AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025140083
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ORIGINAL RESEARCH ARTICLE

Identification of core symptoms and symptom clusters in primary hepatocellular carcinoma during the intermittent period between transcatheter arterial chemoembolization treatments

Jianfeng Zhang1 ,  Hongyan Duan2 ,  Jie Zhang3 ,  Mengchen Ji4 ,  Xia Shen5 ,  Yueqin Ni6*
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1 Department of Research and Teaching, Taizhou Hospital of Integrated Traditional Chinese and Western Medicine, Taizhou, Jiangsu, China
2 Department of Nursing Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China
3 Department of Interventional Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
4 Department of Nursing, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
5 Department of Nursing, School of Health and Nursing, Wuxi Taihu University, Wuxi, Jiangsu, China
6 Department of Hepatology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu, China
EJMO, 025140083 https://doi.org/10.36922/EJMO025140083
Received: 2 April 2025 | Revised: 2 May 2025 | Accepted: 4 June 2025 | Published online: 3 July 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Patients with liver cancer frequently receive multiple transcatheter arterial chemoembolization (TACE) treatments. While some studies have investigated the symptoms and symptom clusters that occur following TACE, there is limited understanding of the core symptoms and symptom clusters experienced during the intervals between TACE treatments. Objective: This study aims to identify core symptoms and symptom clusters in patients with primary hepatocellular carcinoma (HCC) during the intermittent period of TACE, providing a reference for precise symptom management. Methods: A convenience sample of 344 patients undergoing intermittent TACE was recruited. Symptom prevalence and severity were evaluated using the Chinese version of the MD Anderson symptom inventory and the HCC-specific symptom module. Principal component analysis was used to extract symptom clusters. A symptom network was constructed to illustrate inter-symptom relationships and to calculate centrality indices. Results: Four symptom clusters were identified: upper gastrointestinal, feeling of illness, emotional-psychological, and liver function impairment. Lack of appetite demonstrated the highest strength (rs = 1.10) and closeness (rc = 0.0076) centrality in the symptom network. The strongest marginal association was found between distress and sadness (r = 0.545). Conclusion: Lack of appetite emerged as the core symptom, while the emotional–psychological cluster was the core symptom cluster. Nursing interventions should prioritize addressing appetite loss and managing emotional symptoms such as distress and sadness to enhance the effectiveness of symptom management during the intermittent period of TACE in patients with primary HCC.

Keywords
Core symptom
Network analysis
Primary liver cancer
Symptom clusters
Transcatheter arterial chemoembolization
Funding
None.
Conflict of interest
The authors declare that they have no conflict of interest.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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