Five symptom clusters reveal hidden burden of pancreatic cancer chemotherapy

A research team has identified five interconnected symptom clusters affecting patients receiving adjuvant chemotherapy after pancreatic cancer surgery, with psychological symptoms—including nervousness, sadness, and anxiety—among the most severe and prevalent. The findings also reveal that clinical, nutritional, functional, and sociodemographic factors are associated with different symptom patterns. By moving beyond the treatment of isolated complaints, this symptom-cluster framework could help clinicians recognize high-risk patients earlier and develop more targeted nutritional, psychological, and supportive-care strategies.

Pancreatic cancer remains one of the most lethal malignancies, and surgery offers the only potentially curative treatment. Adjuvant chemotherapy can reduce postoperative recurrence and prolong survival, but its toxic effects, combined with surgical trauma and psychological distress, frequently produce multiple simultaneous symptoms. Previous research has examined pain, fatigue, gastrointestinal problems, and emotional distress in pancreatic cancer, yet evidence focusing specifically on patients undergoing postoperative adjuvant chemotherapy remains limited. Moreover, symptoms are often managed individually even though they may share underlying mechanisms and intensify one another, leaving clinicians without sufficient evidence for coordinated interventions.

A study (DOI: 10.48130/ejcc-0026-0006) published in European Journal of Cancer Care on 17 July 2026 by Kuei-Ching Pan's team, Nanjing Medical University, reports five distinct symptom clusters and identifies patient and treatment characteristics associated with their severity.

The researchers conducted a single-center, cross-sectional study involving 224 adults with pathologically confirmed pancreatic cancer who had undergone surgery and completed at least one cycle of adjuvant gemcitabine plus nab-paclitaxel chemotherapy. Participants were recruited at a tertiary hospital in Nanjing, China, between January and October 2025. Demographic and clinical information was collected through medical records and interviews, while nutritional risk was evaluated using Nutritional Risk Screening 2002. On the seventh day of the chemotherapy cycle, researchers assessed symptoms with the Chinese version of the Memorial Symptom Assessment Scale and evaluated functional status using the Karnofsky Performance Status scale. Exploratory factor analysis was then applied to 21 symptoms occurring in 20%–80% of participants, and multiple linear regression was used to identify factors associated with cluster severity. Patients experienced an average of 14.88 symptoms. Nervousness was the most prevalent, severe, and distressing symptom, occurring in 76.3% of participants; anxiety affected 75.4%, sadness 75.0%, lack of energy 70.5%, and lack of appetite 67.0%. The analysis identified gastrointestinal, psychological, physiological energy-depletion, neuromuscular, and body-image-disturbance clusters, together explaining 72.13% of symptom variance. Greater gastrointestinal symptom severity was associated with more chemotherapy cycles, a longer time since diagnosis, higher nutritional-risk scores, and elevated aspartate aminotransferase levels. Psychological symptoms were associated with disease stage, tumor location, chronic disease, and poorer functional status. Energy-depletion symptoms were associated with chronic disease, lower functional status, and smoking history, whereas neuromuscular symptoms were linked to alcohol history and chemotherapy exposure. Education, primary caregiver, and time since diagnosis were associated with body-image disturbance. A sensitivity analysis excluding patients with stage IV disease largely preserved the five-cluster structure and most regression findings.

The study shows that postoperative chemotherapy symptoms should be understood as interconnected patterns rather than separate adverse effects. The findings support risk-stratified care that combines nutritional screening, psychological support, functional exercise, and monitoring for gastrointestinal and neurological toxicity. Because the study used a single-center, cross-sectional design and assessed symptoms at only one time point, multicenter longitudinal research is needed to confirm the clusters and track how they evolve across chemotherapy cycles and treatment regimens.

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References

DOI

10.48130/ejcc-0026-0006

Original Source URL

https://doi.org/10.48130/ejcc-0026-0006

Funding information

This study was supported by the Nanjing Medical Science and Technology Development Fund (Grant Nos YKK20219 and YKK23258). The funding agency had no role in the study design, data collection and analysis, interpretation of results, manuscript writing, or the decision to submit the manuscript for publication.

About European Journal of Cancer Care

European Journal of Cancer Care (e-ISSN 1365-2354) is an open-access, peer-reviewed journal dedicated to publishing original research on multiprofessional cancer care. The journal provides a forum for multiprofessional and service-user dialogue, and the reporting of original research or rigorous reviews within the field of cancer care both in Europe and internationally.