title: Late radiation-induced bowel syndromes, tobacco smoking, age at treatment and time since treatment - gynecological cancer survivors.
abstract: BACKGROUND
  It is unknown whether smoking; age at time of radiotherapy or time since radiotherapy influence the intensity of late radiation-induced bowel syndromes.
  
  
  METHODS
  We have previously identified 28 symptoms decreasing bowel health among 623 gynecological-cancer survivors (three to twelve years after radiotherapy) and 344 matched population-based controls. The 28 symptoms were grouped into five separate late bowel syndromes through factor analysis. Here, we related possible predictors of bowel health to syndrome intensity, by combining factor analysis weights and symptom frequency on a person-incidence scale.
  
  
  RESULTS
  A strong (p < .001) association between smoking and radiation-induced urgency syndrome was found with a syndrome intensity (normalized factor score) of 0.4 (never smoker), 1.2 (former smoker) and 2.5 (current smoker). Excessive gas discharge was also related to smoking (p = .001). Younger age at treatment resulted in a higher intensity, except for the leakage syndrome. For the urgency syndrome, intensity decreased with time since treatment.
  
  
  CONCLUSIONS
  Smoking aggravates the radiation-induced urgency syndrome and excessive gas discharge syndrome. Smoking cessation may promote bowel health among gynecological-cancer survivors. Furthermore, by understanding the mechanism for the decline in urgency-syndrome intensity over time, we may identify new strategies for prevention and alleviation.
authors.affiliation: a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.|b Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.affiliation: a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
authors.forename: Fei
authors.initials: F
authors.lastname: Sjöberg
authors.affiliation: a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
authors.forename: Viktor
authors.initials: V
authors.lastname: Skokic
authors.affiliation: a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Bull
authors.affiliation: a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.affiliation: a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Alevronta
authors.affiliation: c Department of Health Care Sciences , Ersta Sköndal Bräcke University College , Stockholm , Sweden.
authors.forename: Gail
authors.initials: G
authors.lastname: Dunberger
authors.affiliation: a Division of Clinical Cancer Epidemiology, Department of Oncology , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Bergmark
authors.affiliation: d Mathematical Sciences , Chalmers University of Technology and University of Gothenburg , Gothenburg , Sweden.
authors.forename: Rebecka
authors.initials: R
authors.lastname: Jörnsten
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000073116:Cancer Survivors; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D007422:Intestines / Q000473:pathology / Q000528:radiation effects*; D043183:Irritable Bowel Syndrome / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D000073869:Tobacco Smoking / Q000009:adverse effects*; D055815:Young Adult