Symptom Experiences in Colorectal Cancer Survivors After Cancer Treatments: A Systematic Review and Meta-analysis

Abstract

Background: With improved survivorship rates for colorectal cancer (CRC), more CRC survivors are living with long-term disease and treatment side effects. Little research exists on CRC symptoms or symptom management guidelines to support these individuals after cancer treatments.

Objectives: The aims of this study were to systematically review symptom experiences, risk factors, and the impact of symptoms and to examine the pooled frequency and severity of symptoms via meta-analyses in CRC survivors after cancer treatments.

Methods: Relevant studies were systematically searched in 7 databases from 2009 to 2019. Meta-analysis was conducted for pooled estimates of symptom frequency and severity.

Results: Thirty-five studies met the inclusion criteria. Six studies assessed multiple CRC symptoms, whereas 29 focused on a single symptom, including peripheral neuropathy, psychological distress, fatigue, body image distress, cognitive impairment, and insomnia. The pooled mean frequency was highest for body image distress (78.5%). On a scale of 0 to 100, the pooled mean severity was highest for fatigue (50.1). Gastrointestinal and psychological symptoms, peripheral neuropathy, and insomnia were also major problems in CRC survivors. Multiple factors contributed to adverse symptoms, such as younger age, female gender, and lack of family/social support. Symptoms negatively impacted quality of life, social and sexual functioning, financial status, and caregivers' physical and mental conditions.

Conclusions: Colorectal cancer survivors experienced multiple adverse symptoms related to distinct risk factors. These symptoms negatively impacted patients and caregivers' well-being.

Implications for practice: Healthcare providers can use study findings to better assess and monitor patient symptoms after cancer treatments. More research is needed on CRC-specific symptoms and their effective management.

Figure 1.

Theoretical framework: Symptom Management Model for CRC Survivors. Note. Symptom experiences, disease outcomes, and symptom management strategies are interrelated within the contexts of health and illness, person, and environment. CRC symptoms, potential impacts of CRC symptoms, and potential risk factors of CRC symptoms are focused on understanding the dynamics and interplay of these various health components to inform effective interventions for CRC survivors. Adapted from Dodd M. et al. Advancing the science of symptom management. J Adv Nurs, 2001:33(5):668-676. Abbreviations: CRC, colorectal cancer; QOL, quality of life.

Figure 2.

Article Search Flow Diagram for Systematic Review and Meta-Analyses

Figure 3.

Forest Plot of Pooled Frequencies of Symptoms in Colorectal Cancer Survivors after Cancer Treatments via Meta-Analyses. Note. Random effect model was used except for body image distress. Abbreviation: CI, confidence intervals; FRQ, frequency; LCL, Low confidence interval limit; UCL, upper confidence interval limit; WGHT, weight of each study.

Figure 3.

Forest Plot of Pooled Frequencies of Symptoms in Colorectal Cancer Survivors after Cancer Treatments via Meta-Analyses. Note. Random effect model was used except for body image distress. Abbreviation: CI, confidence intervals; FRQ, frequency; LCL, Low confidence interval limit; UCL, upper confidence interval limit; WGHT, weight of each study.

Figure 3.

Forest Plot of Pooled Frequencies of Symptoms in Colorectal Cancer Survivors after Cancer Treatments via Meta-Analyses. Note. Random effect model was used except for body image distress. Abbreviation: CI, confidence intervals; FRQ, frequency; LCL, Low confidence interval limit; UCL, upper confidence interval limit; WGHT, weight of each study.

Figure 4.

Forest Plot of Pooled Severities of Symptoms in Colorectal Cancer Survivors after Cancer Treatments via Meta-Analyses. Note. Fixed effect model was used for fecal incontinence, embarrassment with bowel movement, abdominal pain, appetite loss, nausea and/or vomiting, and sore mouth and tongue. Pooled mean severity data on a 0-100 scale. Abbreviation: CI, confidence intervals; FRQ, frequency; LCL, Low confidence interval limit; UCL, upper confidence interval limit; WGHT, weight of each study.

Figure 4.

Forest Plot of Pooled Severities of Symptoms in Colorectal Cancer Survivors after Cancer Treatments via Meta-Analyses. Note. Fixed effect model was used for fecal incontinence, embarrassment with bowel movement, abdominal pain, appetite loss, nausea and/or vomiting, and sore mouth and tongue. Pooled mean severity data on a 0-100 scale. Abbreviation: CI, confidence intervals; FRQ, frequency; LCL, Low confidence interval limit; UCL, upper confidence interval limit; WGHT, weight of each study.

Figure 4.

Forest Plot of Pooled Severities of Symptoms in Colorectal Cancer Survivors after Cancer Treatments via Meta-Analyses. Note. Fixed effect model was used for fecal incontinence, embarrassment with bowel movement, abdominal pain, appetite loss, nausea and/or vomiting, and sore mouth and tongue. Pooled mean severity data on a 0-100 scale. Abbreviation: CI, confidence intervals; FRQ, frequency; LCL, Low confidence interval limit; UCL, upper confidence interval limit; WGHT, weight of each study.

Figure 4.

Forest Plot of Pooled Severities of Symptoms in Colorectal Cancer Survivors after Cancer Treatments via Meta-Analyses. Note. Fixed effect model was used for fecal incontinence, embarrassment with bowel movement, abdominal pain, appetite loss, nausea and/or vomiting, and sore mouth and tongue. Pooled mean severity data on a 0-100 scale. Abbreviation: CI, confidence intervals; FRQ, frequency; LCL, Low confidence interval limit; UCL, upper confidence interval limit; WGHT, weight of each study.