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Sexual Function, Quality of Life, and Mood After Radiation Therapy in Patients with Anal Cancer

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Abstract

Purpose/Objective(s)

Definitive chemoradiation (CRT) results in high cure rates of anal cancer, with advanced radiation (RT) techniques improving toxicity. However, there is limited data regarding these patients’ sexual function (SF), quality of life (QOL), and mood. We hypothesized that anal cancer treatment would result in detrimental effects on SF, QOL, and mood.

Materials/Methods

We prospectively surveyed patients with anal cancer treated with definitive CRT. We assessed SF for women with the Female Sexual Function Index (FSFI) and for men with the International Index of Erectile Function (IIEF). For all patients, we assessed QOL using EORTC QLQ-C30 and CR29 and mood using the Hospital Anxiety and Depression Scale (HADS). We reported descriptive statistics for SF, QOL, and mood and used univariate analysis to evaluate predictors of SF for women.

Results

Of 50 eligible patients, 84% completed the surveys. Median time from RT until survey was 36 months (1–97 months). Women (n = 34) reported poor SF overall (mean FSFI score = 15, scale 2–36, standard deviation (SD) 10.4). Most women reported poor SF related to satisfaction, desire, orgasm, arousal, pain, and lubrication. Men (n = 8) also had poor overall satisfaction (mean IIEF score = 6.1, scale 2–10, SD 3.6). Men reported poor erectile function and lower satisfaction with intercourse. Mean QLQ-C30 QOL score was 86.5 (SD 16.3). Results from EORTC QLQ-CR-20 demonstrated patients experienced poor sexual interest. Per HADS, 2.5% reported depression and 18% anxiety.

Conclusion

Patients with anal cancer experience sexual dysfunction after RT, with QOL and mood symptoms similar to patients with other cancers. Our data support the need for ongoing efforts to understand and address issues with SF, QOL, and mood following RT for these patients.

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References

  1. Nigro ND, Vaitkevicius V, Buroker T, Bradley G, Considine B. Combined therapy for cancer of the anal canal. Dis Colon Rectum. 1981;24:73–5.

    Article  CAS  PubMed  Google Scholar 

  2. Flam M, John M, Pajak TF, Petrelli N, Myerson R, Doggett S, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol. 1996;14:2527–39.

    Article  CAS  PubMed  Google Scholar 

  3. Bartelink H, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol. 1997;15:2040–9.

    Article  CAS  PubMed  Google Scholar 

  4. James R, Wan S, Glynne-Jones R, Sebag-Montefiore D, Kadalayil L, Northover J, et al. A randomized trial of chemoradiation using mitomycin or cisplatin, with or without maintenance cisplatin/5FU in squamous cell carcinoma of the anus (ACT II). J Clin Oncol. 2009;27:LBA4009.

    Article  Google Scholar 

  5. Allal A, Sprangers M, Laurencet F, Reymond M, Kurtz J. Assessment of long-term quality of life in patients with anal carcinomas treated by radiotherapy with or without chemotherapy. Br J Cancer. 1999;80:1588–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Das P, Cantor SB, Parker CL, Zampieri JB, Baschnagel A, Eng C, et al. Long-term quality of life after radiotherapy for the treatment of anal cancer. Cancer. 2010;116:822–9.

    Article  PubMed  Google Scholar 

  7. Sodergren SC, et al. Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy. Support Care Cancer. 2015;23:3613–23.

    Article  PubMed  Google Scholar 

  8. Bentzen AG, Balteskard L, Wanderås EH, Frykholm G, Wilsgaard T, Dahl O, et al. Impaired health-related quality of life after chemoradiotherapy for anal cancer: late effects in a national cohort of 128 survivors. Acta Oncol. 2013;52:736–44.

    Article  PubMed  Google Scholar 

  9. Bruheim K, Guren MG, Dahl AA, Skovlund E, Balteskard L, Carlsen E, et al. Sexual function in males after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2010;76:1012–7.

