Measurement properties of patient-reported outcome measures for colorectal cancer: a systematic review

Background: Colorectal cancer (CRC) imposes a significant global burden, with approximately 1.93 million new cases diagnosed in 2022. While various patient-reported outcome measures (PROMs) exist to assess the quality of life and symptom burden in this population, their measurement properties vary significantly, particularly between original and translated versions. Objective: To systematically evaluate the measurement properties and methodological quality of PROMs for patients with colorectal cancer, and to provide evidence-based guidance for instrument selection in clinical practice and research. Methods: of January 2026. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Consensus-based Standards for the selection of health measurement instruments (COSMIN) Risk of Bias checklist. Measurement properties were evaluated according to COSMIN criteria, and the overall quality of evidence was graded using a modified GRADE approach. Instruments were categorized into recommendation levels (A or B) based primarily on evidence for content validity and internal consistency. Results: Fifteen studies involving 13 colorectal cancer-specific PROMs were included. Overall, the quality of evidence for most instruments was moderate to low, with frequent deficiencies in content validity, structural validity, and responsiveness. Four instruments-Functional Assessment of Cancer Therapy-Colorectal (FACT-C), Memorial Sloan-Kettering Cancer Center Bowel Function Questionnaire (MSKCC-BFQ), Functional Assessment of Cancer Therapy-Colorectal Cancer Symptom Index-9 (FCSI-9), and the Low Anterior Resection Syndrome (LARS) score-demonstrated sufficient content validity and acceptable internal consistency, and were therefore classified as Grade A. The remaining instruments were rated as Grade B due to incomplete psychometric validation or methodological limitations. Conclusion: Current PROMs for colorectal cancer show variable and generally limited measurement evidence. Original English instruments tend to have more robust psychometric support than Chinese versions and newly developed local scales. FACT-C, MSKCC-BFQ, FCSI-9, and the LARS score can be prioritized for use, while further high-quality validation studies are needed to strengthen the evidence base for other instruments. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278205, identifier CRD420261278205.