Network analysis of the multidimensional symptom experience of oncology

Papachristou, Nikolaos and Barnaghi, Payam and Cooper, Bruce and Kober, Kord M. and Maguire, Roma and Paul, Steven M. and Hammer, Marilyn and Wright, Fay and Armes, Jo and Furlong, Eileen P. and McCann, Lisa and Conley, Yvette P. and Patiraki, Elisabeth and Katsaragakis, Stylianos and Levine, Jon D. and Miaskowski, Christine (2019) Network analysis of the multidimensional symptom experience of oncology. Scientific Reports, 9. 2258. ISSN 2045-2322 (

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Oncology patients undergoing cancer treatment experience an average of fifteen unrelieved symptoms that are highly variable in both their severity and distress. Recent advances in Network Analysis (NA) provide a novel approach to gain insights into the complex nature of co-occurring symptoms and symptom clusters and identify core symptoms. We present findings from the first study that used NA to examine the relationships among 38 common symptoms in a large sample of oncology patients undergoing chemotherapy. Using two different models of Pairwise Markov Random Fields (PMRF), we examined the nature and structure of interactions for three different dimensions of patients’ symptom experience (i.e., occurrence, severity, distress). Findings from this study provide the first direct evidence that the connections between and among symptoms differ depending on the symptom dimension used to create the network. Based on an evaluation of the centrality indices, nausea appears to be a structurally important node in all three networks. Our findings can be used to guide the development of symptom management interventions based on the identification of core symptoms and symptom clusters within a network.


Papachristou, Nikolaos, Barnaghi, Payam, Cooper, Bruce, Kober, Kord M., Maguire, Roma ORCID logoORCID:, Paul, Steven M., Hammer, Marilyn, Wright, Fay, Armes, Jo, Furlong, Eileen P., McCann, Lisa, Conley, Yvette P., Patiraki, Elisabeth, Katsaragakis, Stylianos, Levine, Jon D. and Miaskowski, Christine;