Impact of continuous care based on multidisciplinary collaboration on the quality of life of patients with colorectal cancer undergoing chemotherapy.

Aim: Colorectal cancer (CRC) patients undergoing chemotherapy face multifaceted challenges post-discharge, including symptom burden, psychological distress, and fragmented care. Conventional follow-up often inadequately addresses these holistic needs. This study aimed to evaluate the efficacy of a structured multidisciplinary collaborative continuous care model compared to routine care in this population. Methods: A total of 120 CRC patients receiving chemotherapy were randomly assigned to either a study group or a control group. The control group received routine continuous care. The study group received a comprehensive intervention, which included the establishment of five specialized teams (Clinical, Resource, Follow-up, Volunteer, and Rehabilitation Club teams). The intervention encompassed individualized nutrition and symptom management, structured health education (including chemotherapy, ostomy care, and vascular access), proactive follow-up via an electronic system and social media groups, psychological counseling, peer support activities, and home visits. Outcomes were assessed at baseline and 3 months post-intervention using validated scales for gastrointestinal function, cancer-related fatigue, psychological resilience, self-management efficacy, quality of life, incidence of chemotherapy-related adverse reactions, and medication adherence. Results: After the 3-month intervention, the study group demonstrated significantly greater improvements than the control group across all measured outcomes. Specifically, the study group showed lower GSRS scores (indicating better gastrointestinal function), lower CFS scores (less fatigue), higher CD-RISC scores (greater resilience), higher SUPPH scores (improved self-efficacy), and higher WHOQOL-BREF scores (enhanced quality of life). Furthermore, the study group had a significantly lower incidence of chemotherapy-related adverse reactions and better medication adherence. All improvements were observed over the 3-month study period; longer-term effects remain to be determined. Conclusion: The implementation of a multidisciplinary collaborative continuous care model significantly improved physical symptoms, psychological well-being, self-management capabilities, treatment tolerance, adherence, and quality of life in CRC patients undergoing chemotherapy over a 3-month follow-up period. These findings demonstrate the short-term effectiveness of this model for post-discharge supportive care. However, longer-term follow-up is needed to assess durability of these benefits and impact on clinical outcomes such as treatment completion, rehospitalization, and recurrence. This model provides an effective, holistic framework for optimizing supportive care during the critical post-discharge period. Clinical trial registration: Identifier, 2025-SR-0021.