Structured gastroenterological intervention and improved outcome for patients with chronic gastrointestinal symptoms following pelvic radiotherapy.
Purpose: Fifty percent of patients develop chronic gastrointestinal (GI) symptoms following pelvic radiotherapy that adversely affect quality of life. Fewer than 20 % are referred to a gastroenterologist. We aimed to determine if structured gastroenterological evaluation is of benefit to this patien...
| Published in: | Supportive Care in Cancer Vol. 21; no. 8; pp. 2255 - 2266 |
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| Main Authors: | , , , , , , , , , , , |
| Format: | research Journal Article |
| Published: |
Springer Nature
Aug2013
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104080065&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104080065 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09414355 O1J jtl: Supportive Care in Cancer issn: 09414355 maglogo: N pubinfo: dt: Aug2013 vid: 21 iid: 8 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 104080065 NLM23512314 2012177094 10.1007/s00520-013-1782-y NLM23512314 104080065 ppf: 2255 ppct: 11 formats: fmt: @attributes: type: P tig: atl: Structured gastroenterological intervention and improved outcome for patients with chronic gastrointestinal symptoms following pelvic radiotherapy. aug: au: Henson, Caroline C Davidson, Susan E Ang, Yeng Babbs, Chris Crampton, John Kelly, Mark Lal, Simon Limdi, Jimmy K Whatley, Greg Swindell, Ric Makin, Wendy McLaughlin, John affil: Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Wilmslow Road, M20 4BX, Manchester, UK, Hensonncl@aol.com. sug: subj: Gastrointestinal Diseases Therapy Pelvis Radiation Effects Adult Aged Aged, 80 and Over Clinical Assessment Tools Female Gastrointestinal Diseases Diagnosis Gastrointestinal Diseases Etiology Gastrointestinal Neoplasms Radiotherapy Genital Neoplasms, Female Radiotherapy Human Internal Medicine Male Middle Age Questionnaires Radiotherapy Adverse Effects Urologic Neoplasms Radiotherapy Adult: 19-44 years Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Female Male ab: Purpose: Fifty percent of patients develop chronic gastrointestinal (GI) symptoms following pelvic radiotherapy that adversely affect quality of life. Fewer than 20 % are referred to a gastroenterologist. We aimed to determine if structured gastroenterological evaluation is of benefit to this patient group.Methods: Sixty patients with GI symptoms at ≥ 6 months after radical pelvic radiotherapy were identified prospectively from oncology clinics in this service evaluation. Those requiring urgent investigation were excluded. Patients were assessed at baseline using patient-reported questionnaires: inflammatory bowel disease questionnaire (IBDQ), Vaizey incontinence questionnaire, and the Common Terminology Criteria for Adverse Events (CTCAE) pelvis questionnaire. Participants were referred for gastroenterological evaluation using an algorithmic approach. Further assessments were made at 3 and 6 months.Results: Twenty men and 36 women with primary gynecological (31), urological (17), or lower GI (8) tumors were included (mean age, 58.5 years). Median time from radiotherapy to baseline assessment was 3.0 years. Multiple GI symptoms were reported (median, 8; range, 4-16) including frequency, urgency, loose stool, fecal incontinence, flatulence, bloating/distension, and rectal bleeding. Common diagnoses included radiation proctopathy, bile acid malabsorption, diverticulosis, and colonic polyps. Statistically significant improvements in all questionnaire scores between baseline and 6 months were found: IBDQ (p = 0.014), Vaizey (p < 0.0005), and CTCAE rectum-bowel subset (p = 0.001).Conclusions: Gastroenterological evaluation identifies significant, potentially treatable diagnoses in patients who develop chronic GI symptoms following pelvic radiotherapy. Some findings are incidental and unrelated to previous cancer treatment. Radiation-induced GI symptoms have historically been considered "untreatable." We report the first data to show that structured gastroenterological assessment has the potential to improve outcome by identifying diagnoses and facilitating focused treatment. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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