Symptoms associated with minimally invasive esophagectomy in older adults with esophageal cancer: Application of latent class analysis and network analysis.

INTRODUCTION: Older adults with esophageal cancer often present with multiple coexisting symptoms after minimally invasive esophagectomy owing to factors such as surgical trauma. Significant heterogeneity exists in the symptom experiences of different patient groups, suggesting the need to provide a basis for precise clinical interventions by identifying the symptom characteristics and core symptoms of different categories. Studies using latent class analysis (LCA) combined with a symptom network approach to explore postoperative symptom characteristics in older adults with esophageal cancer are lacking. This investigation was designed to utilize LCA to recognize varied symptom categories among patients and to analyze the core symptom traits within each category.

MATERIALS AND METHODS: Older adults one month post-minimally invasive esophagectomy who received treatment in the thoracic surgery departments of four tertiary-level hospitals in Hefei City, Anhui Province from August 2022 to February 2024 were selected by convenience sampling. A general information questionnaire and the Convalescence Symptom Assessment Scale for Oesophagectomy Patients were administered to collect data from the participants. LCA was performed to identify symptom categories. Category characteristics were determined by regression analysis and network analysis.

RESULTS: Of the 450 patients, 27.3% (Class 1) were placed in the "high symptom burden group" and 72.7% (Class 2) were categorized into the "low symptom burden group". Patients who were married, had family monthly income less than ¥3000, had stage I/II esophageal cancer, and underwent cervical anastomosis were more likely to be in Class 2. Network analysis revealed that in Class 1, cough with phlegm (rs = 1.81) and sadness (rs = 1.71) served as core symptoms, while limited mobility (rs = 1.84) and worry (rs = 1.66) emerged as the core symptoms in Class 2.

DISCUSSION: Patients exhibit heterogeneity in their symptom manifestations, with different categories having distinct symptom networks. This study identified two patient types based on symptom severity, providing valuable insights for personalized care, maximizing the effects of interventions, and reducing patients' symptom burden. In the future, large-scale, multi-center longitudinal studies are needed to validate and further explore the two distinct classes identified in this study.