Observational studySupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2026
Network temperature and stability of symptom clusters in colorectal cancer patients undergoing adjuvant chemotherapy: a prospective longitudinal study.
Observational study in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 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
purposePostoperative colorectal cancer patients receiving adjuvant chemotherapy often experience a high symptom burden that compromises quality of life, yet evidence on the stage-specific stability of symptom clusters remains limited. We applied network temperature to characterize temporal changes in the configurational stability of symptom states during chemotherapy and to examine whether these patterns differed among symptom clusters.
methodsThis prospective longitudinal observational study was conducted at three chemotherapy stages. Symptoms with prevalence of at least 20% at all assessments were included in multigroup Ising network models. Symptom clusters were identified using the Spinglass community detection algorithm. Temperature estimates and their 95% confidence intervals were obtained using 1000 patient-level nonparametric bootstrap resamples.
resultsAmong 380 patients, three clusters emerged: emotional distress, somatic-gastrointestinal, and fatigue-neuropathy. Overall relative network temperature decreased across chemotherapy stages. The fatigue-neuropathy cluster showed a marked reduction in temperature from the initial reference level (T1 = 1.00; T2 = 0.60 [0.49-0.74]; T3 = 0.45 [0.36-0.55]), whereas the emotional distress cluster showed an increasing temperature trajectory over time (T1 = 1.00; T2 = 1.06 [0.96-1.19]; T3 = 1.12 [1.01-1.25]).
conclusionAmong colorectal cancer patients receiving adjuvant chemotherapy, overall symptom-network temperature decreased across stages, indicating a more constrained distribution of symptom-state configurations. The fatigue-neuropathy cluster showed progressive concentration of symptom-state configurations, whereas the emotional distress cluster maintained greater configurational variability throughout chemotherapy. These findings highlight the importance of longitudinal, cluster-informed symptom assessment during chemotherapy.
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