Symptoms during chemotherapy in colorectal cancer patients

Support Care Cancer. 2019 Aug;27(8):3007-3017. doi: 10.1007/s00520-018-4598-y. Epub 2019 Jan 3.


Purpose: Colorectal cancer (CRC) patients experience several physical and psychological co-occurring symptoms, but little is known about symptom variation during chemotherapy cycles. Therefore, the aims were (1) to assess the occurrence and severity of frequently occurring symptoms (worrying, lack of energy, numbness/tingling, nausea, and pain) at multiple time points during chemotherapy, (2) to investigate differences in symptom trajectories between chemotherapy groups, and (3) to determine whether selected patient and clinical characteristics are associated with symptom severity throughout the treatment trajectory.

Methods: In total, 120 CRC patients receiving chemotherapy with curative or palliative intent completed the Memorial Symptom Assessment Scale (MSAS), Self-Administered Comorbidity Questionnaire (SCQ-19), and Karnofsky Performance Status (KPS) scale eight times, during two cycles of chemotherapy and 3 and 6 months after enrolment. Data were analyzed using linear mixed models for repeated measures to assess the effects of selected variables on outcomes over time.

Results: The patients experienced greatest symptom severity in the days following the administration of chemotherapy; these were lack of energy, numbness/tingling (oxaliplatin group), and nausea. Palliative patients reported significantly higher pain scores compared with curative patients over time, whereas the severity of worrying decreased over time in both treatment groups. Age, sex, educational level, performance status, treatment intent and type of chemotherapy were significantly associated with symptom severity throughout the chemotherapy trajectory.

Conclusion: Clinicians can use these findings to identify and inform patients about risk for more severe symptom burden, in order to offer supportive care at the right time during the chemotherapy treatment.

Keywords: Chemotherapy; Colorectal neoplasm; Longitudinal; Memorial Symptom Assessment Scale; Symptoms; Trajectory.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colorectal Neoplasms / drug therapy*
  • Colorectal Neoplasms / physiopathology*
  • Colorectal Neoplasms / psychology
  • Comorbidity
  • Female
  • Humans
  • Karnofsky Performance Status
  • Linear Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Surveys and Questionnaires