Patients with non-metastatic anal cancer may experience reduced quality of life and persistent functional symptoms after chemoradiotherapy.
A new cross-sectional cohort study published in Radiotherapy and Oncology evaluated patient-reported health-related quality of life after chemoradiotherapy and compared outcomes with a matched normative Dutch population.
The study found that patients reported lower overall health-related quality of life, worse functioning across all domains, and higher symptom burden, particularly fatigue, diarrhoea, bowel dysfunction, and defecation-related embarrassment.
Why This Study Matters
Chemoradiotherapy is the standard curative treatment for most patients with non-metastatic anal squamous cell carcinoma. This approach aims to achieve locoregional disease control while avoiding abdominoperineal resection and permanent stoma in most patients.
However, even when treatment is successful oncologically, patients may experience long-term effects involving bowel function, urinary symptoms, sexual function, fatigue, body image, and social functioning.
Patient-reported outcome measures are important because they capture symptoms and functional problems that may not be fully reflected in routine clinical toxicity reporting. This study helps clarify the long-term patient experience after chemoradiotherapy for anal cancer.
Chemoradiotherapy is the standard curative treatment for most patients with non-metastatic anal squamous cell carcinoma
This approach aims to achieve locoregional disease control while avoiding abdominoperineal resection and permanent stoma in most patients.
However, even when treatment is successful oncologically, patients may experience long-term effects involving bowel function, urinary symptoms, sexual function, fatigue, body image, and social functioning.
Patient-reported outcome measures are important because they capture symptoms and functional problems that may not be fully reflected in routine clinical toxicity reporting. This study helps clarify the long-term patient experience after chemoradiotherapy for anal cancer.
This was a cross-sectional cohort study using data from the Prospective Dutch ColoRectal Cancer cohort. Patient-reported outcome measures were linked to clinical data from the Netherlands Cancer Registry.
The study included patients aged 18 years or older with stage I–III anal squamous cell carcinoma diagnosed between 2016 and 2025.
Patients were eligible if they completed at least one health-related quality-of-life questionnaire at least 6 months after completing chemoradiotherapy. The primary endpoint was long-term health-related quality of life compared with a sex-, age-, and comorbidity-matched normative population.
Patient Population
A total of 72 patients were included.
Most patients were female, with a median age of 65 years. Nearly half had stage III disease. Most patients received chemoradiotherapy with mitomycin and capecitabine.
The median interval between the end of chemoradiotherapy and completion of the EORTC QLQ-C30 and QLQ-CR29 questionnaires was 21.7 months. The normative comparison group included 216 matched individuals without cancer.
Quality of Life Outcomes
Patients with anal squamous cell carcinoma reported lower global health status compared with the matched normative population.
The mean global health status score was 68.5 in patients versus 78.5 in controls. All functioning scales were at least 10 points lower in patients compared with controls, indicating clinically relevant differences.
The largest difference was seen in social functioning.
Patients also reported a higher symptom burden across all symptom scales, although fatigue and diarrhoea were the main symptoms exceeding the threshold for clinical relevance. The mean EORTC QLQ-C30 summary score was also significantly lower in patients than in controls.
Disease-Specific Symptoms
Disease-specific symptoms were assessed using the EORTC QLQ-CR29.
Among all patients, prominent symptoms included urinary frequency, buttock pain, bloated feeling, flatulence, faecal incontinence, and embarrassment related to defecation patterns. For patients without a stoma, flatulence and embarrassment by defecation pattern were among the most frequently reported symptoms.
Among patients with a stoma, quality-of-life concerns included worries about travelling, reduced ability to perform hobbies, and limitations in household tasks.
Sexual functioning was also affected, although response numbers were limited.
Bowel Dysfunction and LARS
Bowel dysfunction was common among patients without a stoma.
Among patients who completed the Low Anterior Resection Syndrome questionnaire, 62% reported major LARS.Frequently reported severe symptoms included incontinence for flatus, strong urgency, and needing to open the bowels again within 1 hour.
These findings show that bowel dysfunction after chemoradiotherapy for anal cancer can resemble patterns seen after rectal cancer surgery or pelvic treatment, even without surgical resection.
Clinical Interpretation
This study reinforces that survivorship after anal cancer treatment is not only about disease control.
Patients may continue to experience meaningful symptoms and functional limitations long after chemoradiotherapy. The findings are clinically important because they highlight gaps between tumor-focused outcomes and patient-centered outcomes.
Routine use of PROMs during follow-up may help clinicians identify symptoms earlier, guide supportive care, and improve patient counselling before and after treatment. The results also support the need for better education about possible long-term effects, so patients can have more realistic expectations and receive timely support.
Limitations
This was a cross-sectional study, so it cannot fully describe individual quality-of-life trajectories over time. Baseline patient-reported outcome data were available only for a subset of patients.
The study included patients enrolled in the PLCRC cohort who consented to and completed questionnaires, which may introduce selection bias. There was also no anal cancer-specific quality-of-life questionnaire used in this analysis, although the authors note that future implementation of the EORTC QLQ-ANL27 is planned.
Clinical Takeaway
Patients with non-metastatic anal squamous cell carcinoma report reduced health-related quality of life after chemoradiotherapy compared with a matched normative population.
The most affected areas include global quality of life, role and social functioning, fatigue, diarrhoea, bowel dysfunction, and defecation-related embarrassment.
These findings support the importance of structured survivorship care, better patient education, and routine use of patient-reported outcomes during follow-up after chemoradiotherapy for anal cancer.
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