Identifying Radiation-induced Survivorship Syndromes Affecting Bowel Health in a Cohort of Gynecological Cancer Survivors

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2017 Feb 4

PMID 28158314

Citations 13

Authors

Gunnar Steineck

Viktor Skokic

Fei Sjoberg

Cecilia Bull

Eleftheria Alevronta

Gail Dunberger

Karin Bergmark

Ulrica Wilderang

Jung Hun Oh

Joseph O Deasy

Rebecka Jornsten

Affiliations

Soon will be listed here.

Abstract

Background: During radiotherapy unwanted radiation to normal tissue surrounding the tumor triggers survivorship diseases; we lack a nosology for radiation-induced survivorship diseases that decrease bowel health and we do not know which symptoms are related to which diseases.

Methods: Gynecological-cancer survivors were followed-up two to 15 years after having undergone radiotherapy; they reported in a postal questionnaire the frequency of 28 different symptoms related to bowel health. Population-based controls gave the same information. With a modified factor analysis, we determined the optimal number of factors, factor loadings for each symptom, factor-specific factor-loading cutoffs and factor scores.

Results: Altogether data from 623 survivors and 344 population-based controls were analyzed. Six factors best explain the correlation structure of the symptoms; for five of these a statistically significant difference (P< 0.001, Mann-Whitney U test) was found between survivors and controls concerning factor score quantiles. Taken together these five factors explain 42 percent of the variance of the symptoms. We interpreted these five factors as radiation-induced syndromes that may reflect distinct survivorship diseases. We obtained the following frequencies, defined as survivors having a factor loading above the 95 percent percentile of the controls, urgency syndrome (190 of 623, 30 percent), leakage syndrome (164 of 623, 26 percent), excessive gas discharge (93 of 623, 15 percent), excessive mucus discharge (102 of 623, 16 percent) and blood discharge (63 of 623, 10 percent).

Conclusion: Late effects of radiotherapy include five syndromes affecting bowel health; studying them and identifying the underlying survivorship diseases, instead of the approximately 30 long-term symptoms they produce, will simplify the search for prevention, alleviation and elimination.

Citing Articles

Intra-abdominal Surgery and Intestinal Syndromes After Pelvic Radiation Therapy.

Bull C, Moren A, Skokic V, Wilderang U, Malipatlolla D, Alevronta E Adv Radiat Oncol. 2024; 9(1):101303.

PMID: 38260232 PMC: 10801660. DOI: 10.1016/j.adro.2023.101303.

A Systematic Review of Population-Based Studies of Chronic Bowel Symptoms in Cancer Survivors following Pelvic Radiotherapy.

Biran A, Bolnykh I, Rimmer B, Cunliffe A, Durrant L, Hancock J Cancers (Basel). 2023; 15(16).

PMID: 37627064 PMC: 10452492. DOI: 10.3390/cancers15164037.

The physical and psychological aspects of quality of life mediates the effect of radiation-induced urgency syndrome on disability pension in gynecological cancer survivors.

Noor Baloch A, Hagberg M, Thomee S, Steineck G, Sanden H Cancer Med. 2023; 12(16):17377-17388.

PMID: 37489096 PMC: 10501287. DOI: 10.1002/cam4.6356.

A Fiber-Rich Diet and Radiation-Induced Injury in the Murine Intestinal Mucosa.

Malipatlolla D, Devarakonda S, Patel P, Sjoberg F, Rascon A, Grander R Int J Mol Sci. 2022; 23(1).

PMID: 35008864 PMC: 8745769. DOI: 10.3390/ijms23010439.

A Preparatory Study for a Randomized Controlled Trial of Dietary Fiber Intake During Adult Pelvic Radiotherapy.

Ahlin R, Bergmark K, Bull C, Devarakonda S, Landberg R, Sigvardsson I Front Nutr. 2021; 8:756485.

PMID: 34950688 PMC: 8688914. DOI: 10.3389/fnut.2021.756485.

