Question What is the prevalence of bowel-related symptoms and the association between dietary fiber intake and these symptoms up to 5 years after colorectal cancer (CRC) diagnosis?
Findings In this cohort study of 1751 CRC survivors, the prevalence of bowel-related symptoms was 47% at 6 months, 41% at 2 years, and 36% at 5 years after CRC diagnosis. Higher dietary fiber intake was associated with a lower prevalence of diarrhea.
Meaning The finding of prevalent long-term bowel-related symptoms in CRC survivors suggests a need for symptom management, with a potential role for dietary fiber intake.
Abstract
Importance Colorectal cancer (CRC) survivors frequently report bowel-related symptoms, but longitudinal data are scarce and diet has not been extensively investigated in relation to bowel-related symptoms.
Objective To investigate the prevalence of bowel-related symptoms as well as their association with dietary fiber intake until 5 years after CRC diagnosis..
Exposures Clinical data including CRC treatment strategy, retrieved from hospital records and national registries, and habitual dietary fiber intake, assessed by a food frequency questionnaire, at 6 months, 2 years, and 5 years after CRC diagnosis.
Main Outcomes and Measures Prevalence of self-reported diarrhea, constipation, flatulence or bloating, frequent stools, mucus in stools, or false urgency at 6 months, 2 years, and 5 years after diagnosis, obtained via a questionnaire…
Results Among 1751 CRC survivors who underwent surgery and were included in the analysis, median age at diagnosis was 66 years (IQR, 61-71 years), and 1115 (63.7%) were men.
Bowel-related symptoms were reported by 817 of 1751 survivors (46.7%) at 6 months, 614 of 1511 (40.6%) at 2 years, and 290 of 812 (35.7%) at 5 years after diagnosis. At 6 months after diagnosis, symptoms were predominantly reported by survivors who had received chemotherapy (260 of 446 [58.3%]), whereas symptoms at 2 and 5 years occurred mostly in those who received radiotherapy (86 of 160 [53.8%] at 2 years and 47 of 92 [51.1%] at 5 years).
Of the studied bowel-related symptoms, was associated with the lowest HRQOL score (B, −9.6; 95% CI, −14.0 to −5.2) at 5 years after diagnosis. In multivariable logistic regression analyses, higher fiber intake (per 10-g/d increment) was associated with a significantly lower prevalence of moderate-to-severe diarrhea at 6 months (OR, 0.44; 95% CI, 0.28-0.70) and 2 years (OR, 0.53; 95% CI, 0.30-0.94) after diagnosis, but the association was not statistically significant at 5 years (OR, 0.43; 95% CI, 0.16-1.13).
Conclusions and Relevance In this cohort study of CRC survivors, the prevalence of bowel-related symptoms was considerably high during the 5 years after diagnosis, highlighting a need for effective symptom management.
Higher dietary fiber intake was associated with a lower prevalence of diarrhea, suggesting a potential role of diet in management of bowel-related symptoms in CRC survivors.
Dietary fiber and diarrhea Dietary fiber and diarrhea
