Long-term Quality of Life after Chemoradiation for Anal Cancer

Reviewer: Nathan Jones DO
Abramson Cancer Center of the University of Pennsylvania
Last Modified: September 24, 2008

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Presenter: Prajnan Das
Presenter's Affiliation: UT MD Anderson Cancer Center, Houston, TX
Type of Session: Scientific

Background

  • There are an estimated 4700 cases/year of anal cancer in the US.
  • Definitive radiation therapy with concurrent chemotherapy represents the standard of care for squamous cell carcinoma of the anus.
  • RTOG 9811 demonstrated this approach to provide 75% overall survival and 60% disease-free survival at 5 years
  • Quality of life data is limited for patients treated with this regimen

Materials and Methods

  • Patients were identified who received definitive chemoradiation for anal cancer at MD Anderson Cancer Center from 1993-2003
  • Patients were selected who had a minimum 2-year follow-up, were alive at the time of the study, and whose addresses could be verified by telephone call
  • 80 questionnaires were mailed and 1 phone call was made to obtain informed consent, as well as 2 additional reminder phone calls
  • Questionnaires included FACT-C, MOS sexual problem score, and 13 additional questions regarding demographics and comorbidities
  • FACT-C is a 34-question quality of life survey which is validated for colorectal cancer patients, as no validated anal cancer quality of life survey was available
    • Maximum score is 136 which represents the highest quality of life
  • MOS sexual problem score is a 4-question validated survey to assess sexual quality of life
    • Maximum score is 100 which contrarily represents the lowest sexual quality of life

Results

  • There were 32 respondents to the survey, representing a 40% answer rate
  • There were no significant differences in the clinical or demographic data between those who responded versus those who did not
  • Median radiation dose among respondents was 55 Gy (range 39.6-59.4 Gy)
  • 72% of respondents received concurrent 5-FU and cisplatin, while 19% received concurrent capecitabine and cisplatin and 6% received concurrent 5-FU and mitomycin-C
  • Median time from treatment until survey was 5 years (range 3-13 years)
  • Median FACT-C score was 108 (range 47-128) out of 136 possible
    • For context, FACT-C scores for patients treated for colorectal cancer with 5-FU/LV, at time points post-surgically, and at 2 years and 3 years of follow-up were: 83, 80, and 99-117 respectively
  • There was no correlation between FACT-C scores and time since treatment
  • Patients with history of depression or anxiety scored lower on FACT-C with 92 vs. 109 (p=0.006)
  • FACT-C was divided into subscales assessing physical, social/family, emotional, functional, and colorectal quality of life, with median scores/total possible of 20/28, 23/28, 21/24, 22/28, 21/28, respectively
  • Median MOS sexual problem score was 67 out of 100, with 100 being the worst
    • For context, MOS scores for hormonal therapy, major medical problems, depression, supracervical hysterectomy, and total hysterectomy are 51, 24, 41, 18, and 20 respectively

Author's Conclusions

  • These data demonstrate that anal cancer patients undergoing definitive chemoradiation experience acceptable non-sexual quality of life at a median of 5 years
  • The sexual quality of life appears to be poor
  • More studies are necessary to better understand sexual function and dysfunction
  • Additional studies would be useful to reduce sexual morbidity from treatment, including exploring the use of IMRT to limit dose to the genitalia

Clinical/Scientific Implications

  • These data provide important insight into the quality of life following definitive chemoradiation
  • Additional studies to develop and validate a quality of life questionnaire specific for anal cancer would serve to more specifically address the issues related to these treatment regimens
  • These data can serve as a baseline upon which to compare subsequent patients (for example, anal cancer patients treated with IMRT), although the value will be limited by the relatively small patient numbers


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