References

Dunberger G, Lind H, Steineck G, Waldenstrom A, Nyberg T, Al-Abany M . Fecal incontinence affecting quality of life and social functioning among long-term gynecological cancer survivors. Int J Gynecol Cancer. 2010; 20(3):449-60. DOI: 10.1111/IGC.0b013e3181d373bf. View

Andreyev H, Muls A, Norton C, Ralph C, Watson L, Shaw C . Guidance: The practical management of the gastrointestinal symptoms of pelvic radiation disease. Frontline Gastroenterol. 2015; 6(1):53-72. PMC: 4283714. DOI: 10.1136/flgastro-2014-100468. View

Buja A, Eyuboglu N . Remarks on Parallel Analysis. Multivariate Behav Res. 2016; 27(4):509-40. DOI: 10.1207/s15327906mbr2704_2. View

Steineck G, Helgesen F, Adolfsson J, Dickman P, Johansson J, Norlen B . Quality of life after radical prostatectomy or watchful waiting. N Engl J Med. 2002; 347(11):790-6. DOI: 10.1056/NEJMoa021483. View

Dunberger G, Lind H, Steineck G, Waldenstrom A, Nyberg T, Al-Abany M . Self-reported symptoms of faecal incontinence among long-term gynaecological cancer survivors and population-based controls. Eur J Cancer. 2009; 46(3):606-15. DOI: 10.1016/j.ejca.2009.10.023. View

Yamauchi F, Penzkofer T, Fedorov A, Fennessy F, Chu R, Maier S . Prostate cancer discrimination in the peripheral zone with a reduced field-of-view T(2)-mapping MRI sequence. Magn Reson Imaging. 2015; 33(5):525-30. PMC: 4426240. DOI: 10.1016/j.mri.2015.02.006. View

Zientek L, Thompson B . Applying the bootstrap to the multivariate case: bootstrap component/factor analysis. Behav Res Methods. 2007; 39(2):318-25. DOI: 10.3758/bf03193163. View

Goodman L, Wintrobe M . Nitrogen mustard therapy; use of methyl-bis (beta-chloroethyl) amine hydrochloride and tris (beta-chloroethyl) amine hydrochloride for Hodgkin's disease, lymphosarcoma, leukemia and certain allied and miscellaneous disorders. J Am Med Assoc. 2010; 132:126-32. DOI: 10.1001/jama.1946.02870380008004. View

Gilman A . The initial clinical trial of nitrogen mustard. Am J Surg. 1963; 105:574-8. DOI: 10.1016/0002-9610(63)90232-0. View

10.

Steineck G, Bergmark K, Henningsohn L, Al-Abany M, Dickman P, Helgason A . Symptom documentation in cancer survivors as a basis for therapy modifications. Acta Oncol. 2002; 41(3):244-52. DOI: 10.1080/02841860260088782. View

11.

Teo M, Sebag-Montefiore D, Donnellan C . Prevention and Management of Radiation-induced Late Gastrointestinal Toxicity. Clin Oncol (R Coll Radiol). 2015; 27(11):656-67. DOI: 10.1016/j.clon.2015.06.010. View

12.

Andreyev H . Pelvic radiation disease. Colorectal Dis. 2014; 17(1):2-6. DOI: 10.1111/codi.12812. View

13.

Dunberger G, Lind H, Steineck G, Waldenstrom A, Onelov E, Avall-Lundqvist E . Loose stools lead to fecal incontinence among gynecological cancer survivors. Acta Oncol. 2011; 50(2):233-42. DOI: 10.3109/0284186X.2010.535013. View

14.

Bergmark K, Avall-Lundqvist E, Dickman P, Henningsohn L, Steineck G . Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med. 1999; 340(18):1383-9. DOI: 10.1056/NEJM199905063401802. View

15.

Jackson A, Marks L, Bentzen S, Eisbruch A, Yorke E, Ten Haken R . The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S155-60. PMC: 2854159. DOI: 10.1016/j.ijrobp.2009.08.074. View

16.

Michalski J, Gay H, Jackson A, Tucker S, Deasy J . Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S123-9. PMC: 3319467. DOI: 10.1016/j.ijrobp.2009.03.078. View

17.

Oh J, Thor M, Olsson C, Skokic V, Jornsten R, Alsadius D . A Factor Analysis Approach for Clustering Patient Reported Outcomes. Methods Inf Med. 2016; 55(5):431-439. PMC: 5518610. DOI: 10.3414/ME16-01-0035. View

18.

Mansson A, Henningsohn L, Steineck G, Mansson W . Neutral third party versus treating institution for evaluating quality of life after radical cystectomy. Eur Urol. 2004; 46(2):195-9. DOI: 10.1016/j.eururo.2004.04.010. View

19.

Kreicbergs U, Valdimarsdottir U, Onelov E, Henter J, Steineck G . Talking about death with children who have severe malignant disease. N Engl J Med. 2004; 351(12):1175-86. DOI: 10.1056/NEJMoa040366. View

20.

Steineck G, Schmidt H, Alevronta E, Sjoberg F, Bull C, Vordermark D . Toward Restored Bowel Health in Rectal Cancer Survivors. Semin Radiat Oncol. 2016; 26(3):236-50. DOI: 10.1016/j.semradonc.2016.03.002. View