Experiences of Symptom Burden, Treatment Fatigue, and Quality of Life Among Patients With Metastatic Colorectal Cancer Receiving Chemotherapy
Keywords:
Metastatic colorectal cancer, chemotherapy, symptom burden, treatment fatigue, quality of life, qualitative study, phenomenology, oncology, patient experienceAbstract
Objective: This study aimed to explore the lived experiences of symptom burden, treatment fatigue, and quality of life among patients with metastatic colorectal cancer receiving chemotherapy in Canada.
Methods and Materials: This qualitative phenomenological study was conducted among 24 patients with metastatic colorectal cancer receiving chemotherapy in outpatient oncology and chemotherapy centers in Ontario, Canada. Participants were selected through purposive sampling based on having a confirmed diagnosis of stage IV colorectal cancer, current or recent chemotherapy exposure, ability to communicate in English, and capacity to provide informed consent. Data were collected using a demographic and clinical information form, semi-structured individual interviews, and interviewer field notes. Interviews explored physical symptoms, treatment-related fatigue, emotional distress, functional limitation, family and social roles, coping strategies, treatment decision-making, and perceptions of quality of life. Interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed using an interpretative phenomenological approach.
Findings: Inferential thematic analysis identified four major interconnected themes: living in a body dominated by symptoms, chemotherapy as a repetitive and exhausting life cycle, quality of life as a shifting and negotiated concept, and coping with uncertainty while maintaining control. Participants’ accounts indicated that symptom burden was cumulative rather than episodic, with fatigue, gastrointestinal disruption, pain, neuropathy, appetite changes, sleep disturbance, and functional limitation interacting to reduce independence and bodily confidence. Treatment fatigue was inferred as a multidimensional experience involving physical exhaustion, anticipatory distress, emotional weariness, repeated appointments, uncertainty about treatment response, and ambivalence about continuing chemotherapy. Quality of life was interpreted as a dynamic balance between survival, tolerable suffering, dignity, relational connection, autonomy, and meaningful time.
Conclusion: The findings suggest that metastatic colorectal cancer care should move beyond disease control and adverse-event monitoring to include systematic assessment of cumulative symptom burden, treatment fatigue, coping capacity, and patients’ evolving definitions of acceptable quality of life.
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Copyright (c) 2026 Faisal Al-Kuwari (Author); Megan White; Amir Hadžić (Author)
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