Our objective was to evaluate long-term quality of life in patients treated with definitive chemoradiation for anal cancer.
Materials/Methods
The study population included patients treated with definitive chemoradiation for squamous cell anal carcinoma between January 1993 and December 2003, with a minimum of 2-year follow-up after completion of chemoradiation, who were alive at the time of the study, had verifiable mailing addresses, and could speak English. Eligible subjects (n = 80) were mailed a questionnaire that included the Functional Assessment of Cancer Therapy-Colorectal (FACT-C), a 34-item instrument having a maximum score of 136, with higher scores indicating better quality of life. The questionnaire also included the Medical Outcomes Study (MOS) Sexual Problems Scale, a 4-item instrument having a maximum score of 100, with higher scores indicating worse sexual function. Furthermore, the questionnaire had 13 questions on demographic characteristics and co-morbidities.
Results
Of the eligible subjects, 32 (40%) provided informed consent and completed the questionnaire. There were no significant differences in clinical and demographic characteristics between the respondents and non-respondents. Among the 32 respondents, the median dose of radiotherapy was 55 Gy (range 39.6-59.4 Gy), 72% had received concurrent 5-fluorouracil and cisplatin, 19% had received concurrent capecitabine and cisplatin, and 6% had received concurrent 5-fluorouracil and mitomycin C. The median interval between chemoradiation and survey participation was 5 years (range 3-13 years). The median total FACT-C score was 108 (range 47-128), out of a maximum (best possible) score of 136. Patients who reported depression or anxiety had significantly lower total FACT-C scores than those who did not report depression or anxiety (median score 92 vs. 109, p = 0.006). Patients with age <51 years at the time of treatment had significantly lower total FACT-C scores than those with age ≥51 years (median score 106 vs. 114, p = 0.033). The median score on the physical, social/family, emotional, functional, and colorectal subscales of FACT-C was 20, 23, 21, 22, and 21, out of maximum (best possible) score of 28, 28, 24, 28, and 28, respectively. The median score on the MOS sexual functioning scale was 67 (range 0-100), out of a maximum (worst possible) score of 100.
Conclusions
Patients treated with chemoradiation for anal cancer reported acceptable overall quality of life scores, but poor sexual functioning scores. Investigations are warranted into treatment techniques that could reduce sexual morbidity, such as intensity modulated radiation therapy (IMRT) to spare genitalia.
U.T. M.D. Anderson Cancer Center, Houston, TX
Author Disclosure: P. Das, None; S.B. Cantor, None; C.L. Parker, None; J.B. Zampieri, None; A. Baschnagel, None; C. Eng, None; M.E. Delclos, None; S. Krishnan, None; N.A. Janjan, None; C.H. Crane, None.
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