Purpose <p>This study aimed to identify the incidence rate, severity and distribution characteristics of symptoms in ovarian cancer patients during first-line maintenance therapy, and to determine the composition of symptom clusters, so as to provide evidence for clinical medical staff to optimize symptom management strategies for ovarian cancer patients receiving first-line maintenance therapy.</p> Methods <p>A cross-sectional survey design was adopted. Ovarian cancer patients undergoing first-line maintenance therapy were enrolled to investigate their symptom burden, and exploratory factor analysis was used to identify symptom clusters.</p> Results <p>A total of 220 patients were included in this study. The results showed that among the 38 symptoms, fatigue had the highest incidence rate, and sleep disturbance was the most severe in terms of symptom intensity. Based on the incidence rate and severity of symptoms, a total of 6 symptom clusters were identified, namely the gastrointestinal-cardiac symptom cluster, joint discomfort symptom cluster, fatigue-related symptom cluster, emotional disturbance symptom cluster, menopausal symptom cluster, and xerostomia-bitter taste symptom cluster. The top three symptom clusters in terms of severity were the fatigue-related symptom cluster, gastrointestinal-cardiac symptom cluster and menopausal symptom cluster.</p> Conclusion <p>Ovarian cancer patients receiving first-line maintenance therapy present complex, diverse symptoms grouped into six symptom clusters. This study’s findings may inform targeted comprehensive symptom management to reduce their symptom burden.</p>