Symptoms and quality of life during chemotherapy in patients with colorectal cancer

Abstract

Norway has one of the highest rates of colorectal cancer (CRC) in the world. Cancer treatment causes distressing side effects, and patients with CRC can experience severe and distressing symptoms due to the disease and the treatment. The total symptom burden of physical and mental symptoms might reduce the quality of life (QoL). The CRC patients receive chemotherapy treatment in cycles administered in an outpatient setting. Then patients can continue to live their normal life, but the patients and their family will be more responsible for their symptom management. However, research on multiple symptoms over time was lacking. The aim of this thesis was to evaluate the symptom burden and QoL using self-reported questionnaires. The symptom occurrence, frequency, severity and distress were measured before the start of chemotherapy, during two chemotherapy cycles, and at three and six months. Additional aims were to measure QoL over the same period and to identify if demographic and clinical variables or symptoms were associated with QoL. In total 120 CRC outpatients were included. They reported in average 10 symptoms at enrollment before the start of chemotherapy. Worrying (65%) was the most occurring symptom, followed by lack of energy (59%), feeling drowsy (54%), feeling bloated (53%), pain (51%), and sleeping difficulties (50%). Problems with sexual interest were the most severe and distressing symptom. Nausea and lack of energy became worse in the days after chemotherapy. Factors as being female, younger and have reduced physical function were associated with more severe symptoms. The total symptom burden of physical and mental symptoms impaired the QoL in these patients. In order to detect and treat severe and distressing symptoms during chemotherapy and improve QoL, systematic patient-reported symptom assessments are encouraged in clinical practice. It is important that health professions pay attention to the high symptom burden in these patients.