A network analysis of symptom clusters and core symptoms in colorectal cancer patients undergoing postoperative chemotherapy

Objective To identify symptom clusters in patients after colorectal cancer surgery upon completion of six cycles of chemotherapy and to determine core symptoms using network analysis, thereby providing evidence for developing precise symptom management strategies. Methods A cross-sectional study was conducted. A convenience sample of 211 patients who had completed six cycles of chemotherapy after colorectal cancer surgery was recruited from two tertiary hospitals between February and October 2025. Participants were assessed using the MD Anderson Symptom Inventory for Gastrointestinal Cancer (MDASI-GI). Symptom clusters were extracted via exploratory factor analysis, and a symptom network was constructed using R software to identify core symptoms. Results Three symptom clusters were identified: gastrointestinal-psychological, neurotoxicity, and CRC-specific. Network analysis revealed that “Poor appetite” had the highest node strength ( r s =1.362) and expected influence ( r e =1.362), while “Nausea” had the highest closeness centrality ( r c =0.007) and betweenness centrality ( r b =48). Fatigue had the highest incidence rate (89.6%). Conclusion Poor appetite and nausea are key symptoms in the symptom network of colorectal cancer patients after surgery and chemotherapy. In clinical practice, giving priority to managing these two core symptoms, while routinely addressing fatigue as a high-frequency concern, may improve patients’ overall symptom experience more effectively and enable more focused care.