11. Jian Zhao, PhD

Introduction: Pain is a common complaint among patients with cancer presenting to the emergency department (ED). This study examined the relationships among pain and psychological symptoms between two groups of patients with cancer, those who had undergone surgery either within or greater than 3 months prior to their ED admission.
Methods: In this prospective observational cohort study, patients with cancer presenting to the ED with pain (>4 NRS) completed validated self-report measures assessing sociodemographics, cancer-related treatments, pain severity and interference, medication use, psychological symptoms (depression, anxiety, pain catastrophizing, sleep disturbance), and recent cancer-related surgical history. Network analysis included construction of correlation matrices of pain and psychological symptoms and centrality measures identified key symptoms and their interconnections among patients with recent (3month).
Results: Of the 173 enrolled participants, 120 had previously undergone cancer-related surgery, with abdomen pain reported most frequently (n=42), along with lower back and pelvic pain. Network analysis revealed distinct symptom clusters in each group. Among patients with recent surgery, helplessness showed the highest degree and closeness centrality, suggesting its strong interconnections with other symptoms. Average pain intensity bridged physical and psychological symptoms. For patients with surgery >3mo, pain interference and average pain severity were the most central symptoms. Sleep disturbance exhibited high betweenness centrality linking symptom clusters. Although the network for patients beyond 3-months post-surgery demonstrated a higher global strength(27.30) than the early phase network(20.55), the difference was not statistically significant(p = 0.37).
Conclusion: Network analysis highlights dynamic symptom interconnections in post-surgical cancer patients, with helplessness, pain interference, and sleep disturbance emerging as key targets for intervention, depending on recovery phase. Future studies should adopt longitudinal designs to confirm these observations and explore targeted interventions to improve symptom management and reduce ED visits among cancer patients.