Characteristics of Symptom Clusters and Sentinel Symptoms in Lung Cancer Patients Before and at the Completion of Radiotherapy.

Objective To investigate the characteristics of symptom clusters and sentinel symptoms in lung cancer patients before and at the completion of radiotherapy,thus providing a theoretical basis for targeted symptom management. Methods A convenience sampling method was used to recruit patients from the Department of Radiotherapy at Yunnan Cancer Hospital between January and October 2024.A general information questionnaire and the Anderson symptom inventory-lung cancer module(revised) were employed for data collection.The exploratory factor analysis was performed for the symptoms with an incidence rate greater than 20% one day before and at the completion of radiotherapy to identify symptom clusters at different time points.The Apriori algorithm was then adopted to model the associations among symptoms within each cluster and to identify the sentinel symptoms. Results A total of 244 patients were included in this study.Three symptom clusters existed before radiotherapy:psychological symptom cluster(sadness,distress,and sleep disorder),lung cancer-related respiratory symptom cluster(cough,expectoration,chest tightness,and shortness of breath),and perception symptom cluster(pain and numbness).Distress and cough were the sentinel symptoms of psychological symptom cluster and lung cancer related respiratory symptom cluster,respectively.At the end of radiotherapy,the psychological symptom cluster and lung cancer-related respiratory symptom cluster remained unchanged.The radiotherapy side effect symptom cluster(dry mouth,pain,loss of appetite) appeared,and the perception symptom cluster expanded to encompass 5 items(amnesia,drowsiness,fatigue,nausea,and constipation).Pain and drowsiness were the sentinel symptoms of radiotherapy side effect symptom cluster and perception symptom cluster,respectively. Conclusions There are several symptom clusters in lung cancer patients before and at the completion of radiotherapy,and sentinel symptoms exist in symptom clusters at different periods.Nurses can take sentinel symptoms as the intervention targets to formulate effective and targeted nursing measures and reduce the incidence or severity of other symptoms in the cluster,thus diminishing the whole symptom cluster and reducing the burden of patients' symptoms.