Network analysis of head and neck symptoms and fear of cancer recurrence in postoperative laryngeal cancer patients: simulation-based intervention modeling.

purposeTo examine the network structure linking head and neck symptoms with fear of cancer recurrence (FCR)-related concerns in postoperative laryngeal cancer patients and to identify candidate targets using simulation-based intervention modeling.

methodsThis cross-sectional study included 284 postoperative laryngeal cancer patients. Head and neck symptoms were assessed with the MD Anderson Symptom Inventory-Head and Neck Module, and FCR-related concerns with the Fear of Progression Questionnaire-Short Form. Analyses included EBICglasso network estimation, expected influence, bridge expected influence, Bayesian network modeling, and Ising simulation.

resultsThe network contained 239 edges. Check-up anxiety, major treatment worry, and throat sores had the highest expected influence. Disease progression worry, worry about family future, and check-up anxiety were the leading bridge nodes. The Bayesian network identified seven cross-domain arcs. In simulations across all 34 nodes, swallowing difficulty yielded the largest point estimate for simulated aggravation (+ 19.28%; 95% CI 3.42 to 37.89), whereas choking cough yielded the largest point estimate for simulated relief (-17.51%; 95% CI -29.81 to -4.26).

conclusionThese findings highlight the potential value of considering head and neck symptoms and FCR-related concerns together in postoperative assessment and supportive care for patients with laryngeal cancer. Disease progression worry, worry about family future, and check-up anxiety may serve as key bridge nodes. In the full 34-node simulation, swallowing difficulty and choking cough emerged as candidate targets associated with the largest point estimates for simulated aggravation and relief, respectively.