Background Adjuvant chemotherapy (CT) has improved the survival rates of colorectal cancer (CRC) patients. However, concerns regarding long-term side effects often lead CRC patients to express reluctance towards CT. As patients’ perceptions are important in decision-making processes, this study investigated whether undergoing CT is associated with perceived symptom severity compared to patients who did not receive CT.

Methods 233 incident CRC patients who underwent elective surgery completed the EORTC QLQ-C30 questionnaire 1-, 3-, 6-, and 12 months post-surgery. Baseline sociodemographic and clinical data were collected from medical records. Patient-reported symptom severity was assessed using the questionnaire’s symptom scales. Generalized Estimating Equations (GEE) were used to analyse associations between CT and perceived symptoms over time while adjusting for baseline characteristics.

Results Patients receiving CT (n=113) reported higher mean scores for all QLQ-C30 symptoms during CT. However, scores gradually became comparable to patients without CT by 12 months. CT was significantly associated with higher perceived severity for diarrhea (p<0.001) and financial difficulties (p=0.013) over time. Younger CRC patients reported more severe nausea (p<0.01), pain (p=0.030) and financial difficulties (p=0.050) irrespective of CT status.

Conclusions CRC patients who underwent CT did not seem to experience significantly worse symptoms than patients who did not underwent CT. Future studies could explore potential disparities between CRC patients’ perceptions and clinicians’ scoring of symptom severity; and investigate how and why younger patients experience poorer symptoms.