title: Chronic adverse events and quality of life after radiochemotherapy in anal cancer patients. A single institution experience and review of the literature.
abstract: OBJECTIVE
  To report on chronic adverse events (CAE) and quality of life (QOL) after radiochemotherapy (RCT) in patients with anal cancer (AC).
  
  
  METHODS
  Of 83 patients who had received RCT at our department between 1988 and 2011, 51 accepted the invitation to participate in this QOL study. CAE were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0 and QOL was assessed with the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) questionnaire.
  
  
  RESULTS
  CAE could be evaluated in 49 patients. There was a tendency toward a higher rate of grade 3 CAE in female patients, i.e. 18 out of 37 (49 %) vs. 2 out of 12 (17 %) male patients (p = 0.089). The most common grade 3 CAE were dyspareunia and vaginal symptoms (itching, burning and dryness) in 35 and 22 % of female patients, respectively, followed by stool incontinence in 13 % of all patients (6 out of 49). Both FACT-C and CAE information were available for 42 patients, allowing evaluation of the impact of CAE on QOL. The median total FACT-C score was 110 (40-132) out of a possible maximum of 136. The absence of grade 3 CAE (115 vs. 94, p = 0.001); an interval of ≥ 67 months after the end of the treatment (111 vs. 107, p = 0.010), no stool incontinence vs. grade 3 stool incontinence (111 vs. 74, p = 0.009), higher education (114 vs. 107, p = 0.013) and no dyspareunia vs. grade 3 dyspareunia (116 vs. 93, p = 0.012) were significantly associated with a higher median FACT-C score.
  
  
  CONCLUSIONS
  The majority of AC patients treated with RCT have acceptable overall QOL scores, which are comparable to those of the normal population. Patients with grade 3 CAE-particularly dyspareunia and fecal incontinence-have a poorer QOL compared to patients without CAE. In order to improve long-term QOL, future strategies might aim at a reduction in dose to the genitalia and more intensive patient support measures.
authors: Department of Radiation Oncology, Marienhospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, Herne, Germany. khfmed@yahoo.com
authors: K
authors: K
authors: Fakhrian
authors: T
authors: T
authors: Sauer
authors: A
authors: A
authors: Dinkel
authors: S
authors: S
authors: Klemm
authors: T
authors: T
authors: Schuster
authors: M
authors: M
authors: Molls
authors: H
authors: H
authors: Geinitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods / Q000523:psychology; D004414:Dyspareunia / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D011832:Radiation Injuries / Q000209:etiology; D012007:Rectum / Q000528:radiation effects; D014566:Urogenital System / Q000528:radiation effects; D014621:Vagina / Q000528:radiation effects
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