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Structured gastroenterological intervention and improved outcome for patients with chronic gastrointestinal symptoms following pelvic radiotherapy

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Abstract

Purpose

Fifty percent of patients develop chronic gastrointestinal (GI) symptoms following pelvic radiotherapy that adversely affect quality of life. Fewer than 20 % are referred to a gastroenterologist. We aimed to determine if structured gastroenterological evaluation is of benefit to this patient group.

Methods

Sixty patients with GI symptoms at ≥6 months after radical pelvic radiotherapy were identified prospectively from oncology clinics in this service evaluation. Those requiring urgent investigation were excluded. Patients were assessed at baseline using patient-reported questionnaires: inflammatory bowel disease questionnaire (IBDQ), Vaizey incontinence questionnaire, and the Common Terminology Criteria for Adverse Events (CTCAE) pelvis questionnaire. Participants were referred for gastroenterological evaluation using an algorithmic approach. Further assessments were made at 3 and 6 months.

Results

Twenty men and 36 women with primary gynecological (31), urological (17), or lower GI (8) tumors were included (mean age, 58.5 years). Median time from radiotherapy to baseline assessment was 3.0 years. Multiple GI symptoms were reported (median, 8; range, 4–16) including frequency, urgency, loose stool, fecal incontinence, flatulence, bloating/distension, and rectal bleeding. Common diagnoses included radiation proctopathy, bile acid malabsorption, diverticulosis, and colonic polyps. Statistically significant improvements in all questionnaire scores between baseline and 6 months were found: IBDQ (p = 0.014), Vaizey (p < 0.0005), and CTCAE rectum-bowel subset (p = 0.001).

Conclusions

Gastroenterological evaluation identifies significant, potentially treatable diagnoses in patients who develop chronic GI symptoms following pelvic radiotherapy. Some findings are incidental and unrelated to previous cancer treatment. Radiation-induced GI symptoms have historically been considered “untreatable.” We report the first data to show that structured gastroenterological assessment has the potential to improve outcome by identifying diagnoses and facilitating focused treatment.

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Conflict of interest

Dr. Caroline Henson received grant support from Macmillan Cancer Support and a small award from the Shire SpR Project Innovation Fund. Otherwise, none of the authors have a financial relationship with the organization that sponsored the research. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

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Authors and Affiliations

  1. Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Wilmslow Road, M20 4BX, Manchester, UK

    Caroline C. Henson & Susan E. Davidson

  2. GI Centre, Institute of Inflammation and Repair, University of Manchester, Manchester, UK

    Yeng Ang & John McLaughlin

  3. Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK

    Chris Babbs & Simon Lal

  4. Department of Gastroenterology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK

    John Crampton & Mark Kelly

  5. Department of Gastroenterology, Pennine Acute Hospitals NHS Foundation Trust, Manchester, UK

    Jimmy K. Limdi

  6. Department of Gastroenterology, Tameside Hospital NHS Foundation Trust, Ashton under Lyne, UK

    Greg Whatley

  7. Department of Statistics, The Christie NHS Foundation Trust, Manchester, UK

    Ric Swindell

  8. Department of Palliative Care, The Christie NHS Foundation Trust, Manchester, UK

    Wendy Makin

Authors
  1. Caroline C. Henson
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  2. Susan E. Davidson
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  3. Yeng Ang
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  4. Chris Babbs
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  5. John Crampton
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  6. Mark Kelly
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  7. Simon Lal
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  8. Jimmy K. Limdi
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  9. Greg Whatley
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  10. Ric Swindell
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  11. Wendy Makin
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  12. John McLaughlin
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Corresponding author

Correspondence to Caroline C. Henson.

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Henson, C.C., Davidson, S.E., Ang, Y. et al. Structured gastroenterological intervention and improved outcome for patients with chronic gastrointestinal symptoms following pelvic radiotherapy. Support Care Cancer 21, 2255–2265 (2013). https://doi.org/10.1007/s00520-013-1782-y

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  • DOI: https://doi.org/10.1007/s00520-013-1782-y

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