Prevalence of long-term patient-reported consequences of treatment for colorectal cancer: a systematic review

Document Type : Systematic Review or Meta Analysis


1 Faculty of Science, School of Psychology, Quality of Life Office, University of Sydney, Sydney, Australia

2 Faculty Medicine and Health, Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Sydney, Australia

3 Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands

4 Faculty of Medicine and Health, Discipline of Surgery, University of Sydney, Sydney, Australia Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia

5 Faculty of Science, School of Psychology, Quality of Life Office, University of Sydney, Sydney, Australia Faculty Medicine and Health, Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Sydney, Australia


Aim: Colorectal cancer (CRC) survivors experience persistent late effects of treatments, including a range of symptoms and functional impairments. There is limited evidence on the prevalence of such problems in CRC survivors. We conducted a systematic review to synthesise the evidence on the range and prevalence of patient-reported symptoms and functioning impairments experienced by CRC survivors in the acute and long-term period following their primary treatment for CRC.
Method: We searched MEDLINE, Embase, Pubmed, Cochrane electronic databases (from 2000 to April 2021) to identify studies reporting longitudinal prevalence (i.e. a minimum of two assessment time-points) of any patient-reported outcomes (PROs) at 12 months or more since treatment. Two reviewers independently screened and extracted data on study characteristics and PRO prevalence. PROs were synthesised descriptively across time-points, from baseline before treatment, during treatment and up to 3-years post-treatment to determine prevalence of PROs over time and the extent of persistent problems in long-term post-treatment survivorship.
Results: Of 5587 studies screened, 29 met eligibility and were included. Three years after primary treatment, up to 55-65% of colon cancer survivors reported issues with mobility and 40% reported pain and discomfort. Fecal incontinence was reported by up to 83% of rectal cancer survivors. High prevalence of problems with sexual and urinary function were also reported.
Conclusion: Persistent late effects of treatment, assessed with validated patient-reported measures, should be screened for early in post-treatment survivorship to detect problems and refer to appropriate management strategies to reduce symptom burden and improve quality of life of CRC survivors.


