Long-Term Patient-Reported Quality of Life of Anal Cancer Survivors Treated With Intensity Modulated Radiation Therapy and Concurrent Chemotherapy: Results From a Prospective Phase II Trial

Joseph, Kurian; Balushi, Mustafa Al; Ghosh, Sunita; Stenson, Trevor H.; Abraham, Aswin George; Elangovan, Arun; Warkentin, Heather; Paulson, Kim; Tankel, Keith; Usmani, Nawaid; Severin, Diane; Schiller, Dan; Wong, Clarence; Mulder, Karen; Doll, Corinne; King, Karen E.; Nijjar, Tirath

doi:10.1016/j.ijrobp.2023.04.023

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…Approximately 10% of patients with anal cancer 311 receive an ostomy prior to chemoradiation treatment and, of those patients, at least half go on to live with a permanent ostomy 166 . Treatment of anal cancer with chemoradiation spares patients the morbidity associated with abdominoperineal resection 310 ; however, it can still adversely affect sexual function [312][313][314] . For example, in a prospective study evaluating the effects of chemoradiation on quality of life in sexual minority men with anal cancer (mean age: 59.3 years) 307 , Mauro et al showed that quality of life and sexual function (specifically penile erectile function) worsened during treatment.…”

Section: Anal Cancermentioning

confidence: 99%

“…Radiation therapy can lead to problematic RAI in patients with anal and rectal cancer through long-term anal pain, perianal discomfort, rectal bleeding and faecal incontinence 4,42,44,310,313,314 (Fig. 6).…”

Section: Radiation and Raimentioning

confidence: 99%

“…b, Radiation-related problematic RAI. Radiation contributes to problematic RAI in patients with anal and rectal cancer through long-term anal pain, perianal discomfort, rectal bleeding and faecal incontinence 4,42,44,310,313,314 . Radiation can damage the functional anatomy involved in pleasurable RAI due to normal functional tissue cell death, inflammation, mucosal ulceration and fibrosis 319 .…”

Section: Treatment Choicementioning

confidence: 99%

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Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Dickstein,

Edwards,

Rowan

et al. 2024

Nat Rev Gastroenterol Hepatol

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The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI -encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable. Sections Key points• Receptive anal intercourse (RAI) is common worldwide.• Pleasurable RAI occurs through stimulation of the perianal or anal nerves and prostate or paraurethral glands, inducing vasodilation, erectile tissue engorgement, anopelvic tissue sensitization, and anal sphincter and pelvic muscular contractions.• Patients with a stoma and anorectal stump should be counselled on hygiene and dilator use to minimize infections, maintain anorectal patency, and prevent a permanent stoma, promoting RAI restoration.• Antidiarrhoeals, anti-flatulence medications, fibre supplements, lower residue diet to control regularity, avoiding spicy foods, timing meals, and defecation prior to RAI can help control symptoms and relieve distress.• Survivors of anal, rectal, and colon cancer and patients with gastrointestinal disease should be counselled on problematic RAI due to anal sphincter, neurovasculature, and prostate or paraurethral gland damage resulting in arousal dysfunction, anodyspareunia or orgasm dysfunctions.• Management strategies, including anal dilators for anodyspareunia, anal vibrators for arousal disorders, pelvic floor strengthening for anorgasmia and psychological interventions for decreased desire, should be discussed with patients.Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author selfarchiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

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Section: Anal Cancermentioning

confidence: 99%

Section: Radiation and Raimentioning

confidence: 99%

Section: Treatment Choicementioning

confidence: 99%

See 1 more Smart Citation

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Dickstein,

Edwards,

Rowan

et al. 2024

Nat Rev Gastroenterol Hepatol

View full text Add to dashboard Cite

show abstract

“… 1 However, radiation to the pelvis can lead to significant acute and permanent side effects that impair patient quality of life (QOL). 2 , 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal

Rooney,

Niedzielski,

Salazar

et al. 2024

Advances in Radiation Oncology

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Daily Vaginal Dilator Use During Radiation for Women With Squamous Cell Carcinoma of the Anus: Vaginal Wall Dosimetry and Patient-Reported Sexual Function

Arzola,

Chang,

Rooney

et al. 2024

Practical Radiation Oncology

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Long-Term Patient-Reported Quality of Life of Anal Cancer Survivors Treated With Intensity Modulated Radiation Therapy and Concurrent Chemotherapy: Results From a Prospective Phase II Trial

Cited by 4 publications

References 31 publications

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal

Daily Vaginal Dilator Use During Radiation for Women With Squamous Cell Carcinoma of the Anus: Vaginal Wall Dosimetry and Patient-Reported Sexual Function

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