ArticleBMJ open2026
What are the symptom heterogeneity and network characteristics among lung cancer survivors in China? A cross-sectional latent profile and network analysis.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo identify latent symptom subgroups, compare symptom network characteristics across subgroups and examine factors associated with subgroup membership among lung cancer survivors.
designCross-sectional study using latent profile analysis and symptom network analysis.
settingFour hospitals in Shanghai, China, including a national thoracic oncology centre, two tertiary general hospitals and one regional general hospital.
participantsA total of 942 lung cancer survivors who had completed surgical treatment or received at least one course of initial antitumour therapy and were in a stable follow-up phase or treatment interval. The mean age was 64.43±10.70 years and 65.10% were male. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were latent symptom subgroups identified by latent profile analysis and symptom network characteristics derived from partial correlation networks. Secondary outcomes were socio-demographic, clinical, functional and psychosocial factors associated with subgroup membership, assessed using multivariable multinomial logistic regression following least absolute shrinkage and selection operator (LASSO) variable selection.
resultsThree symptom subgroups were identified: a low-symptom group (n=488, 51.80%), a moderate-symptom group (n=364, 38.64%) and a high-symptom group (n=90, 9.55%). Network density was descriptively higher in the high-symptom group than in the low-symptom group (0.468 vs 0.175). Central symptoms differed across subgroups, with cough in the low-symptom group, vomiting in the moderate-symptom group and distress in the high-symptom group. After LASSO selection and collinearity assessment, 22 predictors were entered into the final multivariable multinomial logistic regression model. Compared with the low-symptom group, surgery with adjuvant therapy was associated with higher odds of membership in the moderate-symptom group (adjusted OR (aOR)=4.054, 95% CI 2.094 to 7.850), whereas better exercise capacity was associated with lower odds of membership in the high-symptom group (6-minute walk distance ≥450 m: aOR=0.101, 95% CI 0.027 to 0.372). The final model had a Nagelkerke pseudo-R² of 0.522.
conclusionsSymptom burden among lung cancer survivors is heterogeneous and differs in both severity profiles and network structure. Integrating latent profile analysis with symptom network analysis may provide a useful framework for stratified symptom assessment and individualised symptom management in survivorship care. TRIAL REGISTRATION NUMBER: MR-31-24-027806 (https://www.medicalresearch.org.cn/clinicalResearch/researchInfo?id=eb897346-a67b-4465-a553-1d1a3488bc30).
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