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Assessment of long-term rectal function in patients who received pelvic radiotherapy: a pooled North Central Cancer Treatment Group trial analysis, N09C1

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Abstract

Purpose

Pelvic radiotherapy (PRT) is known to adversely affect bowel function (BF) and patient well-being. This study characterized long-term BF and evaluated quality of life (QOL) in patients receiving PRT.

Methods

Data from 252 patients were compiled from two North Central Cancer Treatment Group prospective studies, which included assessment of BF and QOL by the BF questionnaire (BFQ) and Uniscale QOL at baseline and 12 and 24 months after completion of radiotherapy. BFQ scores (sum of symptoms), Uniscale results, adverse-event incidence, and baseline demographic data were compared via t test, χ 2, Fisher exact, Wilcoxon, and correlation methodologies.

Results

The total BFQ score was higher than baseline at 12 and 24 months (P < 0.001). More patients had five or more symptoms at 12 months (13 %) and 24 months (10 %) than at baseline (2 %). Symptoms occurring in greater than 20 % of patients at 12 and 24 months were clustering, stool–gas confusion, and urgency. Factors associated with worse BF were female sex, rectal or gynecologic primary tumors, prior anterior resection of the rectum, and 5-fluorouracil chemotherapy. Patients experiencing grade 2 or higher acute toxicity had worse 24-month BF (P values, <.001–.02). Uniscale QOL was not significantly different from baseline at 12 or 24 months, despite worse BFQ scores.

Conclusions

PRT was associated with worse long-term BF. Worse BFQ score was not associated with poorer QOL. Further research to characterize the subset of patients at risk of significant decline in BF is warranted.

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Abbreviations

BFQ:

Bowel function questionnaire

NCCTG:

North Central Cancer Treatment Group

QOL:

Quality of life

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Acknowledgments

This study was conducted as a collaborative trial of the North Central Cancer Treatment Group and Mayo Clinic and was supported in part by Public Health Service grant CA-25224, CA-37404, CA-35101, CA-35103, CA-35195, CA-37417, CA-35269, CA-63848, CA-52352, CA-35415, CA-63849, CA-35119, CA-35431, and CA-35267 and from the National Cancer Institute Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health.

Additional participating institutions include the following: Michigan Cancer Research Consortium (Philip J. Stella, MD), Ann Arbor, Michigan; Essentia Health Cancer Center (Daniel A. Nikcevich, MD), Duluth, Minnesota; Medcenter One Health Systems (John T. Reynolds, MD) and Mid Dakota Clinic (John T. Reynolds, MD), Bismarck, North Dakota; Missouri Valley Cancer Consortium (Gamini S. Soori, MD), Omaha, Nebraska; Sioux Community Cancer Consortium (Miroslaw Mazurczak, MD), Sioux Falls, South Dakota; Cedar Rapids Oncology Project CCOP (Deborah Weil Wilbur, MD), Cedar Rapids, Iowa; Meritcare Hospital CCOP (Preston D. Steen, MD), Fargo, North Dakota; Altru Health Systems (Grant Seeger, MD), Grand Forks, North Dakota; Mayo Clinic Arizona (Michele Y. Halyard, MD), Scottsdale, Arizona; Metro-Minnesota Community Clinical Oncology Program (Patrick J. Flynn, MD), St. Louis Park, Minnesota; Montana Cancer Consortium (Benjamin T. Marchello, MD), Billings, Montana; Upstate Carolina CCOP (James D. Bearden, III, MD) Spartanburg, South Carolina; Toledo Community Hospital Oncology Program CCOP (Rex B. Mowat, MD), Toledo, Ohio; Saskatchewan Cancer Foundation (Muhammad Salim, MD), Saskatoon, Saskatchewan, Canada; Wichita Community Clinical Oncology Program (Shaker R. Dakhil, MD), Wichita, Kansas; Mayo Clinic Florida (Kurt A. Jaeckle, MD), Jacksonville, Florida; and CentraCare Clinic (Donald J. Jurgens, MD), St. Cloud, Minnesota.

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Lindsay C. Brown, Michelle A. Neben-Wittich, Timothy F. Kozelsky, Michael G. Haddock & James A. Martenson

  2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Pamela J. Atherton

  3. Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA

    Charles L. Loprinzi

  4. Siouxland Hematology-Oncology Associates, Sioux City, IA, USA

    Donald B. Wender

  5. Department of Medical Oncology, Iowa Oncology Research Association, Des Moines, IA, USA

    Robert J. Behrens

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Corresponding author

Correspondence to James A. Martenson.

Additional information

Portions of the manuscript have been published in abstract form: Int J Radiat Oncol Biol Phys. 2010 Nov; 78(3 Suppl):S596.

Appendix Bowel Function Questionnaire

Appendix Bowel Function Questionnaire

Each of these statements or questions below describes symptoms or problems which sometimes occur in patients who have had radiation therapy.

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Brown, L.C., Atherton, P.J., Neben-Wittich, M.A. et al. Assessment of long-term rectal function in patients who received pelvic radiotherapy: a pooled North Central Cancer Treatment Group trial analysis, N09C1. Support Care Cancer 21, 2869–2877 (2013). https://doi.org/10.1007/s00520-013-1853-0

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