Home-based symptom management for patients with malignant lymphoma undergoing intermittent chemotherapy: A prospective observational study using network analysis.

[OBJECTIVE] This study aimed to explore the symptom burden of patients with malignant lymphoma at home during the intermittent periods of chemotherapy and identify core symptoms using network analysis.

[METHODS] A prospective observational study was conducted, recruiting 208 patients from December 2019 to December 2020. Symptom burden was assessed using the MD Anderson Symptom Inventory-Chinese version (MDASI-C) at three time points during the first to third chemotherapy cycles (T1-T3). Symptom networks were constructed for each time point, and centrality indices were analyzed to identify core and bridge symptoms. Network comparison tests (NCT) were used to examine changes in symptom interconnectivity over time.

[RESULTS] A total of 208 participants were included in the data analysis. Fatigue and vomiting were the most prevalent and severe symptoms reported at all time points, respectively. In the presented symptom network, lack of appetite (  ​= ​1.13), sadness (  ​= ​1.20), and nausea (  ​= ​1.13) were the core symptoms of T1, T2, and T3, respectively. Lack of appetite (  ​= ​21,  ​= ​0.01), distress (  ​= ​25,  ​= ​0.01), and dry mouth (  ​= ​11,  ​= ​0.01) were identified as bridge symptoms at T1, T2, and T3, respectively. NCT results indicated no statistical differences in the global symptom network strength and overall edge weight among the three time points, while sadness exhibited higher betweenness and closeness in the network of T2 (T1 vs. T2,  ​= ​0.03,  ​= ​0.03; T2 vs. T3,  ​= ​0.01,  ​= ​0.03).

[CONCLUSIONS] The findings highlight lack of appetite, sadness, and nausea as critical targets for symptom management in patients with malignant lymphoma undergoing intermittent chemotherapy. Caregivers and healthcare providers should focus on these symptoms to improve home-based symptom management and enhance patient well-being.