QoL after anal cancer RT
Patient reported quality of life after helical IMRT based concurrent chemoradiation of locally advanced anal cancer

https://doi.org/10.1016/j.radonc.2016.06.020Get rights and content

Abstract

Background and purpose

Concurrent chemoradiation (CCRT) is the standard treatment for locally advanced anal canal carcinoma, although treatment-related side effects can affect patient quality of life (QOL). The purpose was to prospectively evaluate the effects of Tomotherapy (HT) based CCRT on patient reported QOL in locally advanced anal cancer.

Patients and Methods

Fifty-four patients treated with HT and concurrent 5-fluorouracil/mitomycin-C underwent QOL evaluation at baseline, after treatment, and during follow-up with EORTC core (QLQ-C30) and colorectal (QLQ-CR29) questionnaires. The QOL scores at baseline and post-treatment were compared.

Results

All C30 functional symptoms, except emotional and cognitive functioning, were impaired end-of-treatment and recovered by 3 months follow-up. The majority of symptom scores were worse end-of-treatment but recovered by 3 months except for fecal incontinence (FI), diarrhea, urinary incontinence (UI), and dyspareunia which persisted. FI returned to baseline at 12 months while diarrhea, UI, and dyspareunia persisted.

Conclusions

Most impaired functions and symptoms following HT based CCRT were temporary and improved by 3 months post-therapy. Late complications affecting QOL were FI, sexual function, UI, and diarrhea. Our observations support routine use of IMRT and emphasize the significance of precise evaluation of sexual, urinary, and anorectal functions before starting CCRT and routine incorporation of QOL evaluations.

Section snippets

Patient selection

Anal cancer patients were treated with helical Tomotherapy (Accuray, Inc, Sunnyvale, CA) and concurrent 5-flurouracil/mitomycin-C combination (5FU/MMC) as part of an in-house prospective phase II study [10]. All patients were biopsy confirmed, non-metastatic, and newly diagnosed. All patients were staged as per AJCC/UICC (2010) staging guidelines.

The study was approved by the Regional Research Ethics board and written informed consent was obtained from all patients enrolled into the study. The

Patients

Patient characteristics are summarized in Table 1. Among 58 patients enrolled, there were 54 patients evaluable for this QOL analysis. The reasons for ineligibility were that 1 patient withdrew consent and did not have CCRT and 3 patients did not complete baseline QOL assessment. The median age was 57 years (37–83) and there were 36 females and 18 males.

The median QOL follow-up was 26.6 months from treatment initiation (range 0–66.43 months). The median number of QOL questionnaires completed per

Discussion

Health related QOL has become an important outcome measure for anal cancer treatment, because of improved survival following CCRT. The sphincter-sparing CCRT approach can be influenced by function of the preserved sphincter or treatment-related factors [17]. QOL provides a better understanding of the impact of the disease and therapy on the patient. Currently there are limited published data on QOL evaluation in ACC patients treated with CCRT and the majority are retrospective and lack

Funding

This study was funded by the Alberta Cancer Board seed funding and Grant and Alberta Innovates Health Solutions (Grant: 2011-RES0008619.) The funding agencies had no role in study design, data analysis, or manuscript preparation.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Acknowledgments

The authors thank Juliette Jordan, Wanda Churchill, and Elizabeth Gaetz for help with patient enrolment and data collection.

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