**Background:** Early discharge after colorectal cancer surgery is common due to Enhanced Recovery After Surgery (ERAS) guidelines, shifting much of the recovery burden to patients at home. Previous research has shown that patients experience uncertainty, anxiety, and a feeling of being abandoned after discharge. While several studies have examined recovery during the first year, few have focused on day-to-day variations during the critical first month. Retrospective data collection may introduce recall bias, and single time-point assessments miss daily fluctuations. This study aimed to identify and describe areas of concern with attention to day-to-day variations during the first month after colorectal cancer surgery.
**Methods:** A multi-method design was used, combining semi-structured diaries and face-to-face interviews. Seven patients (mean age 71.7 years, SD 6.5; 5 female, 2 male) who underwent elective colorectal cancer surgery (4 colon, 3 rectal) participated. Patients were recruited from a specialist colorectal surgery unit following ERAS guidelines. They completed semi-structured diaries daily for a mean of 21 days (range 20–30 days postoperatively), rating pain on a 0–10 scale, appetite, ability to eat/drink, mobility, activity level, and worries, with open-ended sections for elaboration. Face-to-face interviews (mean duration 46 minutes, range 24–59 min) were conducted 1 month after surgery. Diary data were compiled into figures and tables to identify four areas of concern, which then served as a framework for directed content analysis of interview transcripts.
**Key Results:** Four areas of concern emerged: (1) Pain: Mean pain intensity was low (generally <3 on a 10-point scale) and decreased over the month, but pain caused reduced mobility, tiredness, and negative mood. Some participants reported higher intensity due to perineal stitches or abdominal drains. (2) Activities of daily living and social life: Most participants could manage self-care but struggled with dressing, housework, and longer walks. Social participation was hampered by frequent, unpredictable urge to defecate, pain, and fatigue. Dependence on family members was common after discharge. (3) Appetite and ability to eat and drink: This was the most prominent concern. Only a few participants reported good appetite during the first month; most experienced poor or 'in between' appetite consistently. Ability to eat and drink as before surgery showed day-to-day variation with slight deterioration in weeks 2–3. Reasons included loss of taste, lack of appetite, and inability to tolerate regular food—smoothies and ice-cream were easier. (4) Worries: Participants rated worries as mild overall, with a minor increase during weeks 2–3. Worries focused on tiredness, urgent bowel needs, pathological diagnostics, and future uncertainty. Bowel-related worries were most prominent; participants were unprepared for changes and frightened something was wrong, but felt relief after speaking with a specialist nurse or doctor.
**Clinical Implications:** The findings directly inform patient education at hospital discharge. Nurses should prepare patients for: (a) low-level pain that may still limit mobility and require management; (b) reduced self-care capacity initially, requiring family support; (c) significant appetite loss and taste changes, with recommendations for small, frequent meals and easily digestible foods like smoothies; (d) altered bowel function causing urgency and social hesitation, with evidence-based dietary and medication strategies; and (e) common worries about bowel changes and cancer prognosis, which can be alleviated by anticipatory guidance and access to specialist advice. The study reinforces that follow-up interventions (e.g., nurse-led clinics, telephone contact) are important as symptoms evolve. Limitations include the small sample (n=7) due to high dropout, potential selection bias from ward-nurse recruitment, and the semi-structured diary possibly limiting free expression. Future research should collect patient-developed self-care strategies and consider digital diary methods to improve participation.