Table 1.

Studies focusing on Multiple Symptoms in Colorectal Cancer Survivors (N = 6)

Author(s)/ Yearref#	Aim	Study Design/ Country	Setting/Sample (mean age, sex, ethnicity)	Primary Symptom Measures	Cancer Related Factorsa	Findings Regarding Symptom Experiences
Lin et al. (2018)24	To assess pelvic floor symptoms, physical and psychological symptoms, and QOL before and after surgery for CRC.	Prospective longitudinal design. Australia	30 survivors with CRC from 2 urban hospitals (colon 67%, rectal 33%; 56 y.o.; 47% females; 100% Caucasian)	-Symptom: Australian Pelvic Floor Questionnaire, Physical Activity Questionnaire, HADS, EORTC- QLQ-C30,CR29	- Stage I (20%), II (36.7%), III (33.3%) - Surgery+CTx+ RTx (13.3%), Surgery + CTx (50%), Surgery (100%)	Time to assess symptoms: Baseline and at 6 months after surgery. Symptoms reported: Pelvic floor symptoms, anxiety, fatigue, insomnia, appetite loss, financial difficulties, body image, weight loss, and urinary frequency were reported as very severe symptoms. Bowel symptoms were significantly worse at post-surgery. Impacts of symptoms: low physical activity.
Drury et al. (2017)2	To examine pain and QOL.	Cross-sectional design. Ireland	252 survivors with CRC from cancer centers (colon 64%, rectal 24%; 66 y.o.; 45% females; 100% Caucasian)	-Pain, depression and anxiety: FACT-C, and EuroQOL-5D	- Previous: Surgery (91%) CTx (60%), RTx (25%) - Current: CTx (7%), RTx (5%)	Time to assess symptoms: Mean 5 years after treatment. 40% of survivors reported severe pain, and prevalent in CRC survivors for long-time Pain-related other symptoms: Fatigue, bowel dysfunctions, sleep disturbances. Risk factors of pain: Younger age, female, current CTx, and previous RTx. Impacts of pain on QOL: Poor self-reported health (cancer survivorship quality), daily life interferences, poor physical, emotional, functional, social/family and CRC-specific well-being.
Gosselin et al. (2016)22	To determine symptom frequency and intensity, and identify cluster based on the symptom-subgroups.	Prospective, longitudinal, population-based design. USA	275 survivors with RC from a Cancer Surveillance database (63 y.o.; 34% females; 68% Caucasian)	-Symptoms: Fatigue (Short-Form Health Survey), Pain (Brief Pain Inventory), Symptoms (EORTC QLQ-C30, and CR 29)	-Stage I (14%), II (33%)), III (44%), IV (7%), Recurrence (9%) -Surgery (50%), Colostomy current (40%) & past (19%), CTx (100%), RTx (100%)	Time to assess symptoms: Baseline and 15 months after diagnosis. Symptom reported: Fatigue (most common symptoms), GI symptoms, insomnia (next common symptoms). Risk factors of symptoms: CTx-Oxaliplatin (pain in hands and feet), Colostomy-related concerns, younger age and non-married or partnered. Symptom subgroups: Cluster 1 (minimally symptomatic, n = 40), Cluster 2 (Tired/trouble sleeping, n = 138), Cluster 3 (moderate symptomatic, n = 42), Cluster 4 (highly symptomatic, n = 55).
Bailey et al. (2015)5	To investigate symptoms of long-term survivors, and examine differences by age at diagnosis.	Cross-sectional design. USA	830 survivors with CRC from tertiary Cancer Center CRC registry (colon 46%, rectal 52%, both 2%; 56 y.o.; 44% females; 84% Caucasian)	-Symptoms: EORTC-CR 29.	-Mean 11 years after diagnosis -Stage I (50%), II (31%), III (9.6%) -Surgery (96%), CTx (81%), RTx (54%). Permanent Colostomy (15%)	Time to assess symptoms: At least 5 years after cancer diagnosis. Symptom reported: Anxiety, GI symptoms, sexual dysfunction, and urinary symptoms (most common). Risk factors of symptoms: “Age-at-diagnosis” Younger-onset survivors reported worse anxiety, body image, and embarrassment with bowel movements, whereas later-onset survivors highlighted sexual dysfunction, micturition problems, and impotence. Impacts of symptoms: Troubles with sexual relationships, body image change, long-term coping.
van Ryn et al. (2014)47	To assess symptoms and risk factors of symptoms.	Cross-sectional design. USA	1,109 survivors with CRC from the Veterans Affairs Cancer Registry (65 y.o.; gender not specified; 81% Caucasian)	-Symptoms frequency: Patient-Centered Quality of Supportive Care (PICO) tool	-Stage I (35%), II (25%), III (20%), IV (17%) -Surgery (81%), CTx (40%), RTx	Time to assess symptoms: At least 8 years after diagnosis. Five symptoms categories assessed: Fatigue, bowel problems, pain, fatigue, depression. Risk factors of symptoms and symptom care quality: Non-Hispanic White, and older age were less likely to report symptoms. CTx, and Stage IV were positively associated with symptoms. The better coordination of care was associated with better symptom management.
Cotrim & Pereira (2008)33	To identify and assess the impact on symptoms and QOL in survivors undergoing surgery.	Cross-sectional design. Portugal	153 survivors with CRC from Cancer Center (67% colon, 33% rectal; 64 y.o.; 33% females; 100% Portuguese)	-Symptoms: EORTC QLQ-C30 and CR 38, Body Image Scale,	-Surgery (48%), Surgery+CTx (22%), Surgery+CTx+RTx (67%), Ostomy (30%)	Time to assess symptoms: 6-8 months after surgery. Symptoms reported: Sexual dysfunction, fatigue, and diarrhea. Risk factors of symptoms: Undergoing stoma predicted higher psychological distress, fatigue, diarrhea, sexual problems, and poor QOL than non-stoma survivors. Impacts of symptoms: Poor QOL, and caregivers’ overall symptom burden and their QOL. Body image disturbances, and sexual problems.

Note. Abbreviation: CRC, colorectal cancer; CTx, chemotherapy; EORTC-QLQ, European Organization for Research and Treatment of Cancer QOL Questionnaire; FACT-C, Functional Assessment of Cancer Therapy-Colorectal; GI, gastrointestinal; HADS, Hospital Anxiety and Depression Scale; QOL, quality of life; RC, rectal cancer; RTx, radiation therapy; YO, years old.

^aOnly data provided in the selected studies are presented in the table.