Longitudinal Study of Symptom Cluster Trajectories and Sentinel Symptoms in Patients With Cervical Cancer After Surgery and During the First Chemotherapy Cycle

BACKGROUND: Patients with cervical cancer often experience multiple concurrent symptoms that may cluster and change during treatment. Understanding symptom cluster trajectories and identifying sentinel symptoms may support early symptom management. OBJECTIVE: The aim is to investigate postoperative and first-cycle chemotherapy symptoms in patients with cervical cancer, analyze symptom cluster trajectories, and identify sentinel symptoms. METHODS: A prospective longitudinal study collected data at 5 time points: postoperative day 5 (T1), before the first chemotherapy (T2), and 1, 2, and 3 weeks after chemotherapy (T3-T5). Symptoms were assessed using the Symptom Assessment of Cancer Therapy-Cervix and Symptom Onset Timing Questionnaire. Latent class growth analysis identified symptom clusters and trajectories, and the Apriori algorithm detected sentinel symptoms. RESULTS: Among 152 patients, 4 symptom clusters were identified. Hair loss did not cluster with other symptoms. Cluster 1 (gastrointestinal-genitourinary symptoms) showed a low-level, low-fluctuation downward trajectory. Cluster 2 (abdominal bloating-vaginal bleeding-poor appetite-weight loss-numbness) demonstrated a moderate-level downward trajectory with greater severity early after surgery. Cluster 3 (pain-fatigue) showed a high-level, high-fluctuation trajectory, with pain identified as the sentinel symptom. Cluster 4 (nervousness-depression-anxiety) showed a high-level trajectory with a slight increase over time, with nervousness identified as the sentinel symptom. No sentinel symptoms were identified in clusters 1 or 2. CONCLUSION: Distinct symptom cluster trajectories were observed after surgery and early chemotherapy. Sentinel symptoms within key clusters may provide targets for early intervention. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE: Monitoring symptom cluster trajectories and sentinel symptoms may support timely, cluster-based symptom management.