title: Long-term anorectal, urinary and sexual dysfunction causing distress after radiotherapy for anal cancer: a Danish multicentre cross-sectional questionnaire study.
abstract: OBJECTIVE
  The objective of primary radiotherapy for anal cancer is to remove cancer while maintaining anorectal function. However, little is known about anorectal function among long-term survivors without colostomy. Using a cross-sectional questionnaire study, we examined symptoms and distress related to the dysfunction of pelvic organs after radiotherapy for anal cancer.
  
  
  METHODS
  A questionnaire regarding anorectal, urinary and sexual symptoms was sent to anal cancer patients without recurrence or colostomy, diagnosed during 1996-2003, and treated with curative intent (chemo)radiotherapy at three Danish centres. For each symptom we assessed frequency and severity and the level of symptom-induced distress (no, little, moderate or great distress).
  
  
  RESULTS
  Of 94 eligible patients, 84 (89%) returned the completed questionnaire at a median of 33 months after radiotherapy. Incontinence for solid stools, liquid stools and gas occurred at least monthly in 31%, 54% and 79% of patients, respectively. Overall 40% of patients reported great distress from incontinence for solid or liquid stools at least monthly. Faecal urgency occurring at least monthly was experienced by 87% of patients and caused great distress in 43%. Stress, urge or another type of urinary incontinence occurred at least monthly in 45% and caused great distress in 21%. Urinary urgency occurred at least monthly in 48% but only caused great distress in 14%. Sexual desire was severely decreased in 58% and only 24% were satisfied with their sexual function.
  
  
  CONCLUSIONS
  Distressing long-term anorectal and sexual dysfunction was common after radiotherapy for anal cancer, and morbidity due to urinary dysfunction was moderate.
authors.affiliation: Department of Gastrointestinal Surgery A, Aalborg University Hospital, Aalborg, Denmark.|Department of Colorectal Surgery P, Aarhus University Hospital, Aarhus, Denmark.|Department of Clinical Epidemiology, Clinical Institute, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: K G
authors.initials: KG
authors.lastname: Sunesen
authors.affiliation: Department of Clinical Epidemiology, Clinical Institute, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Nørgaard
authors.affiliation: Department of Colorectal Surgery P, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Lundby
authors.affiliation: Department of Oncology, Herlev Hospital, Copenhagen University, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Havsteen
authors.affiliation: Department of Colorectal Surgery P, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Buntzen
authors.affiliation: Department of Gastrointestinal Surgery A, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: O
authors.initials: O
authors.lastname: Thorlacius-Ussing
authors.affiliation: Department of Colorectal Surgery P, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Laurberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000532:radiotherapy*; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology*
keywords: Anus neoplasms; faecal incontinence; faecal urgency; radiotherapy