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Observational Study
. 2020 Oct;28(10):4881-4889.
doi: 10.1007/s00520-020-05309-z. Epub 2020 Jan 29.

A proposed tailored investigational algorithm for women treated for gynaecological cancer with long-term gastrointestinal consequences

Ann Muls  1   2 , Alexandra Taylor  3 , Susan Lalondrelle  3 , Mohammed Kabir  3 , Christine Norton  4 , Ailsa Hart  5 , H Jervoise Andreyev  6
Affiliations
Observational Study

A proposed tailored investigational algorithm for women treated for gynaecological cancer with long-term gastrointestinal consequences

Ann Muls et al. Support Care Cancer. 2020 Oct.

Abstract

Background and aim: Long-term changes in gastrointestinal function impacting quality of life after treatment for cancer are common. Peer reviewed guidance to investigate and manage GI dysfunction following cancer treatment has been published. This study reviewed gastrointestinal symptoms of women previously treated for gynaecological cancer and considered whether suggested algorithms could be amended to optimise management for this cohort.

Methods: Demographic and clinical data recorded for patients attending a specialist consequences of cancer treatment gastroenterology service prospectively are reported using median and range. The Wilcoxon signed rank test analysed changes in symptoms between initial assessment to discharge from the service.

Results: Between April 2013 and March 2016, 220 women, with a median age of 57 years (range 24-83 years), treated for gynaecological cancer (cervical (50%)), endometrial (28%), ovarian (15%), vaginal or vulval (7%) attended. Twelve gastrointestinal symptoms were statistically significantly reduced by time of discharge from the specialist gastroenterology clinic including bowel frequency ≥ 4/day (88%), type 6 or 7 stool consistency (36%), urgency (31%) and incontinence (21%). General quality of life improved from a median score of 4 at first assessment to a median of 6 at discharge (p < 0.001). A median of four (range, 1-9) diagnoses were made.

Conclusion: Women with gastrointestinal symptoms after cancer treatment benefit from a systematic management approach. After excluding disease recurrence, a proposed investigational algorithm and the oncology team includes FBC, U&Es, LFTs, thyroid function test, vitamin B12, vitamin D, a hydrogen methane breath test and a SeHCAT scan. If rectal bleeding is present, iron studies, flexible sigmoidoscopy or colonoscopy should be performed. Patients with normal investigations or symptoms not responding to treatment require gastroenterology input.

Keywords: Abdominal pain; Bile acid malabsorption; Bloating; Cancer; Chemotherapy; Consequences of treatment; Diarrhoea; Endoscopy; Gastrointestinal; Gynaecological malignancy; Incontinence; Late effects; Quality of life; Radiotherapy; Side effects; Small intestinal bacterial overgrowth; Toxicity; Urgency.

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Conflict of interest statement

Ms. Muls reports grants from the National Institute for Health Research, during the conduct of the study. Dr. Taylor has nothing to disclose. Dr. Lalondrelle reports personal fees from Sanofi Genzyme, grants from MSD, personal fees from Roche, grants and personal fees from Elekta, outside the submitted work. Mr. Mohammed has nothing to disclose. Professor Norton reports personal fees from Takeda, personal fees from Tillotts Pharma, personal fees from Ferring, outside the submitted work. Professor Hart has served as a consultant, advisory board member or speaker for AbbVie, Atlantic, Bristol-Myers Squibb, Celltrion, Falk, Ferring, Janssen, MSD, Napp Pharmaceuticals, Pfizer, Pharmacosmos, Shire and Takeda. She also serves on the Global Steering Committee for Genentech. Professor Andreyev reports non-financial support from GE Healthcare and manufacturers of SeHCAT, outside the submitted work.

The corresponding author has full control over the primary data.

Figures

Fig. 1
Fig. 1
Paired symptom scores (n = 220) at baseline and discharge; left bar, baseline assessment; right bar, discharge assessment (NS, not significant, *p < 0.05)
Fig. 2
Fig. 2
Concerns highlighted by women treated for gynaecological malignancy on the holistic needs assessment (n = 157)
See this image and copyright information in PMC

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