Bowel dysfunction following pelvic organ cancer: a prospective study on the treatment effect in nurse-led late sequelae clinics

Michelle’s review

In this prospective Danish study, 380 cancer survivors (46% rectal, 15% gynaecological, 13% anal, 12% colon, 12% prostate, and 2% other cancers) were seen in nurse-led clinics.

Validated questionnaires were completed at the initial appointment and at discharge and used to identify 15 different bowel symptoms and the impact of these on quality of life.

96% of those referred to the clinics were multisymptomatic, with two or more severe symptoms at baseline.  Regardless of cancer type, the most frequent symptoms were faecal urgency (95%), fragmented defaecation (93%), emptying difficulties (92%), flatus/faecal incontinence (flatus 89%, liquid 59%, solid 33%), and obstructed defaecation (79%).

Patients followed an individualised conservative treatment-based algorithm. Step 1 included dietary & fibre advice, defaecation dynamics, pelvic floor exercises and use of anti-diarrhoeals or laxatives. Depending on progress, step 2 added in biofeedback and / or transanal irrigation (TAI).  Those who failed to improve were referred to a surgeon (step 3).

At discharge, 69% had received conservative treatment only and 24% also received transanal irrigation; 4% were surgically treated; 3% discontinued treatment. Statistically significant improvements were seen in all 15 bowel symptoms and improved quality of life.

Interestingly, of all the conservative treatments initiated, TAI was the one most likely to be continued at discharge. 73% of patients continued with it suggesting it was effective in relieving symptoms.

This is an important study since it highlights that patients who have had any pelvic organ cancer (not only rectal cancer), can experience the myriad of symptoms known as low anterior resection syndrome (LARS). These patients are multisymptomatic and have a high symptom burden. They can be successfully treated in nurse-led clinics with conservative treatments, inclusive of TAI.  Awareness of these issues amongst health care professionals will enable earlier identification of patients whose symptoms and quality of life can be improved.

Please not there is no open access to this paper, however you can learn more here: Mekhael M, