Assessment of long-term quality of life in patients with anal carcinomas treated by radiotherapy with or without chemotherapy

Abstract

Summary This study was conducted to assess long-term Quality of Life (QOL) in patients treated by radiotherapy with or without chemotherapy for anal carcinomas. Patients with a maximum age of 80 years, and who were alive at least 3 years following completion of treatment with a functioning anal sphincter and without active disease, were selected for this study. Of 52 such patients identified, 41 (79%) were evaluable. There were 35 females and six males with a median age of 71 years (55-80). The median follow-up interval was 116 months (range 37-218). QOL was assessed using two self-rating questionnaires developed by the European Organization for Research and Treatment of Cancer: one for cancer-specific QOL (EORTC QLQ-C30) and one for site-specific QOL (EORTC QLQ-CR38). For the function scales a higher score represents a higher level of functioning (100 being the best score), whereas for the symptom scales a higher score indicates a higher level of symptomatology/problems (0 being the best score). For the QLQ-C30, the functional scale scores ranged from 71 (global quality of life) to 85 (role function) and the symptom scale scores from 6 (nausea-vomiting) to 28 (diarrhoea). For the QLQ-CR38 module the functional scale scores ranged from 13 (sexual functioning) to 74 (body image) and for the symptom scale scores from 5 (weight loss) to 66 (sexual dysfunction in males). None of the functional and symptom scale scores seemed to be better in patients with longer followup. In patients treated with sphincter conservation for anal carcinomas, long-term QOL as measured by the EORTC QLQ-C30 and QLQ-CR38 appears to be acceptable, with the exception of diarrhoea and perhaps sexual function. Moreover, the subset of patients who presented with severe complications and/or anal dysfunction showed poorer scores in most scales.

Long‐term anorectal, urinary and sexual dysfunction causing distress after radiotherapy for anal cancer: a Danish multicentre cross‐sectional questionnaire study

“…No anal-cancer-specific questionnaire exists. Instruments previously used for long-term assessment after radiotherapy or chemoradiotherapy for anal cancer include the LENT-SOMA system [10,43] and a number of sexual, gastrointestinal, cancer-specific and colorectal-cancer-specific QoL scales [1,3,6,7,9,10]. The low anterior resection syndrome (LARS) score is a new symptom-based scoring system for bowel dysfunction after low anterior resection with or without preoperative radiotherapy for rectal cancer [44,45].…”

“…Consequently, colostomy-free survival is often used as a mea-sure of clinical success. However, long-term survivors with a preserved anal sphincter often suffer from severe disturbances of anorectal function [1][2][3][4][5]. Faecal incontinence is experienced by as many as half of these patients [1][2][3]5,6], but the impact of faecal incontinence on quality of life (QoL) is controversial [1,3,4,[6][7][8][9][10].…”

Anal cancer: Current standards in care and recent changes in practice

“…As noted by Allal et al, 165 sexual functioning is affected by treatments of anal cancer in both men and women. Considerable reductions in sexual interest and sexual dysfunction are reported among anal cancer survivors.…”

Sexual Function, Incontinence, and Wellbeing in Women after Rectal Cancer—A Review of the Evidence

“…Few population-based studies have evaluated QoL after rectal cancer and data comparing women with rectal cancer with appropriate community controls are lacking [46][47][48][49]. Much of the research includes sampling patients at a wide range of times since diagnosis [50,51], or is based on selective samples of hospital patients [46,48,52]. A large population-based study of 439 CRC patients 1 year after diagnosis, including community controls [53], examined QoL using the cancer-specific EORTC QLQ-C30 and found that issues such as emotional and social functioning, fatigue, dyspnea, insomnia, constipation, diarrhea, and financial difficulties were the main factors affecting QoL in younger CRC patients, compared with community controls.…”

“…Some have reported that patients with colostomies experience more problems with physical, psychological, social, and sexual functioning than patients with preserved anal sphincter function [57,58]. Survivors with a permanent stoma following radiotherapy and surgery for rectal cancer reported improved bowel symptoms, fatigue, and pain [51]. However, having a stoma has also been associated with diminished body image and social functioning [59,60].…”