    Article  PubMed  Google Scholar 

  10. Jensen PT, Froeding L. Pelvic radiotherapy and sexual function in women. Transl Androl Urol. 2015;4:186.

    PubMed  PubMed Central  Google Scholar 

  11. Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, et al. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol. 2005;23:7428–36.

    Article  PubMed  Google Scholar 

  12. Coady D, Kennedy V. Sexual health in women affected by cancer: focus on sexual pain. Obstet Gynecol. 2016;128:775–91.

    Article  PubMed  Google Scholar 

  13. Viswanathan AN, Lee LJ, Eswara JR, Horowitz NS, Konstantinopoulos PA, Mirabeau-Beale KL, et al. Complications of pelvic radiation in patients treated for gynecologic malignancies. Cancer. 2014;120:3870–83.

    Article  PubMed  Google Scholar 

  14. Han K, Cummings BJ, Lindsay P, Skliarenko J, Craig T, le LW, et al. Prospective evaluation of acute toxicity and quality of life after IMRT and concurrent chemotherapy for anal canal and perianal cancer. Int J Radiat Oncol Biol Phys. 2014;90:587–94.

    Article  PubMed  Google Scholar 

  15. Mitra D, Hong TS, Horick N, Rose B, Drapek LN, Blaszkowsky LS, et al. Long-term outcomes and toxicities of a large cohort of anal cancer patients treated with dose-painted IMRT per RTOG 0529. Adv Radiat Oncol. 2017;2:110–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mitchell MP, Abboud M, Eng C, Beddar AS, Krishnan S, Delclos ME, et al. Intensity-modulated radiation therapy with concurrent chemotherapy for anal cancer: outcomes and toxicity. Am J Clin Oncol. 2014;37:461–6.

    Article  CAS  PubMed  Google Scholar 

  17. Mirabeau-Beale K, Hong TS, Niemierko A, Ancukiewicz M, Blaszkowsky LS, Crowley EM, et al. Clinical and treatment factors associated with vaginal stenosis after definitive chemoradiation for anal canal cancer. Pract Radiat Oncol. 2015;5:e113–8.

    Article  PubMed  Google Scholar 

  18. Kachnic LA, et al. NRG oncology/RTOG 0529: long-term outcomes of dose-painted intensity modulated radiation therapy, 5-fluorouracil, and mitomycin-C in anal canal cancer. Int J Radiat Oncol Biol Phys. 2017;99:S64–5.

    Article  Google Scholar 

  19. Kachnic LA, Winter K, Myerson RJ, Goodyear MD, Willins J, Esthappan J, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys. 2013;86:27–33.

    Article  CAS  PubMed  Google Scholar 

  20. Carter J, Stabile C, Seidel B, Baser RE, Gunn AR, Chi S, et al. Baseline characteristics and concerns of female cancer patients/survivors seeking treatment at a female sexual medicine program. Support Care Cancer. 2015;23:2255–65.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Baser RE, Li Y, Carter J. Psychometric validation of the female sexual function index (FSFI) in cancer survivors. Cancer. 2012;118:4606–18.

    Article  PubMed  Google Scholar 

  22. Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31:1–20.

    Article  PubMed  Google Scholar 

  23. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.

    Article  CAS  PubMed  Google Scholar 

  24. Burnett AL, Aus G, Canby-Hagino ED, Cookson MS, D’Amico AV, Dmochowski RR, et al. Erectile function outcome reporting after clinically localized prostate cancer treatment. J Urol. 2007;178:597–601.

    Article  PubMed  Google Scholar 

  25. Rosen RC, Cappelleri J, Smith M, Lipsky J, Pena B. Development and evaluation of an abridged, 5-item version of the international index of erectile function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

    Article  CAS  PubMed  Google Scholar 

  26. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI J Natl Cancer Inst. 1993;85:365–76.

    Article  CAS  PubMed  Google Scholar 

  27. Magaji BA, et al. EORTC QLQ-CR29. Asian Pac J Cancer Prev. 2015;16:8101–5.

    Article  PubMed  Google Scholar 

  28. Whistance R, et al. Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer. 2009;45:3017–26.

    Article  CAS  PubMed  Google Scholar 

  29. 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;52:69–77.

