Symptoms during chemotherapy in colorectal cancer patients

  • Kari RöhrlEmail author
  • Marianne Grønlie Guren
  • Milada Cvancarova Småstuen
  • Tone Rustøen
Original Article



Colorectal cancer (CRC) patients experience several physical and psychological co-occurring symptoms, but little is known about symptom variation during chemotherapy cycles. Therefore, the aims were (1) to assess the occurrence and severity of frequently occurring symptoms (worrying, lack of energy, numbness/tingling, nausea, and pain) at multiple time points during chemotherapy, (2) to investigate differences in symptom trajectories between chemotherapy groups, and (3) to determine whether selected patient and clinical characteristics are associated with symptom severity throughout the treatment trajectory.


In total, 120 CRC patients receiving chemotherapy with curative or palliative intent completed the Memorial Symptom Assessment Scale (MSAS), Self-Administered Comorbidity Questionnaire (SCQ-19), and Karnofsky Performance Status (KPS) scale eight times, during two cycles of chemotherapy and 3 and 6 months after enrolment. Data were analyzed using linear mixed models for repeated measures to assess the effects of selected variables on outcomes over time.


The patients experienced greatest symptom severity in the days following the administration of chemotherapy; these were lack of energy, numbness/tingling (oxaliplatin group), and nausea. Palliative patients reported significantly higher pain scores compared with curative patients over time, whereas the severity of worrying decreased over time in both treatment groups. Age, sex, educational level, performance status, treatment intent and type of chemotherapy were significantly associated with symptom severity throughout the chemotherapy trajectory.


Clinicians can use these findings to identify and inform patients about risk for more severe symptom burden, in order to offer supportive care at the right time during the chemotherapy treatment.


Colorectal neoplasm Chemotherapy Symptoms Trajectory Longitudinal Memorial Symptom Assessment Scale 



The authors thank the patients for their valuable contribution to this study. Furthermore, we thank the study nurse Ms. Kolstad, and Oslo University Hospital, Oslo, for their help and facilitation, Mr. Pripp for his statistical advice at the early study process, and Mr. Horgmo and Ms. Ellefsen of the Medical Photography and Illustration Service, University of Oslo, for the valuable graphic support.


The Institute of Health and Society, Faculty of Medicine, Nursing Science, Oslo University supported this study, with additional grants from The Norwegian Nurses Organization.

Compliance with ethical standards

The Regional Ethical Committee (2009/1451), the Hospital Privacy Ombudsman, and the institutional review board at Oslo University Hospital approved the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Kari Röhrl
    • 1
    Email author
  • Marianne Grønlie Guren
    • 2
  • Milada Cvancarova Småstuen
    • 3
    • 4
  • Tone Rustøen
    • 1
    • 5
  1. 1.Department of Nursing Science, Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway
  2. 2.Department of Oncology and K.G. Jebsen Colorectal Cancer Research Centre, Cancer MedicineOslo University HospitalOsloNorway
  3. 3.National Advisory Unit on Late Effects after Cancer TreatmentOslo University HospitalOsloNorway
  4. 4.Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
  5. 5.Department of Research and Development, Division of Emergencies and Critical CareOslo University HospitalOsloNorway

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