Abstract
PurposeThe impact of anal cancer treatment for the patients is best evaluated by the patients themselves. The purpose of this study was to investigate quality of life (QoL) in patients with anal cancer at 3 and 6 years after treatment.MethodsA Swedish national cross-sectional prospective cohort study with patients diagnosed with anal cancer between 2011 and 2013. Patients were invited to respond to a QoL questionnaire at 3 and 6 years, with focus on bowel, urinary and sexual function, social and mental function, co-morbidity, lifestyle, daily activities, personal characteristics, and perceived QoL. It also contained questions on the severity of the symptoms regarding occurrence, frequency, and duration and the level of “bother” experienced related to functional symptoms.QoL and prevalence of bother with urinary, sexual, bowel dysfunction, and anal pain were described. The prevalence of impaired QoL was compared with a healthy reference population. The association between QoL and experiencing bother was quantified by regression models.ResultsFrom an original cohort of 464 patients with anal cancer, 264 (57%) were alive and contacted at 3 years and 230 (50%) at 6 years. One hundred ninety-five (74%) patients responded to the 3-year and 152 (66%) to the 6-year questionnaire. Sixty percent reported low QoL at both 3 and 6 years. Impaired QoL was more prevalent among patients with major bother due to bowel dysfunction (at 3 years RR 1.42, 95% CI (1.06–1.9) p-value 0.020, at 6 years RR 1.52, 95% CI (1.03–2.24) p-value 0.034) and urinary dysfunction (at 6 years RR 1.44, 95% CI (1.08–1.91) p-value 0.013). There was a tendency to a positive relationship between the number of bodily functions causing bother and risk for impaired QoL.ConclusionPatients treated for anal cancer reported bother regarding several bodily functions as well as poor QoL both at 3 and 6 years without much improvement. Bother was also associated with low QoL indicating that function-related bother should be addressed.
Highlights
Material and methodsTreatment for anal cancer has improved immensely over the past decades with combined chemoradiation being the primary therapeutic option and surgery mainly reserved for patients with incomplete response or recurrence [8, 15]
The high curation rates lead to a sizeable cohort of anal cancer survivors and, the concept of survivorship, i.e., living with longterm side effects related to the received treatment [1, 19] becomes increasingly important
As side effects caused by radiotherapy can be progressive and develop years after exposure long-term follow-up is of importance, or the burden of symptoms experienced by anal cancer survivors may be underestimated [19]
Summary
Material and methodsTreatment for anal cancer has improved immensely over the past decades with combined chemoradiation being the primary therapeutic option and surgery mainly reserved for patients with incomplete response or recurrence [8, 15]. Previous studies on QoL in patients with anal cancer and long-term follow-up were presented in a review performed by Sodergren et al describing 11 studies using mainly EORTC QoL questionnaire (EORTC QLQC-30 or EORTC QLQCR-29). Results from these studies showed that bowel problems with diarrhea and impaired sexual function were the most common areas affecting QoL, and conclusion from the review was that there was a need for QoL questionnaire more specific for patients with anal cancer in future studies [19]. This has been put into place, and there is a new EORTC questionnaire for patients treated for anal cancer (EORTCANL27) [18]
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