A Systematic Review of Population-Based Studies of Chronic Bowel Symptoms in Cancer Survivors following Pelvic Radiotherapy

Abstract

Pelvic radiotherapy can damage surrounding tissue and organs, causing chronic conditions including bowel symptoms. We systematically identified quantitative, population-based studies of patient-reported bowel symptoms following pelvic radiotherapy to synthesize evidence of symptom type, prevalence, and severity. Medline, CINAHL, EMBASE, and PsychINFO were searched from inception to September 2022. Following independent screening of titles, abstracts, and full-texts, population and study characteristics and symptom findings were extracted, and narrative synthesis was conducted. In total, 45 papers (prostate, n = 39; gynecological, n = 6) reporting 19 datasets were included. Studies were methodologically heterogeneous. Most frequently assessed was bowel function (‘score’, 26 papers, ‘bother’, 19 papers). Also assessed was urgency, diarrhea, bleeding, incontinence, abdominal pain, painful hemorrhoids, rectal wetness, constipation, mucous discharge, frequency, and gas. Prevalence ranged from 1% (bleeding) to 59% (anal bleeding for >12 months at any time since start of treatment). In total, 10 papers compared radiotherapy with non-cancer comparators and 24 with non-radiotherapy cancer patient groups. Symptom prevalence/severity was greater/worse in radiotherapy groups and symptoms more common/worse post-radiotherapy than pre-diagnosis/treatment. Symptom prevalence varied between studies and symptoms. This review confirms that many people experience chronic bowel symptoms following pelvic radiotherapy. Greater methodological consistency, and investigation of less-well-studied survivor populations, could better inform the provision of services and support.

From pelvic radiation to social isolation: a qualitative study of survivors’ experiences of chronic bowel symptoms after pelvic radiotherapy

“…Questionnaire-based studies have reported varied prevalence of these symptoms and, perhaps more importantly, an associated decrease in overall quality of life (QoL) and across various QoL domains (e.g. [4][5][6]). However, few studies have used qualitative methods to explore survivors' experiences of living with these bowel symptoms.…”

From Pelvic Radiation to Social Isolation: A Qualitative Study of Survivors’ Experiences of Chronic Bowel Symptoms after Pelvic Radiotherapy

“…The bowel symptoms that people treated with pelvic radiation may experience are wide-ranging and include urgency, frequency, bleeding, incontinence, mucous discharge, diarrhoea, excess wind, constipation and pain. Questionnaire-based studies have reported varied prevalence of these symptoms and, perhaps more importantly, an associated decrease in overall quality-of-life (QoL) and across various QoL domains (e.g., [4][5][6]). However, few studies have used qualitative methods to explore survivors' experiences of living with these bowel symptoms.…”