Assessment of acute bowel function after radiotherapy for prostate cancer: Is it accurate enough?
- 96 Downloads
Background and purpose
Pelvic radiotherapy for prostate cancer can be associated with bowel toxicity, which may have a significant impact on quality of life. Our aim was to assess the adequacy of the tools currently used to assess bowel symptoms after radiotherapy, including physician and patient reported outcomes. This sub-study on acute toxicity was part of a prospective trial assessing long-term bowel dysfunction.
Materials and methods
Between February 2013 and July 2015, 75 patients with prostate cancer who received radiotherapy completed the LENT/SOMA and the EPIC questionnaires baseline and 2 weeks after the treatment. The Bristol stool scale and two additional questions on faecal urgency were added. Physicians assessed toxicity using Common Terminology Criteria for Adverse Events v.4.0. Agreement between patients and clinicians was assessed using the Cohen’s κ coefficient.
Acute toxicity during radiotherapy was very low. The pattern of overall bowel bother was similar before and after treatment. Faecal urgency significantly increased after radiotherapy compared to baseline but was only detected by the additional questions and not by the physicians or the patient-reported outcomes (PRO) questionnaires. Correlation between physician and PRO was poor for most symptoms.
Bowel symptoms such as urgency may remain undetected by usual tools to assess toxicity after radiotherapy. Assessment of bowel toxicity should be reappraised in order to identify those patients who may have symptoms with an impact on their quality of life.
KeywordsRadiotherapy Prostate cancer Bowel dysfunction Faecal urgency Quality of life
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Shao YH, Demissie K, Shih W, Mehta AR, Stein MN, Roberts CB, et al. Contemporary risk profile of prostate cancer in the United States. J Natl Cancer Inst. 2009;101:1280–3.Google Scholar
- 6.Bacon C, Giovannucci E, Testa M, Kawachi I. The impact of cancer treatment on quality of life outcomes for patients with localized prostate cancer. J Urol. 2001;166:1804–10.Google Scholar
- 9.Basch E, Reeve BB, Mitchell SA, Clauser SB, Minasian LM, Dueck AC, Mendoza TR, Hay J, Atkinson TM, Abernethy AP, Bruner DW, Cleeland CS, Sloan JA, Chilukuri R, Baumgartner P, Denicoff A, St Germain D, O’Mara AM, Chen A, Kelaghan J, Bennett AV, Sit L, Roga SD. Development of the National Cancer Institute’s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Natl Cancer Inst. 2014;106:dju244.Google Scholar
- 11.Petersen SE, Bentzen L, Emmertsen KJ, Laurberg S, Lundby L, Høyer M. Development and validation of a scoring system for late anorectal side-effects in patients treated with radiotherapy for prostate cancer. Radiother Oncol. 2014;111:94–9.Google Scholar
- 12.Yeoh EK, Bartholomeusz DL, Holloway RH, Fraser RJ, Botten R, Di Matteo A, et al. Disturbed colonic motility contributes to anorectal symptoms and dysfunction after radiotherapy for carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 2010;78:773–80.Google Scholar
- 13.Krol R, Smeenk RJ, van Lin ENJT, Hopman WPM. Impact of late anorectal dysfunction on quality of life after pelvic radiotherapy. Int J Colorectal Dis. 2013;28:519–26.Google Scholar
- 17.Chang P, Szymanski KM, Dunn RL, Chipman JJ, Litwin MS, Nguyen PL, Sweeney CJ, Cook R, Wagner AA, DeWolf WC, Bubley GJ, Funches R, Aronovitz JA, Wei JTSM. Expanded prostate cancer index composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer. J Urol. 2011;186:865–72.CrossRefPubMedGoogle Scholar
- 18.Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44:77–80.Google Scholar
- 20.National Institute of Cancer. Common terminology criteria for adverse events (CTCAE). NIH Publ [Internet]. 2010;2009:0–71. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf. Accessed 16 Jan 2012.
- 22.Stefanelli A, Pascale G, Rainieri E, Ursino S, Colella M, Zini G, et al. Can we decrease the acute proctitis in prostate cancer patients using hyaluronic acid during radiation therapy: a prospective historically controlled clinical study. Eur Rev Med Pharmacol Sci. 2012;16:639–45.PubMedGoogle Scholar
- 24.Peach MS, Showalter TN, Ohri N. Systematic review of the relationship between acute and late gastrointestinal toxicity after radiotherapy for prostate cancer. Prostate Cancer. 2015;2015:1–11.Google Scholar
- 26.Andreyev J. Gastrointestinal symptoms after pelvic radiotherapy: a new understanding to improve management of symptomatic patients. Lancet Oncol. 2007;8:1007–17.Google Scholar
- 28.Andreyev HJN, Wotherspoon A, Denham JW, Hauer-Jensen M. “Pelvic radiation disease”: new understanding and new solutions for a new disease in the era of cancer survivorship. Scand J Gastroenterol. 2011;46:389–97.Google Scholar
- 29.Harrington S, Lee J, Colon G, Alappattu M. Oncology section EDGE task force on prostate cancer: a systematic review of outcome measures for health-related quality of life. Rehabil Oncol (American Phys Ther Assoc Oncol Sect). 2016;34:27–35.Google Scholar
- 30.Schmidt S, Garin O, Pardo Y, Valderas JM, Alonso J, Rebollo P, et al. Assessing quality of life in patients with prostate cancer: a systematic and standardized comparison of available instruments. Qual Life Res. 2014;23:2169–81.Google Scholar
- 31.Sultan AH, Monga A, Lee J, Emmanuel A, Norton C, Santoro G, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. Int Urogynecol J. 2017;28:5–31.Google Scholar
- 32.Atkinson TM, Ryan SJ, Bennett AV, Stover AM, Saracino RM, Rogak LJ, et al. The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review. Support Care Cancer. 2016;24:3669–76.CrossRefPubMedPubMedCentralGoogle Scholar