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Review
. 2023 Aug 9;15(16):4037.
doi: 10.3390/cancers15164037.

A Systematic Review of Population-Based Studies of Chronic Bowel Symptoms in Cancer Survivors following Pelvic Radiotherapy

Adam Biran  1 , Iakov Bolnykh  1 , Ben Rimmer  1 , Anthony Cunliffe  2 , Lisa Durrant  3 , John Hancock  4 , Helen Ludlow  5 , Ian Pedley  6 , Colin Rees  1 , Linda Sharp  1
Affiliations
Review

A Systematic Review of Population-Based Studies of Chronic Bowel Symptoms in Cancer Survivors following Pelvic Radiotherapy

Adam Biran et al. Cancers (Basel). .

Abstract

Pelvic radiotherapy can damage surrounding tissue and organs, causing chronic conditions including bowel symptoms. We systematically identified quantitative, population-based studies of patient-reported bowel symptoms following pelvic radiotherapy to synthesize evidence of symptom type, prevalence, and severity. Medline, CINAHL, EMBASE, and PsychINFO were searched from inception to September 2022. Following independent screening of titles, abstracts, and full-texts, population and study characteristics and symptom findings were extracted, and narrative synthesis was conducted. In total, 45 papers (prostate, n = 39; gynecological, n = 6) reporting 19 datasets were included. Studies were methodologically heterogeneous. Most frequently assessed was bowel function ('score', 26 papers, 'bother', 19 papers). Also assessed was urgency, diarrhea, bleeding, incontinence, abdominal pain, painful hemorrhoids, rectal wetness, constipation, mucous discharge, frequency, and gas. Prevalence ranged from 1% (bleeding) to 59% (anal bleeding for >12 months at any time since start of treatment). In total, 10 papers compared radiotherapy with non-cancer comparators and 24 with non-radiotherapy cancer patient groups. Symptom prevalence/severity was greater/worse in radiotherapy groups and symptoms more common/worse post-radiotherapy than pre-diagnosis/treatment. Symptom prevalence varied between studies and symptoms. This review confirms that many people experience chronic bowel symptoms following pelvic radiotherapy. Greater methodological consistency, and investigation of less-well-studied survivor populations, could better inform the provision of services and support.

Keywords: cancer survivorship; chronic bowel symptoms; gynecological cancer; pelvic radiation disease; pelvic radiotherapy; prostate cancer; radiotherapy; radiotherapy late-effects; systematic review.

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Conflict of interest statement

Biran: Salary, while working on this review, was paid from an unrestricted project grant from 3D-Matrix, held by LS and CJR and paid to institution. Bolnykh: None. Rimmer: None. Rees: Received grant funding from ARC medical, Norgine. Medtronic, 3D-Matrix solutions and Olympus medical; payments were made to institution. He was an expert witness for ARC medical and Olympus medical. Cunliffe: None. Durrant: None. Hancock: Received honoria payments as a speaker for 3D-Matrix presenting experiences of clinical use of PuraStat. Payments were made to individual. Ludlow: None. Pedley: None. Sharp: Received unrestricted project grant funding from 3D-Matrix and Medtronic; payments were made to institution. The funders had no role in the design of the study; in the collection, analyses, or interpretation of the data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
See this image and copyright information in PMC

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