title: Impaired health-related quality of life after chemoradiotherapy for anal cancer: late effects in a national cohort of 128 survivors.
abstract: BACKGROUND
  Chemoradiotherapy is an effective treatment for anal cancer, yet from follow-up many survivors seem to suffer from late effects. Data of long-term health-related quality of life (HRQOL) in anal cancer survivors are limited, and there is a growing interest in cancer survivorship.
  
  
  METHODS
  A national cohort of all anal cancer survivors treated with curative chemoradiotherapy in 2000-2007 was invited to a cross-sectional study. Of 199 eligible survivors, 128 (64%) returned the questionnaires, the median time since diagnosis was 66 months. The median age was 61 years and 79% were women. HRQOL was evaluated with EORTC questionnaires QLQ-C30 and QLQ-CR29, and neurotoxicity with the Scale of Chemotherapy-Induced Neurotoxicity. An age- and sex-matched reference group of volunteers (n = 269) not treated for pelvic cancer answered the same questionnaires. Results from QLQ-C30 of the reference group were compared to Norwegian and Dutch normative data.
  
  
  RESULTS
  The mean scores of anal cancer survivors were poorer compared to volunteers and normative data. Anal cancer survivors reported significant impairment of function, especially social and role function, compared to the volunteers (difference ≥ 20 points, p < 0.001). Survivors had markedly increased scores for fatigue, dyspnoea, insomnia and diarrhoea (difference ≥ 15 points, p < 0.001). The global quality of life was significantly reduced (difference 15 points, p < 0.001). Anal cancer survivors had increased stool frequency, more buttock pain, flatulence, faecal incontinence, impotence (males), dyspareunia and reduced sexual interest (females) (difference ≥ 15 points, p < 0.001). There was increased frequency of tinnitus in survivors treated with cisplatin-based chemotherapy (p = 0.004).
  
  
  CONCLUSIONS
  Survivors after chemoradiotherapy for anal cancer have significant long-term impairment of HRQOL. Reduced social, role and sexual function, and increased diarrhoea, incontinence for gas and stools, and buttock pain were commonly reported. Increased awareness of this may lead to better management of late effects and better care for cancer survivors.
authors: University Hospital of North Norway, Department of Oncology, Tromsø, Norway. anne.gry.bentzen@unn.no
authors: Anne Gry
authors: AG
authors: Bentzen
authors: Lise
authors: L
authors: Balteskard
authors: Eva Hoff
authors: EH
authors: Wanderås
authors: Gunilla
authors: G
authors: Frykholm
authors: Tom
authors: T
authors: Wilsgaard
authors: Olav
authors: O
authors: Dahl
authors: Marianne Grønlie
authors: MG
authors: Guren
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016022:Case-Control Studies; D059248:Chemoradiotherapy / Q000009:adverse effects*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011788:Quality of Life; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D013997:Time Factors