A study of chronic pelvic pain after radiotherapy in survivors of locally advanced cervical cancer
Chronic pelvic pain (persisting pain in hips, groins or lower back) is poorly described in studies of cervical cancer survivors (CCSs). The aims of this study were to describe chronic pelvic pain and associated variables in CCSs surveyed >5 years post-radiotherapy, and to compare the presence of pain in hips and lower back in CCSs with findings in the general female population.
Ninety-one CCSs treated with radiotherapy between 1994 and 1999 were in 2005 included in a cross-sectional questionnaire-based study. They were asked about demographic variables, clinical symptoms, mental distress, and quality of life (QOL). Normative data (NORM) were collected from a population-study of Norwegian females.
Pain in lower back and hips was significantly more prevalent (p < .001) in CCSs compared to NORMs. 35/92 (38%) of the CCSs had chronic pelvic pain. These women had significantly lower QOL, higher levels of anxiety and depression and more bladder and intestinal problems than those without chronic pelvic pain. In a multivariable regression model, use of analgesics and intestinal and bladder problems were significantly associated with chronic pelvic pain in the CCSs.
CCSs have a higher prevalence of pain in lower back and hips than women in the general population, which might be due to late effects of radiation. 35/92 (38%) of the CCSs suffer from chronic pelvic pain, shown to be associated with high overall mental and somatic morbidity.
Implications for Cancer Survivors
Evaluation and management of pelvic pain is important in follow-up of CCSs treated with radiotherapy.
- Levy MH, Chwistek M, Mehta RS. Management of chronic pain in cancer survivors. Cancer J. 2008;14(6):401–9. CrossRef
- Blomlie V, Rofstad EK, Talle K, Sundfor K, Winderen M, Lien HH. Incidence of radiation-induced insufficiency fractures of the female pelvis: evaluation with MR imaging. AJR Am J Roentgenol. 1996;167(5):1205–10.
- Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294(20):2587–93. CrossRef
- Kwon JW, Huh SJ, Yoon YC, Choi SH, Jung JY, Oh D, et al. Pelvic bone complications after radiation therapy of uterine cervical cancer: evaluation with MRI. AJR Am J Roentgenol. 2008;191(4):987–94. CrossRef
- Vistad I, Kristensen GB, Fossa SD, Dahl AA, Morkrid L. Intestinal malabsorption in long-term survivors of cervical cancer treated with radiotherapy. Int J Radiat Oncol Biol Phys. 2009;73(4):1141–7. CrossRef
- Vistad I, Cvancarova M, Fossa SD, Kristensen GB. Postradiotherapy morbidity in long-term survivors after locally advanced cervical cancer: how well do physicians' assessments agree with those of their patients? Int J Radiat Oncol Biol Phys. 2008;71(5):1335–42. CrossRef
- Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G. Patient-rating of distressful symptoms after treatment for early cervical cancer. Acta Obstet Gynecol Scand. 2002;81(5):443–50. CrossRef
- Bismar MM, Sinicrope FA. Radiation enteritis. Curr Gastroenterol Rep. 2002;4(5):361–5. CrossRef
- Cancer pain. Wall and Melzack’s Textbook of Pain. 5 ed. Philadelphia: Elsevier/Churchill Livingstone; 2005. p. 1120.
- Visceral and other syndromes of the trunk apart from spinal and radicular pain. In: Merskey H, Bogduk N, editors. Classification of Chronic Pain. 2 ed. Seattle: IASP Press; 1994. p. 170.
- Kaasa S, Loge JH, Knobel H, Jordhoy MS, Brenne E. Fatigue. Measures and relation to pain. Acta Anaesthesiol Scand. 1999;43(9):939–47. CrossRef
- Bruera E, Kim HN. Cancer pain. JAMA. 2003;290(18):2476–9. CrossRef
- Delaney A, Fleetwood-Walker SM, Colvin LA, Fallon M. Translational medicine: cancer pain mechanisms and management. Br J Anaesth. 2008;101(1):87–94. CrossRef
- Vahdaninia M, Omidvari S, Montazeri A. What do predict anxiety and depression in breast cancer patients? A follow-up study. Soc Psychiatry Psychiatr Epidemiol 2009 May 21.
- Matulonis UA, Kornblith A, Lee H, Bryan J, Gibson C, Wells C, et al. Long-term adjustment of early-stage ovarian cancer survivors. Int J Gynecol Cancer. 2008;18(6):1183–93. CrossRef
- Klee M, Thranov I, Machin PD. The patients’ perspective on physical symptoms after radiotherapy for cervical cancer. Gynecol Oncol. 2000;76(1):14–23. CrossRef
- Bye A, Trope C, Loge JH, Hjermstad M, Kaasa S. Health-related quality of life and occurrence of intestinal side effects after pelvic radiotherapy—evaluation of long-term effects of diagnosis and treatment. Acta Oncol. 2000;39(2):173–80. CrossRef
- Li C, Samsioe G, Iosif C. Quality of life in long-term survivors of cervical cancer. Maturitas. 1999;32(2):95–102. CrossRef
- Rannestad T, Skjeldestad FE. Pain and quality of life among long-term gynecological cancer survivors: a population-based case-control study. Acta Obstet Gynecol Scand. 2007;86(12):1510–6. CrossRef
- Davidson SE, Burns MP, Routledge JA, Swindell R, Bentzen SM, West CM. Assessment of morbidity in carcinoma of the cervix: a comparison of the LENT SOMA scales and the Franco–Italian glossary. Radiother Oncol. 2003;69(2):195–200. CrossRef
- Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. CrossRef
- Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77. CrossRef
- Ware JE Jr, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: Manual and Interpretation Guide. Boston, Massachusetts, QualityMetric Incorporated; 2000.
