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

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