  1. World Cancer Research Fund. Colorectal Cancer Statistics 2018 [Available from:
  2. Torres Stone RA, Waring ME, Cutrona SL, Kiefe CI, Allison J, Doubeni CA. The association of dietary quality with colorectal cancer among normal weight, overweight and obese men and women: a prospective longitudinal study in the USA. BMJ Open. 2017;7(6):e015619.
  3. American Society of Clinical Oncology. Colorectal Cancer: Statistics 2019 [Available from:
  4. Denlinger CS, Barsevick AM. The challenges of colorectal cancer survivorship. J Natl Compr Canc Netw. 2009;7(8):883-93; quiz 94.
  5. El-Shami K, Oeffinger KC, Erb NL, Willis A, Bretsch JK, Pratt-Chapman ML, et al. American Cancer Society Colorectal Cancer Survivorship Care Guidelines. CA Cancer J Clin. 2015;65(6):428-55.
  6. Lynch BM, van Roekel EH, Vallance JK. Physical activity and quality of life after colorectal cancer: overview of evidence and future directions. Expert Review of Quality of Life in Cancer Care. 2016;1(1):9-23.
  7. Rutherford C, Müller F, Faiz N, King MT, White K. Patient-reported outcomes and experiences from the perspective of colorectal cancer survivors: meta-synthesis of qualitative studies. Journal of Patient-Reported Outcomes. 2020;4(1):27.
  8. American Cancer Society. Surgery for Colon Cancer 2018 [Available from:
  9. A Glaser CW, S Lawton, et al. Quality of life of colorectal cancer survivors in England: Report on a national survey of colorectal cancer survivors using patient reported outcome measures (PROMs). In: England PH, editor.: NHS England Publications Gateway Reference 02777, Public Health England, London (2015); 2015.
  10. Soveri LM, Lamminmaki A, Hanninen UA, Karhunen M, Bono P, Osterlund P. Long-term neuropathy and quality of life in colorectal cancer patients treated with oxaliplatin containing adjuvant chemotherapy. Acta Oncol. 2019;58(4):398-406.
  11. Tong A, Manns B, Hemmelgarn B, Wheeler DC, Evangelidis N, Tugwell P, et al. Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop. Am J Kidney Dis. 2017;69(1):97-107.
  12. Foster C, Wright D, Hill H, Hopkinson J, Roffe L. Psychosocial implications of living 5 years or more following a cancer diagnosis: a systematic review of the research evidence. European journal of cancer care. 2009;18(3):223-47.
  13. Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, et al. Patients' supportive care needs beyond the end of cancer treatment: a prospective, longitudinal survey. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009;27(36):6172-9.
  14. Ju A, White K, King M, Wiltink L, Faiz N, Rutherford C. Prevalence of patient reported outcomes in colorectal cancer survivors: a systematic review. (in development).
  15. Sisler JJ, Taylor-Brown J, Nugent Z, Bell D, Khawaja M, Czaykowski P, et al. Continuity of care of colorectal cancer survivors at the end of treatment: the oncology-primary care interface. Journal of cancer survivorship : research and practice. 2012;6(4):468-75.
  16. Guidance for Industry. Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims In: Administration UFaD, editor. 2009.
  17. Lipscomb J, Gotay CC, Snyder CF. Patient-reported outcomes in cancer: a review of recent research and policy initiatives. CA Cancer J Clin. 2007;57(5):278-300.
  18. Mercieca-Bebber R, King MT, Calvert MJ, Stockler MR, Friedlander M. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas. 2018;9:353-67.
  19. Rutherford C, Campbell R, White K, King M. Patient-reported outcomes as predictors of survival in patients with bowel cancer: a systematic review. Qual Life Res. 2019;28(11):2871-87.
  20. Browne S, Dowie A, Mitchell ED, Wyke S, Ziebland S, Campbell N, et al. Patients' needs following colorectal cancer diagnosis: where does primary care fit in? British Journal of General Practice. 2011;61(592):e692-e9.
  21. Traa MJ, De Vries J, Roukema JA, Rutten HJ, Den Oudsten BL. The sexual health care needs after colorectal cancer: the view of patients, partners, and health care professionals. Support Care Cancer. 2014;22(3):763-72.
  22. Moher D, Liberati A, Tetzlaff J, Altman DG, The PG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Medicine. 2009;6(7):e1000097.
  23. Elm Ev, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-8.
  24. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.
  25. Biondo S, Frago R, Codina Cazador A, Farres R, Olivet F, Golda T, et al. Long-term functional results from a randomized clinical study of transverse coloplasty compared with colon J-pouch after low anterior resection for rectal cancer. Surgery (United States). 2013;153(3):383-92.
  26. Brigic A, Sakuma S, Lovegrove RE, Bassett P, Faiz O, Clark SK, et al. A prospective case control study of functional outcomes and related quality of life after colectomy for neoplasia. International Journal of Colorectal Disease. 2017;32(6):777-87.
  27. Clermonts S, van Loon YT, Schiphorst AHW, Wasowicz DK, Zimmerman DDE. Transanal minimally invasive surgery for rectal polyps and selected malignant tumors: caution concerning intermediate-term functional results. International Journal of Colorectal Disease. 2017;32(12):1677-85.
  28. Couwenberg AM, Burbach JPM, Intven MPW, Consten ECJ, Schiphorst AHW, Smits AB, et al. Health-related quality of life in rectal cancer patients undergoing neoadjuvant chemoradiation with delayed surgery versus short-course radiotherapy with immediate surgery: a propensity score-matched cohort study. Acta Oncologica. 2019;58(4):407-16.
  29. Dizdarevic E, Frøstrup Hansen T, Pløen J, Henrik Jensen L, Lindebjerg J, Rafaelsen S, et al. Long-Term Patient-Reported Outcomes After High-Dose Chemoradiation Therapy for Nonsurgical Management of Distal Rectal Cancer. International Journal of Radiation Oncology, Biology, Physics. 2020;106(3):556-63.
  30. Fazio VW, Zutshi M, Remzi FH, Parc Y, Ruppert R, Furst A, et al. A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg. 2007;246(3):481-8.
  31. Hess V, Winterhalder R, von Moos R, Widmer L, Stocker P, Jermann M, et al. Capecitabine and Oxaliplatin Prior and Concurrent to Preoperative Pelvic Radiotherapy in Patients With Locally Advanced Rectal Cancer: Long-Term Outcome. Clinical Colorectal Cancer. 2017;16(3):240-5.
