Network analysis of core symptom changes in hepatocellular carcinoma survivors after transarterial chemoembolization: A longitudinal study

Objective The aims of this study were to explore the longitudinal trajectories of core symptoms in survivors with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) and to analyze their associations with health-related quality of life (HRQoL) and unmet supportive care needs. Methods This longitudinal study enrolled 271 HCC survivors undergoing TACE in China. Patient-reported outcomes were assessed at three time points—24 h (T1), 7 days (T2), and 1 month (T3) post-TACE—using four validated instruments: the MD Anderson Symptom Inventory–Chinese Version (MDASI-C), the Tumor Symptom Measure for Primary Liver Cancer (TSM-PLC), the Quality of Life Instrument for Liver Cancer (QOL-LC V2.0), and the Short Form of Survivors’ Unmet Needs Scale (SF-SUNS). Exploratory factor analysis was conducted to extract discrete symptom clusters, and network analysis was used to calculate strength centrality (rs)—an index quantifying the sum of absolute edge weights connecting each symptom to all others—to identify core symptoms. Results Five symptom clusters were identified at T1: Fatigue-Cognitive, Post-embolization, Somatic, Emotional, and Hepatobiliary-Specific. The Post-embolization cluster was present only at T1, whereas the remaining four clusters persisted at T2 and T3. However, the core symptom shifted over time: nausea at T1 (rs = 1.154), lack of appetite at T2 (rs = 1.229), and sadness at T3 (rs = 1.107). HRQoL was lowest at T1, improved at T2, and declined at T3, with all pairwise comparisons significant (all p < 0.001). Unmet needs were highest at T3, with all time-point differences significant (all p < 0.001). The largest gaps were observed in information provision, care continuity, and emotional support. Greater symptom severity was significantly associated with poorer HRQoL at all time points (all p < 0.01). Conclusions During the first month post-TACE, the sequence of core symptoms transitioned from nausea to lack of appetite and then to sadness, suggesting time-specific supportive care strategies—including antiemetic prophylaxis, nutritional support, and psychosocial care. Routine assessment of unmet needs may help reduce symptom burden and optimize long-term HRQoL for these survivors.