Tu1058 Late Anorectal Complaints After Pelvic Radiotherapy: Which Symptom Has the Largest Impact on Quality of Life?

BACKGROUND: Late anorectal toxicity is a frequent adverse event of pelvic radiotherapy. It comprises different symptoms such as fecal incontinence, rectal blood loss and urgency. To optimize treatment modalities it is important to know which symptoms have the largest impact on quality of life (QoL). Especially urgency and fecal incontinence are expected to have a profound impact. Our goal was to determine the relative impact of individual anorectal symptoms on QoL in patients irradiated for prostate cancer. METHODS: Patients who underwent evaluation of their anorectal function after prostate irradiation, were asked to complete two validated questionnaires to measure their QoL and the prevalence and severity of anorectal complaints at least one year after radiotherapy. QoL was measured by the Fecal Incontinence Quality of Life scale (FIQL) and the Expanded Prostate Cancer Index Composite Bowel domain (EPICB) bother subscale. The prevalence and severity of anorectal complaints was measured by the EPICB function subscale. RESULTS: Eighty-five men (mean age 72 yrs; range 53 84 yrs), completed the questionnaires (mean time after radiotherapy 2 yrs; range 1-7 yrs). Loose or liquid stools was reported by 48%, rectal urgency by 31%, bloody stool by 22%, frequent defecation by 22%, fecal incontinence by 18%, painful defecation by 18% and abdominal cramps by 12% of the patients. Mean spearman rank correlation coefficients of FIQL domains and EPICB bother scores with individual symptoms ranged 0.23 0.53 for FIQL domains and 0.36 0.73 for EPICB bother scores. The correlation coefficients indicated a strong relationship of fecal incontinence and urgency and a moderate relationship of rectal blood loss and frequent defecation with QoL outcomes. Multiple regression analysis revealed that standardized regression coefficients (β) for QoL outcomes were largest for urgency and incontinence. For urgency they were 0.39 with the lifestyle domain and 0.38 with the coping domain (p < 0.001). For incontinence they ranged between 0.29 and 0.52 (all domains p < 0.001) with the lifestyle, coping, depression and embarrassment domain. Urgency (β = 0.37) and incontinence (β = 0.30) also had the largest impact on bother as measured by the EPICB. CONCLUSIONS: These results support the hypothesis that fecal incontinence and rectal urgency have the largest impact on QoL in patients with anorectal radiation toxicity. Other symptoms such as frequent defecation and lower abdominal cramps also contribute, but less profoundly. This underscores the importance of preventing fecal incontinence and urgency and to optimize treatment modalities.