  32. Ho MY, McBride ML, Gotay C, Grunfeld E, Earle CC, Relova S, et al. A qualitative focus group study to identify the needs of survivors of stage II and III colorectal cancer. Psycho-Oncology. 2016;25(12):1470-6.
  33. Liu Y, Lu XM, Niu YF, Tao KX, Wang GB. Application of laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal cancer. Journal of Innovative Optical Health Sciences. 2016;9 (5) (no pagination)(1643002).
  34. Machado M, Nygren J, Goldman S, Ljungqvist O. Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial. Ann Surg. 2003;238(2):214-20.
  35. Matsuda K, Hotta T, Takifuji K, Yokoyama S, Oku Y, Watanabe T, et al. Randomized clinical trial of defaecatory function after anterior resection for rectal cancer with high versus low ligation of the inferior mesenteric artery. The British journal of surgery. 2015;102(5):501-8.
  36. Planellas P, Farrés R, Cornejo L, Rodríguez-Hermosa JI, Pigem A, Timoteo A, et al. Randomized clinical trial comparing side to end vs end to end techniques for colorectal anastomosis. Int J Surg. 2020;83:220-9.
  37. Van Duijvendijk P, Slors JFM, Taat CW, Van Tets WF, Van Tienhoven G, Obertop H, et al. Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. American Journal of Gastroenterology. 2002;97(9):2282-9.
  38. Varpe P, Huhtinen H, Rantala A, Salminen P, Rautava P, Hurme S, et al. Quality of life after surgery for rectal cancer with special reference to pelvic floor dysfunction. Colorectal Disease. 2011;13(4):399-405.
  39. Adam JP, Denost Q, Capdepont M, Van Geluwe B, Rullier E. Prospective and Longitudinal Study of Urogenital Dysfunction after Proctectomy for Rectal Cancer. Diseases of the Colon and Rectum. 2016;59(9):822-30.
  40. Celentano V, Fabbrocile G, Luglio G, Antonelli G, Tarquini R, Bucci L. Prospective study of sexual dysfunction in men with rectal cancer: Feasibility and results of nerve sparing surgery. International Journal of Colorectal Disease. 2010;25(12):1441-5.
  41. Marijnen CAM, Van De Velde CJH, Putter H, Van Den Brink M, Maas CP, Martijn H, et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: Report of a multicenter randomized trial. Journal of Clinical Oncology. 2005;23(9):1847-58.
  42. Saito S, Fujita S, Mizusawa J, Kanemitsu Y, Saito N, Kinugasa Y, et al. Male sexual dysfunction after rectal cancer surgery: Results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. International Journal of Radiation Oncology Biology Physics. 2015;93(2):303-12.
  43. Wang G, Wang Z, Jiang Z, Liu J, Zhao J, Li J. Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. International Journal of Medical Robotics and Computer Assisted Surgery. 2017;13 (1) (no pagination)(e1725).
  44. Pontallier A, Denost Q, Van Geluwe B, Adam J-P, Celerier B, Rullier E. Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surgical Endoscopy. 2016;30(11):4924-33.
  45. Anderson AS, Steele R, Coyle J. Lifestyle issues for colorectal cancer survivors--perceived needs, beliefs and opportunities. Support Care Cancer. 2013;21(1):35-42.
  46. Brew-Graves C, Farewell V, Monson K, Milošević M, Williams NR, Morris E, et al. Pulmonary metastasectomy in colorectal cancer: health utility scores by EQ-5D-3L in a randomized controlled trial show no benefit from lung metastasectomy. Colorectal Disease. 2021;23(1):200-5.
  47. Brown SR, Mathew R, Keding A, Marshall HC, Brown JM, Jayne DG. The impact of postoperative complications on long-term quality of life after curative colorectal cancer surgery. Ann Surg. 2014;259(5):916-23.
  48. King PM, Blazeby JM, Ewings P, Kennedy RH. Detailed evaluation of functional recovery following laparoscopic or open surgery for colorectal cancer within an enhanced recovery programme. International Journal of Colorectal Disease. 2008;23(8):795-800.
  49. Paul CL, Cameron E, Doran C, Hill D, Macrae F, Carey ML, et al. Experiences of colorectal cancer patients in the 2-years post-diagnosis and patient factors predicting poor outcome. Supportive Care in Cancer. 2016;24(12):4921-8.
  50. Mols F, Schoormans D, de Hingh I, Oerlemans S, Husson O. Symptoms of anxiety and depression among colorectal cancer survivors from the population-based, longitudinal PROFILES Registry: Prevalence, predictors, and impact on quality of life. Cancer. 2018;124(12):2621-8.
  51. Vardy JL, Dhillon HM, Pond GR, Renton C, Dodd A, Zhang H, et al. Fatigue in people with localized colorectal cancer who do and do not receive chemotherapy: a longitudinal prospective study. Ann Oncol. 2016;27(9):1761-7.
  52. Land SR, Kopec JA, Cecchini RS, Ganz PA, Wieand HS, Colangelo LH, et al. Neurotoxicity from oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: NSABP C-07. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2007;25(16):2205-11.
  53. van Erning FN, Janssen-Heijnen MLG, Wegdam JA, Slooter GD, Wijsman JH, Vreugenhil A, et al. The Course of Neuropathic Symptoms in Relation to Adjuvant Chemotherapy Among Elderly Patients With Stage III Colon Cancer: A Longitudinal Study. Clinical Colorectal Cancer. 2017;16(3):195-203.
  54. Law CK, Brewer K, Brown C, Wilson K, Bailey L, Hague W, et al. Return to work following laparoscopic-assisted resection or open resection for rectal cancer: Findings from AlaCaRT-Australasian Laparoscopic Cancer of the Rectum Trial. Cancer Med. 2021;10(2):552-62.
  55. Jansen L, Koch L, Brenner H, Arndt V. Quality of life among long-term (≥5 years) colorectal cancer survivors--systematic review. Eur J Cancer. 2010;46(16):2879-88.
  56. Wiltink LM, Marijnen CAM, Meershoek-Klein Kranenbarg E, van de Velde CJH, Nout RA. A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial. Acta Oncologica. 2016;55(4):502-8.
  57. Wiltink LM, Chen TY, Nout RA, Kranenbarg EM, Fiocco M, Laurberg S, et al. Health-related quality of life 14 years after preoperative short-term radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomised trial. Eur J Cancer. 2014;50(14):2390-8.
  58. Smith-Gagen J, Cress RD, Drake CM, Romano PS, Yost KJ, Ayanian JZ. Quality-of-life and surgical treatments for rectal cancer--a longitudinal analysis using the California Cancer Registry. Psychooncology. 2010;19(8):870-8.