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

Abstract

Distressing long-term anorectal and sexual dysfunction was common after radiotherapy for anal cancer, and morbidity due to urinary dysfunction was moderate.

Anal Carcinoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…Late toxicity from pelvic radiation can include bowel dysfunction (ie, increased stool frequency, fecal incontinence, flatulence, rectal urgency), urinary dysfunction, and sexual dysfunction (ie, impotence, dyspareunia, reduced libido). [145][146][147][148] Anal cancer survivors also report significantly reduced global quality of life, with increased frequency of somatic symptoms including fatigue, dyspnea, pain, and insomnia. 145,149,150 Therefore, survivors of anal cancer should be screened regularly for distress.…”

A comprehensive review of sexual health concerns after cancer treatment and the biopsychosocial treatment options available to female patients

“…Female rectal and anal cancer survivors have been found to experience substantial sexual difficulties related to vaginal strictures ostomy interference with sexual activity, soiling of personal and bed clothing, bowel and bladder incontinence, pain, and psychological distress (Sun et al, 2016;Sunesen et al, 2015), with prevalence rates of sexual concerns in the range of 19%-62% (DuHamel et al, 2016). Post-mastectomy and lumpectomy, women are faced with scarring, pain, and lost sensation in breast and/or nipple tissue (Falk & Dizon, 2013;Farthmann et al, 2016;Sekse et al, 2010).…”

“…Importantly, sexual dysfunction can become chronic and persist for many years following cancer treatment; similarly, sexual health concerns frequently manifest as late effects of treatment, with severe consequences for women's sexual wellbeing throughout recovery and survivorship (Jensen & Froeding, 2015;Schover, 2014). Women who undergo allogenic haematopoietic stem cell transplantation (HSCT), pelvic radiotherapy, chemoradiotherapy for anal cancer and endocrine therapies (e.g., aromatase inhibitors (AIs) or tamoxifen) are considered to be particularly high-risk for ongoing or late-effect sexual dysfunction (Dyer et al, 2016;Jensen et al, 2004;Schover, 2014;Sunesen et al, 2015). The entrenchment of treatment-related sexual health side-effects (e.g.…”

“…Women who undergo RT for anal cancer report frequent and distressing physical side effects of treatment (e.g. bowel and bladder incontinence and urgency) that negatively impact sexual functioning (Sunesen et al, 2015). Similarly, women treated with RT for breast cancer often experience scarring, burns, lymphedema and breast skin thickening Falk & Dizon, 2013).…”

Anal sphincter dysfunction in patients treated with primary radiotherapy for anal cancer: a study with the functional lumen imaging probe

“…Several large studies of various regimes of RT and/or CRT for AC have reported 5-year survival rates of 52-73% [2][3][4][5][6][7][8][9][10][11][12]. Unfortunately, long-term survivors often suffer from severe anorectal dysfunction [13][14][15][16][17][18]. In a study from our unit in Aarhus, Denmark, 31% of patients treated for AC suffered from incontinence to solid stools, 54% had incontinence to liquid stools, 79% had incontinence to gas at least once per month, and 56% had daily episodes of urgency to defecate [14].…”