    Article  PubMed  Google Scholar 

  30. Son CH, Law E, Oh JH, Apte AP, Yang TJ, Riedel E, et al. Dosimetric predictors of radiation-induced vaginal stenosis after pelvic radiation therapy for rectal and anal cancer. Int J Radiat Oncol Biol Phys. 2015;92:548–54.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Carroll BT, Kathol RG, Noyes R, Wald TG, Clamon GH. Screening for depression and anxiety in cancer patients using the hospital anxiety and depression scale. Gen Hosp Psychiatry. 1993;15:69–74.

    Article  CAS  PubMed  Google Scholar 

  32. Sellick SM, Edwardson AD. Screening new cancer patients for psychological distress using the hospital anxiety and depression scale. Psycho-Oncology. 2007;16:534–42.

    Article  PubMed  Google Scholar 

  33. Walboomers JM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12–9.

    Article  CAS  PubMed  Google Scholar 

  34. Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer. 2004;101:270–80.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Fayers PM, Machin D. Quality of life: the assessment, analysis and interpretation of patientreported outcomes. Wiley; 2013.

  37. Gotay CC, Kawamoto CT, Bottomley A, Efficace F. The prognostic significance of patient-reported outcomes in cancer clinical trials. J Clin Oncol. 2008;26:1355–63.

    Article  PubMed  Google Scholar 

  38. Lipscomb J, Gotay CC, Snyder CF. Patient-reported outcomes in cancer: a review of recent research and policy initiatives. CA Cancer J Clin. 2007;57:278–300.

    Article  PubMed  Google Scholar 

  39. Nipp RD, Temel JS. Harnessing the power of patient-reported outcomes in oncology. Clin Cancer Res. 2018;24:1777–9.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Nipp Ryan D, et al. The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer. 2017;123:4720–7.

    Article  CAS  PubMed  Google Scholar 

  41. Lage DE, et al. Predictors of posthospital transitions of care in patients with advanced cancer. J Clin Oncol. 2017;36:76–82.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wo JY, Drapek LC, Niemierko A, Silvia BL, Russo AL, Gray PJ, et al. Clinical needs assessment for sexual health among cancer patients receiving pelvic radiation. Int J Rad Oncol Biol Phys. 2017;96(2):E528–9.

    Article  Google Scholar 

  43. Fisher RJ. Social desirability bias and the validity of indirect questioning. J Consum Res. 1993;20:303–15.

    Article  Google Scholar 

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Funding

This study is supported by the Patty Brisben Foundation (awarded to JYW and LCD) and a Rare Cancer Genetics Registry Grant (NIH 4R01CA160233-05, PI: Dianne Finkelstein).

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Authors and Affiliations

  1. Department of Radiation Oncology, Massachusetts General Hospital, Lunder LL2, 55 Fruit Street, Boston, MA, 02114, USA

    Divya Yerramilli, Lorraine Drapek, Bridget Noé, Devarati Mitra, Theodore S. Hong & Jennifer Wo

  2. Division of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Ryan D. Nipp, Samantha M. C. Moran, Sara M. D’Arpino & David P. Ryan

  3. Massachusetts General Hospital Biostatistics Center, Boston, MA, USA

    Nora Horick

  4. Division of Medical Oncology, Department of Medicine, Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, USA

    Don S. Dizon

Authors
  1. Divya Yerramilli
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  2. Lorraine Drapek
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  12. Jennifer Wo
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Correspondence to Divya Yerramilli.

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Yerramilli, D., Drapek, L., Nipp, R.D. et al. Sexual Function, Quality of Life, and Mood After Radiation Therapy in Patients with Anal Cancer. J Gastrointest Canc 51, 204–210 (2020). https://doi.org/10.1007/s12029-019-00233-w

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  • DOI: https://doi.org/10.1007/s12029-019-00233-w

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