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.

Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy

“…Table 3 outlines the QoL issues identified by the studies. Symptom-related data replicate the findings from toxicity reports although bowel functioning issues, in particular diarrhoea, and sexual problems were the most commonly reported issues in the QoL literature and were presented as significant concerns in seven studies [37,42,38,34,44,29,41]. Allal et al [37] reported a threefold increase in diarrhoea in their cohort compared with population norms while 31% of patients assessed by Das et al [38] D sexual interest (reported in 65% patients) reduced enjoyment of sex (71%), difficulties getting aroused (72%), erectile dysfunction (67% of men who responded) and difficulties achieving orgasm (70% of women who responded) [38].…”

“…Baseline QoL data were provided in one study that compared QoL of a sub-group of 199 patients at baseline and 2 months after treatment as part of the ACCORD 03 trial [36]. Six of the studies assessed QoL in the context of known group comparisons, for example according to age, sex, employment and marital status, treatment type and disease parameters [37,38,34,39,36,40,41]. Comparisons were also made using reference values from published normative data from the general population or other disease groups [42,40,43,41,37,38] while two studies included matched healthy volunteers [42,44].…”

“…Six of the studies assessed QoL in the context of known group comparisons, for example according to age, sex, employment and marital status, treatment type and disease parameters [37,38,34,39,36,40,41]. Comparisons were also made using reference values from published normative data from the general population or other disease groups [42,40,43,41,37,38] while two studies included matched healthy volunteers [42,44]. QoL was a primary end point for 9 studies and for 8 of these studies data on longterm QoL issues were provided with intervals between treatment and assessment varying from 2 years [38] to more than 12 years [44,40].…”

“…Allal et al [37] reported a threefold increase in diarrhoea in their cohort compared with population norms while 31% of patients assessed by Das et al [38] D sexual interest (reported in 65% patients) reduced enjoyment of sex (71%), difficulties getting aroused (72%), erectile dysfunction (67% of men who responded) and difficulties achieving orgasm (70% of women who responded) [38]. Comparisons between anal cancer patients and population norms have also highlighted difficulties in social and role functioning [42,41,44], as well as sexual [44,37,42], physical [44], cognitive [41], and emotional function [41,44] (Table 3). …”

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

“…There have been no cases of radionecrosis, consistent with other reports of a low prevalence of this complication following CRT (Dzik-Jurasz et al, 2001). However, we have not prospectively collected detailed quality-oflife information or other potential side effects of treatment, such as sexual dysfunction, which can be significant (Allal et al, 1999).…”