森癥狀評估量表肺癌模塊的修訂和考評[J]. 腫瘤, 2013, 33(5): 434-438.Zhang LL, Zang Y. Revision and evaluation of the lung cancer module of the MD Anderson Symptom Inventory[J]. Tumor, 2013, 33(5): 434-438.
21. Charlson ME, Carrozzino D, Guidi J, et al. Charlson comorbidity index: a critical review of clinimetric properties[J]. Psychother Psychosom, 2022, 91(1): 8-35.
22. Wang D, Fu J. Symptom clusters and quality of life in China patients with lung cancer undergoing chemotherapy[J]. Afr Health Sci, 2014, 14(1): 49-55.
23. 李楠楠, 陳芬榮, 朱惠瑛, 等. 肺癌患者化療前后癥狀群的調查研究[J]. 解放軍護理雜志, 2017, 34(23): 34-38.Li NN, Chen FR, Zhu HY, et al. Investigation on symptom clusters in lung cancer patients before and after chemotherapy[J]. J PLA Nurs, 2017, 34(23): 34-38.
24. Ju X, Bai J, She Y, et al. Symptom cluster trajectories and sentinel symptoms during the first cycle of chemotherapy in patients with lung cancer[J/OL]. Eur J Oncol Nurs, 2023, 63: 102282. DOI: 10.1016/j.ejon.2023.102282.
25. Choi YY, Akter J, Lee J. Symptom clusters among lung cancer patients: a scoping review[J]. Korean J Adult Nurs, 2024, 36(4): 271-297.
26. Hendriks LEL, Remon J, Faivre-Finn C, et al. Non-small-cell lung cancer[J/OL]. Nat Rev Dis Primers, 2024, 10(1): 71. DOI: 10.1038/s41572-024-00551-9.
27. Rudin CM, Brambilla E, Faivre-Finn C, et al. Small-cell lung cancer[J/OL]. Nat Rev Dis Primers, 2021, 7(1): 3. DOI: 10.1038/s41572-020-00235-0.
28. Saetan P, Chaiviboontham S, Pokpalagon P, et al. The effects of the respiratory rehabilitation program on perceived self-efficacy and dyspnea in patients with lung cancer[J]. Asian Nurs Res, 2020, 14(5): 277-285.
29. Viola R, Kiteley C, Lloyd NS, et al. The management of dyspnea in cancer patients: a systematic review[J]. Support Care Cancer, 2008, 16(4): 329-337.
30. Molassiotis A, Smith JA, Bennett MI, et al. Clinical expert guidelines for the management of cough in lung cancer: report of a UK task group on cough[J/OL]. Cough, 2010, 6(1): 9. DOI: 10.1186/1745-9974-6-9.
31. Luo Y, Mao D, Zhang L, et al. Identification of symptom clusters and sentinel symptoms during the first cycle of chemotherapy in patients with lung cancer[J]. Support Care Cancer, 2024, 32(6): 385.
32. Shin J, Hammer MJ, Cooley ME, et al. Lower income, smoking, cardiopulmonary comorbidities, and higher symptom burden influence the occurrence of cough in patients receiving chemotherapy[J/OL]. Oncol Nurs Forum, 2024, 51(4): E4-E24. DOI: 10.1188/24.ONF.E4-E24.
33. Okamoto I, Schuette WHW, Stinchcombe TE, et al. Meta-analysis of pemetrexed plus carboplatin doublet safety profile in first-line non-squamous non-small cell lung cancer studies[J]. Curr Med Res Opin, 2017, 33(5): 937-941.
34. Kwekkeboom KL, Tostrud L, Costanzo E, et al. The role of inflammation in the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer[J]. J Pain Symptom Manage, 2018, 55(5): 1286-1295.
35. Chen L, Deng H, Cui H, et al. Inflammatory responses and inflammation-associated diseases in organs[J]. Oncotarget, 2017, 9(6): 7204-7218.
36. Chen HM, Cheung DST, Lin YY, et al. Relationships of exercise timing with sleep, fatigue and rest-activity rhythms of lung cancer patients in Taiwan: an exploratory study[J/OL]. Eur J Cancer Care, 2020, 29(4): e13233. DOI: 10.1111/ecc.13233.
37. Chang WP, Lin CC. Changes in the sleep-wake rhythm, sleep quality, mood, and quality of life of patients receiving treatment for lung cancer: a longitudinal study[J]. Chronobiol Int, 2017, 34(4): 451-461.
38. U?ur ?, Mert H, Karada? E, et al. Symptom clusters in patients with lung cancer patients receiving chemotherapy[J]. Ad?yaman üniversitesi Sa?l?k Bilimleri Dergisi, 2022, 8(1): 17-26.
39. 楊薪瑤, 崔蕾, 劉雪, 等. 肺癌放化療消化道不良反應癥狀群管理的最佳證據總結[J]. 中華全科醫學, 2026, 24(4): 569-573.Yang XY, Cui L, Liu X, et al. Evidence summary for management of symptom clusters of gastrointestinal adverse reactions caused by radiotherapy and chemotherapy for lung cancer[J]. Chin J Gen Pract, 2026, 24(4): 569-573.
40. Rha SY, Lee J. Stable symptom clusters and evolving symptom networks in relation to chemotherapy cycles[J]. J Pain Symptom Manage, 2021, 61(3): 544-554.
41. Wang YZ, Xue C, Ma C, et al. Associations of the Charlson comorbidity index with depression and mortality among the US adults[J/OL]. Front Public Health, 2024, 12: 1404270. DOI: 10.3389/fpubh.2024.1404270.

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Latest ArticlesAnalysis on the evolution trajectory of symptom clusters and its influencing factors in lung cancer patients during the first chemotherapy cycle

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