Abstract：
BACKGROUND: Frailty has a significant impact on the overall quality of life of older cancer survivors, but the relationships among frailty symptoms are not well understood. This study aims to explore the specific associations among multidimensional symptoms of frailty among older cancer survivors by employing network analysis to provide supportive evidence for targeted interventions in the future.
METHODS: Data were obtained by cluster sampling from three large Grade-A tertiary hospitals in Shandong Province, China, and collected through face-to-face interviews by trained investigators. We included patients who were diagnosed with a solid malignant tumor at the age of 60 years or older. Frailty indicators were measured by the Groningen Frailty Indicator (GFI) and analyzed primarily through network analysis, including network estimation, centrality, and stability analysis. The relative importance of a node in a network was tested by centrality analyses, and Spearman correlations were applied to estimate the relationships between symptom pairs (symptom score) and symptom clusters (standardized symptom score) in the symptom network. In terms of centrality, the indexes of strength, closeness, and betweenness were adopted to measure the importance of nodes.
RESULTS: Five hundred and eight older cancer survivors were included, with an average age of 68.4 years (standard deviation [SD] = 5.4), and a higher proportion were male (n = 307[60.4%]). The prevalence of frailty among older cancer survivors was 58.9% (n = 299), with a mean GFI score of 4.46 (SD = 2.87). The strongest edge was between \"dressing and undressing\" and \"going to the toilet\" (r = 0.58). The nodes with the higher strength centrality were \"going to the toilet\" (rS=1.09), \"walking around outside\" (rS=0.97), and \"part of social network\" (rS=0.96); and the nodes with the higher closeness centrality were \"mark physical fitness\" (rC=0.005), \"calm and relaxed\" (rC=0.005), and \"nervous or downhearted\" (rC=0.005).
CONCLUSIONS: This study demonstrated that older cancer survivors in China have a high prevalence of frailty, with self-care and social participation-related symptoms playing a key role in the multidimensional network of frailty symptoms. Psychological symptoms can rapidly influence other symptoms within this network. Therefore, prioritizing psychological symptoms in the assessment of older adults with cancer is essential for effective frailty management.
METHODS: Data were obtained by cluster sampling from three large Grade-A tertiary hospitals in Shandong Province, China, and collected through face-to-face interviews by trained investigators. We included patients who were diagnosed with a solid malignant tumor at the age of 60 years or older. Frailty indicators were measured by the Groningen Frailty Indicator (GFI) and analyzed primarily through network analysis, including network estimation, centrality, and stability analysis. The relative importance of a node in a network was tested by centrality analyses, and Spearman correlations were applied to estimate the relationships between symptom pairs (symptom score) and symptom clusters (standardized symptom score) in the symptom network. In terms of centrality, the indexes of strength, closeness, and betweenness were adopted to measure the importance of nodes.
RESULTS: Five hundred and eight older cancer survivors were included, with an average age of 68.4 years (standard deviation [SD] = 5.4), and a higher proportion were male (n = 307[60.4%]). The prevalence of frailty among older cancer survivors was 58.9% (n = 299), with a mean GFI score of 4.46 (SD = 2.87). The strongest edge was between \"dressing and undressing\" and \"going to the toilet\" (r = 0.58). The nodes with the higher strength centrality were \"going to the toilet\" (rS=1.09), \"walking around outside\" (rS=0.97), and \"part of social network\" (rS=0.96); and the nodes with the higher closeness centrality were \"mark physical fitness\" (rC=0.005), \"calm and relaxed\" (rC=0.005), and \"nervous or downhearted\" (rC=0.005).
CONCLUSIONS: This study demonstrated that older cancer survivors in China have a high prevalence of frailty, with self-care and social participation-related symptoms playing a key role in the multidimensional network of frailty symptoms. Psychological symptoms can rapidly influence other symptoms within this network. Therefore, prioritizing psychological symptoms in the assessment of older adults with cancer is essential for effective frailty management.
摘要：
背景：虚弱对老年癌症幸存者的整体生活质量有重大影响，但是虚弱症状之间的关系还没有得到很好的理解。本研究旨在通过使用网络分析来探索老年癌症幸存者中虚弱的多维症状之间的特定关联，从而为将来的针对性干预措施提供支持性证据。
方法：采用整群抽样的方法，从山东省三家大型三级甲等医院获得数据，中国,并通过训练有素的调查人员的面对面访谈收集。我们纳入了60岁或以上被诊断患有实体恶性肿瘤的患者。衰弱指标采用格罗宁根衰弱指标(GFI)进行测量,主要通过网络分析,包括网络估计，中心性，和稳定性分析。网络中节点的相对重要性通过中心性分析进行了测试，和Spearman相关性用于估计症状网络中症状对(症状评分)和症状群(标准化症状评分)之间的关系。就中心性而言，强度指标，亲密关系,采用介数来衡量节点的重要性。
结果：纳入了500名老年癌症幸存者，平均年龄为68.4岁（标准偏差[SD]=5.4），男性比例较高（n=307[60.4%]）。老年癌症幸存者中虚弱的患病率为58.9％（n=299），平均GFI评分为4.46(SD=2.87)。最强的优势在“穿衣脱衣”和“上厕所”之间（r=0.58）。强度较高的节点为“上厕所”(rS=1.09)，“在外面走来走去”(rS=0.97)，和“社交网络的一部分”(rS=0.96)；具有较高接近度中心性的节点是“标记身体健康”(rC=0.005)，“平静和放松”(rC=0.005)，和“紧张或沮丧”(rC=0.005)。
结论：这项研究表明，中国老年癌症幸存者的虚弱患病率很高，自我护理和社会参与相关症状在虚弱症状的多维网络中起关键作用。心理症状可以迅速影响该网络中的其他症状。因此,在评估老年癌症患者时优先考虑心理症状对于有效的虚弱管理至关重要。
方法：采用整群抽样的方法，从山东省三家大型三级甲等医院获得数据，中国,并通过训练有素的调查人员的面对面访谈收集。我们纳入了60岁或以上被诊断患有实体恶性肿瘤的患者。衰弱指标采用格罗宁根衰弱指标(GFI)进行测量,主要通过网络分析,包括网络估计，中心性，和稳定性分析。网络中节点的相对重要性通过中心性分析进行了测试，和Spearman相关性用于估计症状网络中症状对(症状评分)和症状群(标准化症状评分)之间的关系。就中心性而言，强度指标，亲密关系,采用介数来衡量节点的重要性。
结果：纳入了500名老年癌症幸存者，平均年龄为68.4岁（标准偏差[SD]=5.4），男性比例较高（n=307[60.4%]）。老年癌症幸存者中虚弱的患病率为58.9％（n=299），平均GFI评分为4.46(SD=2.87)。最强的优势在“穿衣脱衣”和“上厕所”之间（r=0.58）。强度较高的节点为“上厕所”(rS=1.09)，“在外面走来走去”(rS=0.97)，和“社交网络的一部分”(rS=0.96)；具有较高接近度中心性的节点是“标记身体健康”(rC=0.005)，“平静和放松”(rC=0.005)，和“紧张或沮丧”(rC=0.005)。
结论：这项研究表明，中国老年癌症幸存者的虚弱患病率很高，自我护理和社会参与相关症状在虚弱症状的多维网络中起关键作用。心理症状可以迅速影响该网络中的其他症状。因此,在评估老年癌症患者时优先考虑心理症状对于有效的虚弱管理至关重要。
