GI Symptoms Associated With Psychological Distress in CRC Survivors


A majority of women with a history of colorectal cancer experience long-term gastrointestinal symptoms, which may be associated with psychological distress, according to recent research.

Woman suffering from stomach ache. Holding belly and feeling abdominal menstrual pain or bowel and digestion problems | Image credit: © AliceCam - ©

Most female colorectal cancer survivors reported gastrointestinal issues that lingered for years after their diagnosis and treatment.

A majority (81%) of women who have been diagnosed with colorectal cancer experience gastrointestinal (GI) symptoms years after their diagnosis or treatment ends. These symptoms have been associated with poor quality of life, interference with daily social and physical activities and low body image satisfaction, according to recent research published in the journal, PLOS ONE.

“Many cancer treatments show great success, and many cancer survivors are living longer than ever before,” lead study author Claire Han, assistant professor of nursing at The Ohio State University, said in a press release. “GI symptoms among survivors have been under-investigated 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.”

The team of researchers from The Ohio State University analyzed data of 413 postmenopausal colorectal cancer survivors. The average patient age was 71, and more than half (63.2%) had undergone surgical treatment of their cancer, while 34.4% received multiple treatments, such as surgery and chemoradiation. Of note, the average time from diagnosis until data collection was eight years for the group of individuals observed.

The data showed that the most common GI symptom experienced by female colorectal cancer survivors were abdominal bloating and gas (reported by 54.2% of study participants, with 17.2% reporting moderate to severe bloating). Other common GI effects were constipation (44.1%; 12.6% moderate to severe cases), diarrhea (33.4%; 10.4% moderate to severe) and abdominal/pelvic pain (28.6%; 6.8% moderate to severe). In total, 15.4% of cancer survivors reported that they experienced at least one moderate to severe GI symptom.

The research team found that women who were within five years of their cancer diagnosis or who have been diagnosed with stage 3 cancer tended to be more likely to experience long-term GI symptoms.

READ MORE:Physical Function May Decline in Women After Cancer Diagnosis, Throughout Survivorship

Han noted that in her personal experience as a nurse practitioner, many colorectal cancer survivors complained to her about their GI symptoms and difficulty finding relief.

Now, her team’s research highlighted that these long-term effects were often experienced alongside psychological distress. In particular, survivors with GI issues tended to have a worse severity of depression, anxiety and/or fatigue than survivors who were not experiencing these toxicities.

However, this study did not determine if the symptoms caused or associated with quality-of-life factors, such as fatigue, sleep issues and depression/anxiety.

“Cancer survivors with high psychological symptoms may have a higher stress level that could inflame the gut and lead to GI symptoms,” Han said. “The causal direction could be bidirectional — which comes first doesn’t really matter because both types of symptoms are present.”

The researchers did notice, though, that survivors who had healthier dietary habits tended to have a lower severity of diarrhea. Looking ahead, they noted that non-drug interventions are needed to address GI symptoms in this group of individuals.

“No existing evidence-based non-pharmacological interventions focus on GI symptoms in this population. Our findings shed light on the importance of psychosocial support as well as lifestyle interventions (specifically nutritional management) in managing GI symptoms in CRC survivors,” the researcher wrote in the study.

The study authors then went on to conclude:

“Psychological distress would mediate the association between lifestyle and GI symptoms. Thus, here, we emphasize the critical need for early psychosocial interventions to alleviate GI symptoms in this patient group. We also suggest individualized nutritional counseling for improving diet quality, particularly, among patients at high risk of psychological distress, or altered bowel patterns. Furthermore, our results highlight the need for physical rehabilitation programs to be integrated into survivorship care to maintain daily function during cancer treatment and the long-term follow-up phase.”

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