A modified Inflammatory Bowel Disease questionnaire and the Vaizey Incontinence questionnaire are simple ways to identify patients with significant gastrointestinal symptoms after pelvic radiotherapy

Abstract

After radiotherapy for pelvic cancer, chronic gastrointestinal problems may affect quality of life (QOL) in 6 -78% of patients. This variation may be due to true differences in outcome in different diseases, and may also represent the inadequacy of the scales used to measure radiotherapy-induced gastrointestinal side effects. The aim of this study was to assess whether outcome measures used for nonmalignant gastrointestinal disease are useful to detect gastrointestinal morbidity after radiotherapy. Results obtained from a Vaizey Incontinence questionnaire and a modified Inflammatory Bowel Disease questionnaire (IBDQ) -both patient completed -were compared to those from a staff administered Late Effects on Normal Tissue (LENT) -Subjective, Objective, Management and Analytic (SOMA) questionnaire in patients who had completed radiotherapy for a pelvic tumour at least 3 months previously. In all, 142 consecutive patients were recruited, 72 male and 70 female, median age 66 years (range 26 -90 years), a median of 27 (range 3 -258) months after radiotherapy. In total, 62 had been treated for a gynaecological, 58, a urological and 22, a gastrointestinal tract tumour. Of these, 21 had undergone previous gastrointestinal surgery and seven suffered chronic gastrointestinal disorders preceding their diagnosis of cancer. The Vaizey questionnaire suggested that 27% patients were incontinent for solid stools, 35% for liquid stools and 37% could not defer defaecation for 15 min. The IBDQ suggested that 89% had developed a chronic change in bowel habit and this change significantly affected 49% patients: 44% had more frequent or looser bowel movements, 30% were troubled by abdominal pain, 30% were troubled by bloating, 28% complained of tenesmus, 27% were troubled by their accidental soiling and 20% had rectal bleeding. At least 34% suffered emotional distress and 22% impairment of social function because of their bowels. The small intestine/colon SOMA median score was 0.1538 (range 0 -1) and the rectal SOMA median score was 0.1428 (range 0 -1). Pearson's correlations for the IBDQ score and small intestine/colon SOMA score was À0.630 (Po0.001), IBDQ and rectum SOMA À0.616 (Po0.001), IBDQ and Vaizey scores À0.599 (Po0.001), Vaizey and small intestine/colon SOMA 0.452 (Po0.001) and Vaizey and rectum SOMA 0.760 (Po0.001). After radiotherapy for a tumour in the pelvis, half of all patients develop gastrointestinal morbidity, which affects their QOL. A modified IBDQ and Vaizey questionnaire are reliable in assessing new gastrointestinal symptoms as well as overall QOL and are much easier to use than LENT SOMA.

Predicting Late Effects of Pelvic Radiotherapy: Is There a Better Approach?

“…We have assessed both (acute and late) measurements prospectively and used a patient-reported symptom tool. Although this tool is not in common use among oncologist or radiographers, we have previously shown that it is more sensitive than commonly used scoring systems in characterizing symptoms associated with both phases (11,12). It incorporates questions that others have found are important but lacking in more commonly used tools (frequency, urgency, and diarrhea) (13) and symptoms that we have found important to patients (anorectal symptoms and excessive flatus) (14), which are ignored by most scoring tools.…”

Faecal incontinence and health related quality of life in inflammatory bowel disease patients: Findings from a tertiary care center in South Asia

“…Both IBDQ and Vaizey score were selected because of their simplicity and precision, which make those ideal for clinical practice to identify patients who require specialist help and in the clinical research setting to provide a sensitive measure of FI [20,21] .…”

“Pelvic radiation disease”: New understanding and new solutions for a new disease in the era of cancer survivorship

“…It can imprison clinicians and scientists into ways of thinking which do no service to the patient or to research. For example, it may encourage the erroneous belief that radiation-induced toxicity cannot be improved or prevented and to attempt to do so is futile [21,22], that manipulating the radiation dose will solve all problems, completely ignoring the real nature of normal tissue injury [23][24][25] or that worst of all, it is not terribly important to measure it accurately [25][26][27][28].…”