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

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


  • 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


  • 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


Smoothies for All Occasions
by OncoLink Editorial Team
May 24, 2016