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Methods of assessing late radiotherapy effects on bowel function

Nelson, Annmariea; Mann, Malab; Staffurth, Johnc

Current Opinion in Supportive and Palliative Care: June 2019 - Volume 13 - Issue 2 - p 134–141
doi: 10.1097/SPC.0000000000000422
GASTROINTESTINAL SYMPTOMS: Edited by Nicole Blijlevens and Andrea M. Stringer

Purpose of review Pelvic radiation disease in the form of chronic radiation-induced consequences of treatment is under recognized by healthcare professionals and under reported by patients. Gastrointestinal symptoms are not routinely assessed, and may not be causally associated with previous radiotherapy. These symptoms are therefore often under treated.

Recent findings A literature search was conducted in Ovid Medline, which included Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid Embase for articles published between 2016 and April 2018. A total of 11 articles were selected for review. A wide range of patient reported outcome measure instruments are used in research and practice. Clinical symptom grading is restricted to a fewer number of tools but may not always capture issues, such as urgency, that are important to the patient. Clinician and patient concordance in the assessment of outcomes is limited. Initiatives to prompt communication of the relative risks of the late consequences of treatment and comparative effectiveness of treatments decisions are developing, as are new techniques to limit irradiation of healthy tissue.

Summary Nonstandardized outcome measurement reduces the ability to aggregate toxicity and patient outcomes across clinical trials. The development of standardized screening and treatment algorithms for gastrointestinal symptoms can systematically locate and treat gastrointestinal late effects of treatment.

aDivision of Population Medicine, Marie Curie Research Centre, School of Medicine

bSpecialist Unit for Review Evidence, Cardiff University

cDivision of Cancer and Genetics, School of Medicine, Cardiff University and Velindre University NHS Trust, Cardiff, UK

Correspondence to Professor Annmarie Nelson, Division of Population Medicine, Marie Curie Research Centre, School of Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK. Tel: +44 02920 687473; e-mail:

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