A multi-disciplinary model of survivorship care following definitive chemoradiation for anal cancer

Abstract

Following definitive chemoradiation for anal squamous cell carcinoma (ASCC), patients face a variety of chronic issues including: bowel dysfunction, accelerated bone loss, sexual dysfunction, and psychosocial distress. The increasing incidence of this disease, high cure rates, and significant long-term sequelae warrant increased focus on optimal survivorship care following definitive chemoradiation. In order to establish our survivorship care model for ASCC patients, a multi-disciplinary team of experts performed a comprehensive literature review and summarized best practices for the multi-disciplinary management of this unique patient population. We reviewed principle domains of our survivorship approach: (1) management of chronic toxicities; (2) sexual health; (3) HIV management in affected patients; (4) psychosocial wellbeing; and (5) surveillance for disease recurrence and survivorship care delivery. We provide recommendations for the optimization of survivorship care for ASCC patients can through a multi-disciplinary approach that supports physical and psychological wellness.

Impact of Definitive Chemoradiation on Quality-of-Life Changes for Patients With Anal Cancer: Long-term Results of a Prospective Study

“…Notably, in our cohort, several QOL scales showed long-term clinically significant improvement compared with baseline (eg, role and emotional functioning, appetite loss, and pain), which can be explained by the disappearance of the detrimental effect of the tumor itself on the QOL after response to chemoradiation, suggesting that long-term treatment-related toxicity did not outweigh tumor-related side effects in patients with anal cancer except for specific problems (eg, sexual symptoms). A multidisciplinary model of survivorship care after definitive chemoradiation for anal cancer may improve long-term QOL in this patient group through the following: 1) diet modification to improve bowel symptoms 21 ; 2) tailored physical activities to reduce fatigue, pain, insomnia, and anxiety 22 ; 3) individual psychotherapeutic interventions (eg, assistance in expressing emotions and improving coping skills) to help decrease somatic symptoms and psychosocial sequelae of cancer and its treatment 23 ; 4) educational programs and intervention group therapy (eg, sharing personal experiences) to reduce psychological morbidity and facilitate crisis adaptation 24 ; 5) pelvic rehabilitation programs incorporating physical therapy directed toward the pelvic floor and regular use of vaginal (and/or anal) dilator to help improve fecal and/or urinary incontinence, dyspareunia, or sexual dysfunction 25 ; and 6) referral to qualified specialists with drug therapy and directed intervention whenever indicated-for example, probiotics and antidiarrheal medicine (for bowel symptoms), antidepressant medication (for anxiety and depression), pain medication (for abdominal and pelvic pain), phosphodiesterase type 5 inhibitors (for erectile dysfunction), 26 and hyperbaric oxygen (for refractory radiation proctitis). 27 Achieving locoregional control with organ preservation and good long-term QOL are the primary goals of anal cancer treatment.…”

Anal Cancer: The Past, Present and Future

“…Compared with imaging techniques, clinical methods allow for a more in-depth measurement of disease recurrence or persistence, as well as regional relapse [ 63 ]. The periodic assessments are important for the surveillance of disease recurrence and provide an opportunity to address other components of survivorship care, including management of chronic treatment-related complications, sexual health, and psychosocial well-being [ 101 , 102 ].…”

A 2020 update of anal cancer: the increasing problem in women and expanding treatment landscape

“…Owing to the close proximity of the vagina to the anal canal, toxic mucosal effects of radiation can result in vaginal stenosis and dyspareunia [110]. Loss of libido is another consequence, likely a combination of physical toxicities and psychosocial impacts of treatment [111]. Thirty to forty percent of sexually active women become sexually inactive following completion of chemoradiation for anal cancer [112].…”