Abstract
PurposeCurative radiotherapy for cancer may lead to severe late radiation tissue injuries (LRTIs). However, limited knowledge exists about pelvic cancer survivors’ LRTI symptoms, distress, and health-related quality of life (HRQOL). We sought to assess the symptom burden, distress, and HRQOL in survivors with established pelvic LRTIs compared to norm populations and to investigate the relation between these factors.MethodsCancer survivors referred for treatment of established pelvic LRTIs were recruited nationwide. LTRIs were assessed with the Expanded Prostate Cancer Index Composite (EPIC), psychological distress was assessed with the General Health Questionnaire (GHQ-12), and HRQOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORCT-QLQ-C30).ResultsA total of 107 participants (mean age 64, 53% men) were included. Compared to norms, participants reported more urinary (mean 68.7 vs. 89.5; p = 0.00; d = 1.4) and bowel symptoms (mean 62.5 vs. 92.4; p = 0.00; d = 2.7), increased psychological distress (mean 13.4 vs. 10.3; p = 0.00; d = 0.6), and overall poorer HRQOL (mean 54.9 vs. 71.2; p = 0.00; d = 0.7). Higher symptom burden and higher levels of psychological distress were associated with lower HRQOL (r2 = 46%), but psychological distress did not moderate the influence of symptoms on HRQOL.ConclusionCancer survivors with established pelvic LRTIs are highly burdened compared to norms. The association of the LRTI-related symptom burden with HRQOL is independent of the level of psychological distress. Both coping and treatment interventions are crucial to promoting long-term health and HRQOL.Trial registrationNCT03570229.
Highlights
More than 34,000 Norwegians are diagnosed with cancer, where pelvic malignancies—including prostate, urological, bowel, and gynaecological malignancies—account for approximately 35% of all cases [1]
In addition to the symptom burden, it is crucial to have a focus on psychological distress because this may impair health-related quality of life (HRQOL) and increase poor health behaviours, consumption of medical resources, and mortality [17, 18]
Addressing our first study aim, we found that cancer survivors with pelvic late radiation tissue injuries (LRTIs) experienced considerably more symptoms, psychological distress, and impaired overall HRQOL than norms
Summary
More than 34,000 Norwegians are diagnosed with cancer, where pelvic malignancies—including prostate, urological, bowel, and gynaecological malignancies—account for approximately 35% of all cases [1]. The treatment options for pelvic LRTIs are limited and mostly focused on symptom relief [12]. Late effects from cancer and cancer treatment, especially radiotherapy, are associated with psychological distress. This includes emotional symptoms such as worry, sorrow, anxiety, and depression, where higher symptom burden predicts higher levels of distress across cancer diagnoses [13,14,15,16]. Studies of psychological distress in survivors with pelvic LRTIs are very limited. Adams et al [2] found that more severe pelvic LRTI symptoms across cancer types were associated with higher rates of depression but not with higher rates of anxiety
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