A Review of the Literature on Multiple Co-occurring Symptoms in Patients With Colorectal Cancer Who Received Chemotherapy Alone or Chemotherapy With Targeted Therapies

Abstract

Background Patients with colorectal cancer (CRC) rarely experience a single symptom associated with their disease and its treatment. Objective Purpose of this literature review was to summarize the current state of knowledge of multiple co-occurring symptoms in CRC patients who received chemotherapy alone or chemotherapy with targeted therapies. Methods Comprehensive literature search was conducted from 1990 to 2014. These studies were evaluated in terms of the occurrence of multiple, co-occurring symptoms in CRC patients who received CTX alone or CTX with targeted therapies; the most common symptom assessment and quality of life (QOL) instruments used; and the associations identified between select demographic and treatment characteristics, QOL, and multiple co-occurring symptoms. Results Only five studies met this review’s inclusion criteria. Two studies compared symptoms in patients who received CTX alone or CTX with targeted therapies and only one study reported on symptom occurrence. Of the five studies identified, only two used the same instrument to assess symptoms and only two studies evaluated for associations between demographic and treatment characteristics and symptom burden, as well as QOL outcomes. Conclusions Given the larger number of patients with CRC, as well as the increased number of CRC patients who will receive targeted therapies with or without CTX, future studies need to describe the occurrence, severity, and distress of multiple co-occurring symptoms and their impact on CRC patients’ QOL. Implications for Practice To deliver effective symptom management interventions, the most common, severe, and distressing symptoms that CRC patients experience need to be identified.

High symptom burden is associated with impaired quality of life in colorectal cancer patients during chemotherapy:A prospective longitudinal study

“…Assessing symptoms with questionnaires can be bothersome for patients, however self-reported questionnaires provide important and unique information from the patients' perspective for identifying those most at risk and their symptoms. [66,167] In addition, the use of self-reported questionnaires allows clinicians and researchers to capture multiple symptoms. Once symptoms are identified, symptom management strategies can be initiated and interventions with symptom management can be offered.…”

“…Once symptoms are identified, symptom management strategies can be initiated and interventions with symptom management can be offered. [11,87,94,167] To report symptoms directly to health care providers, allows clinicians to offer immediately help. To capture symptoms with paper or electronically based questionnaires are important in order to systematically collect information on the group level.…”

“…[192,193] Cancer patients rarely experience symptoms in isolation; rather, multiple symptoms can occur simultaneously, and this combination can have an additive effect (Paper I). [60,66,99,133,153,167] According to Lenz et al, [99] management of one symptom can contribute to the treatment of other symptoms. For example, in a randomized trial, nurse-led interventions, exercise, and antidepressants improved depression and anxiety in cancer patients.…”

“…15] The questionnaires were not selected specifically for CRC patients, and the diagnoses of specific symptoms such as anorectal function and stomarelated symptoms might have been missed. However, we assume that the content validity (i.e., the MSAS covers relevant items)[76] is good because the MSAS contain 32 symptoms and three open questions, and the comprehensive questionnaires cover symptoms that are important to patients with various types of cancer, as well as those with CRC [66,167]. Cronbach's alpha is the most common test for internal consistency (internal reliability).…”

Oxaliplatin-Induced Neurotoxic Side Effects and Their Impact on Daily Activities

“…Different strategies were used to manage the neurotoxic side effects and the patients re-prioritised or avoided activities due to the side effects, to handle their daily life 5 . A review of the literature pointed out that CRC patient's experience of distressing symptoms need to be identified to deliver effective symptom management interventions 6 . Stringent dose modification is the guidance in clinical praxis to prevent chronic NTS, but few interventions with evidence exist for treatment 2,3,7 .…”