Identification of Core Symptoms and Symptom Clusters in Post-Radical Cystectomy Bladder Cancer Survivors : A Network Analysis

Objective To explore the composition of symptom clusters in post-radical cystectomy (RC) bladder cancer survivors, construct a symptom network, and identify core symptoms to provide a basis for developing targeted symptom management strategies. Methods A cross-sectional design was adopted, including 111 post-RC bladder cancer survivors in a tertiary hospital from May 2023 to May 2025. Symptoms were evaluated using the EORTC QLQ-C30 and QLQ-BLM30 scales. Exploratory factor analysis was used to extract symptom clusters. JASP software was applied to generate network analysis diagrams and centrality index diagrams of each symptom, to analyze the relationships within clusters. Results The most prevalent symptoms were abdominal bloating/flatulence (70.27%), urostomy problems (54.95%), and fatigue (38.74%). Three symptom clusters were extracted: the Fatigue Symptom Cluster, Urostomy Problems Symptom Cluster, and Bowel Symptom Cluster, with a cumulative variance contribution rate of 70.165%. Network analysis showed that fatigue (rs = 1.138) and urostomy problems (rs = 0.995) had the highest Strength. Future worries had the highest Closeness( (rc = 1.667) and Betweenness( (rb = 1.725), located at the center of the symptom network. Conclusions Abdominal bloating/flatulence is the sentinel symptom in the network model; fatigue and urostomy problems are core symptoms; future worries are bridge symptoms. Healthcare providers can formulate precise and efficient symptom management plans by leveraging the synergistic effects of symptoms within clusters, targeting sentinel, core, and bridge symptoms to improve the quality of life in post-RC bladder cancer survivors.