Quality of life and long-term side effects after anal cancer treatment

Abstract

Anal cancer is a rare type of cancer with approximately two hundred new cases in Sweden per year. Treatment usually consists of a combination of radiotherapy and chemotherapy. Overall prognosis is good but about 10% of patients require pelvic surgery to be cured. This is referred to as “salvage surgery”. In this thesis we wanted to investigate patient reported quality of life (QoL) and long-term side effects after anal cancer treatment. Two hundred and five patients with anal cancer, diagnosed between 2011 and 2013 in Sweden, answered a comprehensive questionnaire at three and six years after diagnosis. One hundred and ninety-five patients returned the questionnaire at three years and one hundred and fifty-five patients at six years.

We found QoL to be good in 40% of the patients and low in 60% at both three and six years. Patients with bother from one or more functions had a higher risk of impaired QoL. Major bother was more prevalent in patients that reported low QoL. Impaired bowel function was common and remained stable between three and six years. The combination of chemotherapy and radiotherapy was associated with a higher risk of bowel side effects than radiotherapy alone. Both urinary and sexual function deteriorated between three and six years. Chemotherapy was not associated with a higher risk of urinary incontinence. With a qualitative approach we explored patients’ experiences of bodily functions and QoL after salvage surgery. Eighteen in-depth interviews were performed. Inductive content analysis resulted in 8 categories and 1 theme describing the acceptance and reorientation to a new life despite several long-term bodily changes and functional side-effects.

There are significant long-term side effects after treatment for anal cancer, and there is a clear relationship between symptom burden, bother and QoL. Although bodily functions deteriorate over time QoL does not, indicating an adaptation process between three and six years.