Trajectories of Symptom Clusters and Their Predictive Factors in Patients With Colorectal Cancer 3 Months After Surgery: A Longitudinal Study

TL;DR

This study tracks symptom changes in colorectal cancer patients after surgery and identifies factors that predict different symptom patterns.

Contribution

The study identifies two distinct symptom trajectories and their predictive factors in colorectal cancer patients post-surgery.

Findings

Two symptom trajectory subgroups were identified: 'high symptom—decreases and then increases' and 'low symptoms—continuous decline'.

Predictive factors for the high symptom subgroup include multimorbidity, chronic lung disease, preoperative frailty, and severe anxiety/depression.

Early intervention targeting predictive factors like frailty and mood disorders could improve postoperative outcomes.

Abstract

To examine the changing trajectories of symptom clusters within 3 months following surgery in patients with colorectal cancer (CRC) and identify their predictive factors.

A prospective longitudinal observational study.

Convenience sampling was used to recruit inpatients with CRC who were scheduled for surgical treatment at the Sichuan Provincial People's Hospital between October 2022 and September 2023. The Chinese version of the MD Anderson Symptom Inventory Gastrointestinal Cancer Module was utilized. The prevalence and severity of patients' symptoms were assessed at 7 days (T1), 6 weeks (T2), and 3 months (T3). Before the operation, a total of 240 patients with CRC were recruited. There were 203, 164, and 139 patients participating in T1, T2, and T3, respectively. Exploratory factor analysis identified symptom clusters. Latent class growth modeling determined the developmental trajectories of symptom clusters, and binomial logistic regression analyzed predictors of trajectory classification.

Two clinical subgroups were identified: a “high symptom—decreases and then increases” (17.2%) and a “low symptoms—continuous decline” (82.8%). The latter exhibited significantly lower and progressively declining symptom severity compared to the former. Predictive factors for the “high symptom—decreases and then increases” subgroup included multimorbidity (≥ 2 chronic conditions), chronic lung disease, preoperative frailty, severe anxiety/depression, open surgery, and postoperative chemotherapy.

Targeted management of the mood‐sleep disorder cluster (T1) and the activity intolerance cluster (T2/T3) may significantly improve patients' quality of life. The “high symptom—decreases then increases” subgroup warrants prioritized clinical attention, as early intervention for its predictive factors (e.g., frailty, anxiety, and depression) could enhance postoperative outcomes. Integrating these factors into routine preoperative assessments is recommended.

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