About 80% of geriatric female colorectal cancer survivors may experience a range of gastrointestinal symptoms years after receiving a diagnosis and treatment for their tumors, according to a recent study published by Han et al in PLOS ONE.
Background
While depression, anxiety, and fatigue are commonly monitored following cancer diagnosis and treatment, many colorectal cancer survivors have also reported experiencing gastrointestinal symptoms without finding relief.
“Many cancer treatments show great success, and many cancer survivors are living longer than ever before,” explained lead study author Claire Han, PhD, DNP, RN, APRN-CNP, Assistant Professor of Nursing at The Ohio State University. “[Gastrointestinal] symptoms among survivors have been underinvestigated in the past, but we found that they are very prevalent even up to 25 years after diagnosis, suggesting it’s very important to consider GI symptom management as part of their survivorship care,” she emphasized.
Study Methods and Results
In the new study, the investigators used data from the Women’s Health Initiative’s Life and Longevity After Cancer Study to analyze the outcomes of 413 geriatric female colorectal cancer survivors—all of whom were postmenopausal—with a median age of 71 years and average age of 63 years at diagnosis. Among the patients in the study, 63.2% had undergone surgery for their colorectal cancer, and 34.4% had received multiple treatments such as surgery and chemoradiotherapy.
The investigators found that 81% of the colorectal cancer survivors reported persistent gastrointestinal symptoms, most predominantly abdominal bloating and gas. The average time since diagnosis was 8 years for all of the patients.
The investigators also showed that severe gastrointestinal symptoms were linked to poor quality of life, interference with daily social and physical activities, and low body-image satisfaction. These symptoms were often accompanied by the psychological distress experienced by many cancer survivors. However, the investigators could not determine whether the gastrointestinal symptoms were causes or consequences of quality-of-life issues—particularly fatigue, sleep deficiencies, depression, and anxiety.
Patients who were within 5 years of diagnosis and had survived stage III cancer also had a higher likelihood of reporting persistent gastrointestinal symptoms. The severity of depression, anxiety, fatigue, and sleep deficiencies was higher in patients with gastrointestinal symptoms than in patients without gastrointestinal symptoms.
“Cancer survivors with high psychological symptoms may have a higher stress level that could inflame the gut and lead to [gastrointestinal] symptoms,” Dr. Han underscored. “The causal direction could be bidirectional. [W]hich comes first doesn’t really matter, because both types of symptoms are present,” she stated.
The investigators also incorporated data into their analysis from questionnaires assessing a variety of measures—including demographics, gastrointestinal symptoms, nongastrointestinal symptoms, dietary habits, and physical activity as well as how these measures affected quality of life. Abdominal bloating and gas were reported in 54.2% of the cases (17.2% of which were moderate to severe), followed by constipation in 44.1% (12.6% of which were moderate to severe), diarrhea in 33.4% (10.4% of which were moderate to severe) and abdominal/pelvic pain in 28.6% (6.8% of which were moderate to severe). When all of the symptoms were combined into a composite score, 15.4% of the colorectal cancer survivors reported moderate to severe overall gastrointestinal symptoms.
Conclusions
Although they were unable to identify the mechanisms behind the symptoms, the investigators postulated that the location of the cancer in the colon and rectum as well as treatment-related effects on the gut microbiome could be contributing factors.
The new findings suggested the need for comprehensive interventions for colorectal cancer survivors—including psychosocial support, pain management, individualized nutritional counseling, and physical rehabilitation.
Disclosure: For full disclosures of the study authors, visit journals.plos.org.