- Holmen J, Midthjell K, Kruger O, Langhammer A. The Nord-Trøndelag Health Study 1995–97 (HUNT 2): objectives, contents, methods and participation. Nor Epidemiol. 2003;13(1):19–32.
- Barker CL, Routledge JA, Farnell DJ, Swindell R, Davidson SE. The impact of radiotherapy late effects on quality of life in gynaecological cancer patients. Br J Cancer. 2009;100(10):1558–65. CrossRef
- Miller KD, Triano LR. Medical issues in cancer survivors—a review. Cancer J. 2008;14(6):375–87. CrossRef
- Korfage IJ, Essink-Bot ML, Mols F, van de Poll-Franse LV, Kruitwagen R, van Ballegooijen M. Health-related quality of life in cervical cancer survivors: a population-based survey. Int J Radiat Oncol Biol Phys. 2009;73(5):1501–9. CrossRef
- Thomas E, Peat G, Harris L, Wilkie R, Croft PR. The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain. 2004;110(1–2):361–8. CrossRef
- Rustoen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Prevalence and characteristics of chronic pain in the general Norwegian population. Eur J Pain. 2004;8(6):555–65. CrossRef
- Greimel ER, Winter R, Kapp KS, Haas J. Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study. Psychooncology. 2009;18(5):476–82. CrossRef
- Gulluoglu BM, Cingi A, Cakir T, Gercek A, Barlas A, Eti Z. Factors related to post-treatment chronic pain in breast cancer survivors: the interference of pain with life functions. Int J Fertil Womens Med. 2006;51(2):75–82.
- Ishiyama H, Niino K, Hosoya T, Hayakawa K. Results of a questionnaire survey for symptom of late complications caused by radiotherapy in breast conserving therapy. Breast Cancer. 2006;13(2):197–201. CrossRef
- Peuckmann V, Ekholm O, Rasmussen NK, Groenvold M, Christiansen P, Moller S, et al. Chronic pain and other sequelae in long-term breast cancer survivors: nationwide survey in Denmark. Eur J Pain. 2009;13(5):478–85. CrossRef
- Beriwal S, Gan GN, Heron DE, Selvaraj RN, Kim H, Lalonde R, et al. Early clinical outcome with concurrent chemotherapy and extended-field, intensity-modulated radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2007;68(1):166–71. CrossRef
- Chen MF, Tseng CJ, Tseng CC, Kuo YC, Yu CY, Chen WC. Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity-modulated pelvic radiotherapy: comparison with conventional radiotherapy. Int J Radiat Oncol Biol Phys. 2007;67(5):1438–44. CrossRef
- Ikushima H, Osaki K, Furutani S, Yamashita K, Kishida Y, Kudoh T, et al. Pelvic bone complications following radiation therapy of gynecologic malignancies: clinical evaluation of radiation-induced pelvic insufficiency fractures. Gynecol Oncol. 2006;103(3):1100–4. CrossRef
- Oh D, Huh SJ, Nam H, Park W, Han Y, Lim dH, et al. Pelvic insufficiency fracture after pelvic radiotherapy for cervical cancer: analysis of risk factors. Int J Radiat Oncol Biol Phys. 2008;70(4):1183–8. CrossRef
- Gillette EL, Mahler PA, Powers BE, Gillette SM, Vujaskovic Z. Late radiation injury to muscle and peripheral nerves. Int J Radiat Oncol Biol Phys. 1995;31(5):1309–18. CrossRef
- Reyes-Gibby CC, Wu X, Spitz M, Kurzrock R, Fisch M, Bruera E, et al. Molecular epidemiology, cancer-related symptoms, and cytokines pathway. Lancet Oncol. 2008;9(8):777–85. CrossRef
- Casso D, Buist DS, Taplin S. Quality of life of 5–10 year breast cancer survivors diagnosed between age 40 and 49. Health Qual Life Outcomes. 2004;2:25. CrossRef
- Dow KH, Ferrell BR, Leigh S, Ly J, Gulasekaram P. An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Res Treat. 1996;39(3):261–73. CrossRef
- Sullivan MJ, Lynch ME, Clark AJ. Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain. 2005;113(3):310–5. CrossRef
- A study of chronic pelvic pain after radiotherapy in survivors of locally advanced cervical cancer
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Journal of Cancer Survivorship
Volume 5, Issue 2 , pp 208-216
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- Springer US
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- Pelvic pain
- Cervical cancer
- Radiation therapy
- Long-term survivors
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- Author Affiliations
- 1. Department of Gynaecology, Sorlandet Hospital HF, Service Box 416, 4604, Kristiansand, Norway
- 2. National Resource Center for Late Effects, Department of Oncology, Oslo University Hospital, Oslo, Norway
- 3. University of Oslo, Oslo, Norway
- 4. Department of Gynaecological Oncology, the Radium Hospital, Oslo University Hospital, Oslo, Norway
- 5. Department of Medical Informatics, the Radium Hospital, Oslo University Hospital, Oslo, Norway