Patient-reported outcomes after chemoradiotherapy for anal cancer

Abstract

Background and purpose: Chemoradiotherapy (CRT) for squamous cell carcinoma of the anus (SCCA) results in favorable survival. However, treatment intensity must be balanced against late side effects. The aim of this current study was to prospectively investigate patient-reported outcomes (PROs) before CRT and up to 5 years after completed CRT for SCCA. Patient/material and methods: This prospective study included 120 patients with SCCA receiving CRT to total doses of 54-58 Gy with concomitant mitomycin and 5-fluorouracil. Patients completed PRO questionnaires before CRT, and at 3 months, 1-, 3-, and 5 years after completed CRT. The questionnaires were the EORTC QLQ-C30 and QLQ-CR29, St. Marks incontinence score, Fatigue Questionnaire, the Hospital Anxiety and Depression Scale, and a scoring for neuroticism.

Results: Patients reported a high burden of symptoms and impaired functional outcomes prior to treatment. Tumor-related symptoms, such as buttock pain, improved (difference 11.1, p = 0.002) at a clinically relevant level 3 months after CRT, consistent with tumor response. Other functional outcomes and symptoms, such as body image (difference 11.5, p < 0.001), worsened. While some outcomes, such as anxiety (difference 10.4, p = 0.001), improved over time, several were persistently impaired, in particular anorectal and sexual function, where symptom burden remained high 5 years after CRT. Chronic fatigue (CF) was reported by 28% of patients at 5-year follow-up.

Interpretation: Five years after CRT for SCCA, patients report a persistently high symptom burden regarding anorectal and sexual function, and one-third report CF, demonstrating the long-term impact of treatment.

Figure 1

EORTC-QLQ-C30 and EORTC-QLQ-CR29. Mean values at inclusion, 3 months, 1 year, 3 years, and 5 years after end of chemoradiotherapy. *The reference population includes individuals aged 18 and above, living in Norway, who have not previously been diagnosed with colorectal cancer. Ref: Slørdahl KS et al.²⁸ (A) Functional scales; Body image deteriorated from baseline to 3 months, while role functioning and anxiety improved from 3 months to 5 years. (B) Symptom scales; Dyspareunia and hair loss worsened from baseline to 3 months, and appetite loss improved from 3 months to 5 years after treatment. (C) Symptom scales; Constipation and buttock pain improved from baseline to 3 months, and diarrhea improved from 3 months to 5 years after treatment.