The forgotten burden: nutrition impact symptoms in colorectal cancer survivorship

As survival following colorectal cancer (CRC) continues to improve, an increasing number of survivors experience persistent nutrition impact symptoms (NIS) that adversely affect nutritional status, physical function, and quality of life. This review is timely in synthesising recent evidence on the prevalence, mechanisms, and clinical consequences of NIS, an area that remains under-recognised within survivorship care.

Recent studies consistently demonstrate that bowel dysfunction, including diarrhoea, urgency, faecal incontinence, and constipation, affects a large proportion of CRC survivors for many years after treatment. Evidence highlights multifactorial drivers of NIS, including surgical anatomy, radio- and chemotherapy-induced mucosal injury, and underdiagnosed conditions such as bile acid malabsorption, pancreatic exocrine insufficiency, and small intestinal bacterial overgrowth. Psychosocial distress, unmet supportive care needs, and unsupervised dietary restriction further exacerbate nutritional risk.

NISs are a major, enduring determinant of survivorship outcomes after CRC. Proactive, multidisciplinary care models that integrate nutritional assessment, targeted gastrointestinal investigation, and psychosocial support are essential to mitigate long-term morbidity. Future research should prioritise mechanism-driven interventions with nutritional and quality-of-life endpoints to inform evidence-based survivorship guidelines.