Currently submitted to: JMIR Formative Research
Date Submitted: May 9, 2026
Open Peer Review Period: May 11, 2026 - Jul 6, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Differentiating Radiotherapy-Specific Distress from General Cancer Distress: A Natural Language Processing Analysis of Patient Narratives
ABSTRACT
Background:
Background:
Psychological distress is common among cancer patients and negatively impacts treatment adherence and quality of life. Radiotherapy, with its unique procedures such as daily sessions and physical immobilization, may induce distress distinct from general cancer anxiety. However, existing screening tools cannot differentiate these distress sources. This study leverages online patient narratives and natural language processing to distinguish radiotherapy-specific distress from general cancer distress.
Objective:
Objective:
This study aims to systematically identify, differentiate, and compare the composition, structure, and emotional characteristics of general cancer distress versus radiotherapy-specific distress through the analysis of large-scale online patient narratives.
Methods:
Methods:
Employing a retrospective observational design, we screened 52,831 relevant posts published between 2015 and 2025 on the online health community Reddit, ultimately including 9,860 first-person patient narratives meeting inclusion criteria. We employed Latent Dirichlet Allocation (LDA) thematic modeling for topic identification, supplemented by manual qualitative coding for thematic classification. Structural relationships between topics were analyzed via correlation heatmaps, while emotional polarity and discrete sentiments for both distress categories were quantitatively compared using VADER and RoBERTa models.
Results:
Results:
Radiotherapy-specific distress formed an independent and substantial domain, accounting for 50.4% (n=4,969) of all narratives, comparable to the 49.0% (n=4,831) attributed to general cancer distress. Thematic correlation analysis confirmed that both categories exhibited high internal cohesion but weak inter-category associations, indicating structural independence. Sentiment analysis further revealed that radiotherapy-specific distress carried stronger negative emotional intensity (p < 0.001), with core emotions dominated by “fear” (55.8%) and “anger/frustration” (25.4%); whereas general cancer distress was more frequently expressed as ‘anxiety’ (45.2%) and “sadness” (33.1%).
Conclusions:
Conclusion: This study demonstrates that radiotherapy-specific distress is not a subtype of general cancer anxiety but constitutes an independent domain with distinct compositional and emotional characteristics. Developing targeted assessment and care strategies addressing radiotherapy-specific challenges is essential for achieving truly patient-centered, individualized psychosocial support in oncology. Clinical Trial: Not applicable.
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