Not all wounds are visible: Peer bullying and psychopathology in child and adolescent psychotherapy outpatients.

Colorectal cancer ranks third in global cancer prevalence and second in China [, ]. Primary treatments involve surgery, supplemented by chemoradiotherapy []. Patients with stage I‐III colorectal cancer are commonly treated with curative intent and subsequently enter a defined survivorship rehabilitation phase, with reported 5‐year relative survival rates of approximately 57.0%–91.0%. Patients with stage IV disease often follow metastatic‐disease treatment trajectories involving ongoing systemic therapy, disease control, symptom palliation, and life prolongation, with a substantially lower 5‐year relative survival rate of approximately 14.0% []. Among the persistent symptoms reported by 32.4%–79.0% of colorectal cancer survivors, cancer‐related fatigue (CRF) is among the most common and distressing []. Cancer‐related fatigue is characterized by distressing persistent subjective sense of physical (e.g., bodily weakness, reduced stamina), emotional (e.g., loss of motivation, reduced self‐esteem, depressive feelings), and/or cognitive (e.g., difficulties in concentration, attention, memory, information processing) tiredness or exhaustion associated with cancer or its treatment, which is disproportional to recent activity levels and interferes with usual functioning [, ]. Treatment‐related sequelae predispose colorectal cancer patients to multidimensional CRF. Surgery causes bowel dysfunction (e.g., diarrhoea, incontinence, and stoma), which impairs nutrition, disrupt sleep, and restrict physical and social activities [], collectively resulting in physical fatigue. Chemotherapy regimens commonly used in colorectal cancer, such as CAPEOX (capecitabine and oxaliplatin) and mFOLFOX6 (modified folinic acid, fluorouracil, and oxaliplatin), may induce peripheral neuropathy, gastrointestinal toxicities, and cognitive impairment that amplify physical and cognitive fatigue []. Additionally, stoma formation precipitates emotional fatigue through body image disturbance and social withdrawal, and concerns about leakage or odour []. Critically, CRF does not resolve with treatment completion; without appropriate management, it may persist or even deteriorate within 12 months after treatment []. Very severe CRF is associated with increased all‐cause mortality risk [], and higher continuous CRF scores are associated with more severe anxiety and depressive symptoms [], collectively compromising quality of life. Therefore, strategies to alleviate CRF specifically for colorectal cancer patients are warranted. Non‐pharmacological approaches, particularly physical exercises and psychosocial interventions, represent the predominant evidence‐based strategies for managing CRF []. Although physical exercise has demonstrated enduring effects in reducing CRF among patients with colorectal cancer [], barriers such as fatigue itself and physical limitations may limit sustained engagement, particularly among patients with advanced disease []. Psychosocial interventions, which aim to inform, educate, and enhance individuals' coping capacities in relation to illness and its consequences, may offer particular value by addressing cognitive, emotional, and behavioural processes associated with fatigue that exercise alone may not fully target [].