Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy.
OBJECTIVE
Radiochemotherapy is the standard of care for the treatment of anal carcinoma achieving good loco-regional control and sphincter preservation. This approach is however associated with acute and late toxicities including haematological, skin, bowel function and genito-urinary complications. This paper systematically reviews studies addressing the quality of life (QoL) implications of anal cancer and radiochemotherapy. The paper also evaluates how QoL is assessed in anal cancer.


METHODS
Medline, EMBASE, CINAHL, PsycInfo, Web of Science and the Cochrane Library were searched for publications (1996-2014) reporting the effects on patients of anal cancer and radiochemotherapy.


RESULTS
Of the 152 papers reporting treatment-related effects on patients, only 11 provided a formal assessment of QoL. In the absence of an anal cancer-specific measure, QoL was assessed using generic cancer instruments such as the core EORTC quality of life questionnaire (EORTC QLQ-C30) or colorectal cancer tools such as the EORTC QLQ-CR29. Bowel function, particularly diarrhoea, and sexual problems were the most commonly reported QoL concerns. The review of QoL issues of anal cancer patients treated with radiochemotherapy is limited by the QoL assessment measures used. It is argued that certain treatment-related toxicities, for example skin-induced radiation problems, are overlooked or inadequately represented in existing measures.


CONCLUSIONS
This review emphasises the need to develop an anal cancer-specific QoL measure and to incorporate QoL as an outcome of future trials in anal cancer. The results of this review are informative to clinicians and patients in terms of treatment decision-making.
Cancer Sciences, University of Southampton, Southampton, SO16 6YD, UK. S.C.Sodergren@soton.ac.uk.
Samantha C
SC
Sodergren
Bank of Cyprus Oncology Centre, Nicosia, Cyprus.
Vassilios
V
Vassiliou
Division of Radiation Oncology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada.
Kristopher
K
Dennis
Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
Krzysztof A
KA
Tomaszewski
Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.
Alexandra
A
Gilbert
Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
Robert
R
Glynne-Jones
Cancer Sciences, University of Southampton, Southampton, SO16 6YD, UK.
Karen
K
Nugent
Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.
David
D
Sebag-Montefiore
Cancer Sciences, University of Southampton, Southampton, SO16 6YD, UK.
Colin D
CD
Johnson
D001005:Anus Neoplasms / Q000523:psychology* / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*
Anal cancer; Quality of life; Radiochemotherapy; Toxicities