The impact of chronic radiation enteritis on quality of life, following radiotherapy for cervical or endometrial cancer
Authors: Abayomi J. 
Published: July 2008

Background:  Approximately 12 000 individuals undergo radical radiotherapy in the UK every year, and as many as 50% may suffer the disabling side effects of chronic radiation enteritis (CRE) (Andreyev, 2005). Symptoms of CRE, include diarrhoea, incontinence, abdominal bloating/discomfort and can negatively impact on the quality of physical, psychological and social aspects of life (Abayomi et al.,2005). However, many clinicians feel that faecal incontinence is not a common problem (Putta & Andreyev, 2005). The aim of this study was to examine severity of CRE symptoms in women treated for cervical or endometrial cancer, using a validated questionnaire that explores the impact of faecal incontinence on quality of life (Bugg et al.,2001).

Methods:  Following ethical approval, women who had completed radiotherapy for cervical or endometrial cancer, at least 3 months earlier (n = 117), were recruited from a routine follow‐up oncology clinic. They were asked to complete a validated questionnaire, to identify bowel problems and their impact on quality of life (Bugg et al.,2001). All completed questionnaires (n = 95) were scored, according to severity of symptoms, and compared to the results of the validated questionnaire. Scores in each domain (Table 1) ranged between 0 and 100, the higher the score, the greater the impairment of health‐related quality of life.

 Scoring in each domain, compared to the identified scoring for known faecal incontinence (Bugg et al., 2001).

Domain
Mean score (SD)
Score for known faecal incontinence (SD)
P value*

General health (perception of level of health)
42.8 (17.5)
36.1 (24)
< 0.05*

Incontinence impact (triggers for incontinence & frequency)
38.4 (10.3)
56.9 (26.7)
< 0.001

Role (ability to perform daily activities)
35.8 (18.4)
40 (26.1)
< 0.05

Physical function (ability to perform physical activities)
32.9 (19.0)
44 (28.9)
< 0.001

Social function (affect on social life)
31.3 (18.8)
32.3 (28.3)
NS

Personal function (affect on personal relationships)
26.8 (15.3)
27.9 (32.7)
NS

Emotional problems (Depression, anxiety, nervousness)
38.4 (22.8)
47.6 (27.8)
< 0.001

Sleep/energy (affect on sleep & energy levels)
37.6 (21.8)
31.5 (25.7)
< 0.05*

Severity measures (coping mechanisms such as changing clothes, wearing pads, watching diet)
40.1 (22.6)
57.7 (26.7)
< 0.05*

*Mean score compared with scores of Bugg et al.

Results:  A total of 95 (87%) questionnaires were returned for analysis. Table 1 illustrates the scoring in each domain, as identified by the questionnaire. Fifty‐three percent of women had no score, indicating no symptoms, whilst 47% scored for symptoms. Younger women (P < 0.001) and women with cervical cancer (P < 0.05) were more likely to experience symptoms.

Discussion:  Approximately half of patients reported bowel problems that affected quality of life. Tiredness is a common side‐effect of radiotherapy and this may explain higher scores obtained in domain eight. Lower scores obtained in four domains (Incontinence impact, role, physical function and emotional problems) may be due to the associating ‘cancer’ as the predominant influence on these factors, rather than the bowel problem. There may have been a reluctance to appear ‘ungrateful’, despite these problems, now that subjects are ‘cured’ of cancer (Abayomi et al.,2005). Subjects in the control study may not have the same reasons to understate symptoms.

Conclusion:  Following pelvic radiotherapy patients may develop symptoms of CRE; younger women and women with cervical cancer were more likely to develop symptoms. CRE has a negative impact on quality of life and health professionals need to be more pro‐active in identifying and caring for such women.

References  Abayomi, J., Kirwan, J., Hackett, A. & Bagnall, G. (2005) A study to investigate women's experiences of radiation enteritis following radiotherapy or cervical cancer. J. Hum. Nutr. Diet. 18, 353–363.

Andreyev, J. (2005) Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut54, 1051–1054.

Bugg, G.J., Kiff, E.S. & Hosker, G. (2001) A new condition‐specific health‐related quality of life questionnaire for the assessment of women with anal incontinence. Br. J. Obstet. Gynaecol. 108, 1057–1067.

Putta, S. & Andreyev, H.J. (2005) Faecal incontinence: a late side‐effect of pelvic radiotherapy. Clin. Oncol. 17, 469–477.