title: Faecal incontinence after chemoradiotherapy in anal cancer survivors: long-term results of a national cohort.
abstract: OBJECTIVE
  To examine the prevalence and severity of faecal incontinence amongst anal cancer survivors after chemoradiotherapy.
  
  
  METHODS
  Anal cancer survivors from a complete, unselected, national cohort, minimum 2-years follow-up, were invited to a cross-sectional study. The St. Mark's incontinence score was used to evaluate occurrence and degree of faecal incontinence the last four weeks. The results were compared to age- and sex-matched volunteers from the general population.
  
  
  RESULTS
  Of 199 invited survivors and 1211 volunteers, 66% and 21%, respectively, signed informed consent. The survivors had significantly higher St. Mark's score than the volunteers (mean 9.7 vs. 1.1, p<0.001). Incontinence of stool of any degree was reported by 43% vs. 5% (OR 4.0, CI 2.73-6.01), and urgency was reported by 64% vs. 6% (OR 6.6, CI 4.38-9.90) of the survivors and volunteers, respectively. Only 29% of those with leakage of liquid stool used constipating drugs. Survivors of locally advanced tumours had a higher incontinence score (p<0.01).
  
  
  CONCLUSIONS
  Moderate to severe faecal incontinence is common amongst anal cancer survivors. Post-treatment follow-up should include the evaluation of continence, and incontinent survivors should be offered better symptom management and multidisciplinary approach if simple measures are insufficient.
authors.affiliation: Department of Oncology, University Hospital of North Norway, Tromsø, Norway. anne.gry.bentzen@unn.no
authors.forename: Anne Gry
authors.initials: AG
authors.lastname: Bentzen
authors.forename: Marianne G
authors.initials: MG
authors.lastname: Guren
authors.forename: Barthold
authors.initials: B
authors.lastname: Vonen
authors.forename: Eva H
authors.initials: EH
authors.lastname: Wanderås
authors.forename: Gunilla
authors.initials: G
authors.lastname: Frykholm
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.forename: Olav
authors.initials: O
authors.lastname: Dahl
authors.forename: Lise
authors.initials: L
authors.lastname: Balteskard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000528:radiation effects; D017741:Survivors
keywords: Anus neoplasm; Chemoradiotherapy; Faecal incontinence; Radiotherapy