A systematic review of symptom experiences in survivors of colorectal cancer

186 Background: Colorectal cancer (CRC) is the third most common cancer diagnosis in the US. With expanding survival rates, increasing numbers of CRC survivors live with long-term disease and treatment-side effects. There is limited research about symptom experiences from which to provide evidence-based symptom management guidelines for CRC survivors. This study systematically reviews published studies on symptoms in CRC survivors, with an aim to understand symptom experiences and with a broad goal of developing effective symptom interventions and improving CRC survivorship. Methods: A systematic search for relevant studies between the years 2005-2018 was conducted with Scopus, CINAHL, Medline via PubMed, Web of Science, EMBASE, Cochrane Library (CENTRAL), and PsycINFO. A systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Results: Of an initial 588 unique studies, 33 were identified for inclusion in the systematic review. The majority of studies were conducted in the UK or had a cross-sectional design. The European Organization for Research and Treatment of Cancer Quality of Life-C30 was the most frequently used instrument to assess symptoms. When we converted symptom severity scores and symptom occurrences among CRC survivors on a 0-100 scale, the most severe and frequently reported symptom across the 33 studies was fecal incontinence (mean severity: 50 points; mean occurrence: 52%), followed by fatigue (mean severity: 49 points; mean occurrence: 44%). Patients who reported lack of symptom management information, poor family and social supports, and presence of a stoma also reported more frequent and more severe symptoms. Symptom experiences were correlated with poor quality of life, low physical activity, daily life interferences, problems with sexual relationships, financial concerns, and negative body image. Conclusions: CRC survivors experienced a unique set of symptoms. Research is needed on symptom trajectories across the cancer continuum, strategies to incorporate family and other social supports for managing symptoms, and to enhance communication between oncologists, patients and caregivers that will support improved symptom control.