Temporal biobehavioral pathways from perceived stress to symptom burden in patients with cancer: A three-wave longitudinal cross-lagged panel network analysis to inform supportive care.

BACKGROUND: Cancer-related stress and symptom burden constitute a complex, interrelated process across psychological, biological, and functional domains. Existing studies often examine isolated associations, limiting understanding of their dynamic interactions over time. This study aimed to construct a cross-lagged panel network to examine the longitudinal temporal structure among perceived stress, emotional distress, inflammatory biomarkers, physical functioning, and symptoms. METHODS: A three-wave cross-lagged panel network (CLPN) analysis was conducted in oncology departments of two tertiary hospitals in Nanjing and Tianjin, China. A total of 276 patients completed baseline assessments; 258 and 241 completed follow-ups at 4-8 and 8-12 weeks post-treatment, respectively. Measures included perceived stress, emotional distress, biomarkers (C-reactive protein, interleukin-6, cortisol), functioning, and symptoms. Temporal associations were estimated using ridge-regularized CLPN models. RESULTS: Temporal networks revealed a consistent hierarchical organization of prospective cross-domain associations, with perceived stress occupying an early temporal position, and functioning and symptom-related variables occurring later in the temporal sequence. Bidirectional feedback was observed. Centrality analyses highlighted perceived stress and fatigue as prominent nodes. CONCLUSIONS: Cancer symptom progression appears to follow a temporally organized hierarchical structure, with perceived stress serving as an early predictor. Fatigue functions as a key bridge across domains. These findings highlight the potential importance of early stress management and targeted fatigue interventions and may help inform phase-specific supportive care within multidisciplinary oncology practice.