title: Late symptoms in long-term gynaecological cancer survivors after radiation therapy: a population-based cohort study.
abstract: BACKGROUND
  We surveyed the occurrence of physical symptoms among long-term gynaecological cancer survivors after pelvic radiation therapy, and compared with population-based control women.
  
  
  METHODS
  We identified a cohort of 789 eligible gynaecological cancer survivors treated with pelvic radiation therapy alone or combined with surgery in Stockholm or Gothenburg, Sweden. A control group of 478 women was randomly sampled from the Swedish Population Registry. Data were collected through a study-specific validated postal questionnaire with 351 questions concerning gastrointestinal and urinary tract function, lymph oedema, pelvic bones and sexuality. Clinical characteristics and treatment details were retrieved from medical records.
  
  
  RESULTS
  Participation rate was 78% for gynaecological cancer survivors and 72% for control women. Median follow-up time after treatment was 74 months. Cancer survivors reported a higher occurrence of symptoms from all organs studied. The highest age-adjusted relative risk (RR) was found for emptying of all stools into clothing without forewarning (RR 12.7), defaecation urgency (RR 5.7), difficulty feeling the need to empty the bladder (RR 2.8), protracted genital pain (RR 5.0), pubic pain when walking indoors (RR 4.9) and erysipelas on abdomen or legs at least once during the past 6 months (RR 3.6). Survivors treated with radiation therapy alone showed in general higher rates of symptoms.
  
  
  CONCLUSIONS
  Gynaecological cancer survivors previously treated with pelvic radiation report a higher occurrence of symptoms from the urinary and gastrointestinal tract as well as lymph oedema, sexual dysfunction and pelvic pain compared with non-irradiated control women. Health-care providers need to actively ask patients about specific symptoms in order to provide proper diagnostic investigations and management.
authors.affiliation: Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden. helena.lind@ki.se
authors.forename: H
authors.initials: H
authors.lastname: Lind
authors.forename: A-C
authors.initials: AC
authors.lastname: Waldenström
authors.forename: G
authors.initials: G
authors.lastname: Dunberger
authors.forename: M
authors.initials: M
authors.lastname: al-Abany
authors.forename: E
authors.initials: E
authors.lastname: Alevronta
authors.forename: K-A
authors.initials: KA
authors.lastname: Johansson
authors.forename: C
authors.initials: C
authors.lastname: Olsson
authors.forename: T
authors.initials: T
authors.lastname: Nyberg
authors.forename: U
authors.initials: U
authors.lastname: Wilderäng
authors.forename: G
authors.initials: G
authors.lastname: Steineck
authors.forename: E
authors.initials: E
authors.lastname: Åvall-Lundqvist
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D016022:Case-Control Studies; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000175:diagnosis* / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D011159:Population Surveillance; D011878:Radiotherapy / Q000009:adverse effects*; D012042:Registries; D011795:Surveys and Questionnaires; D017741:Survivors; D014551:Urinary Tract / Q000503:physiopathology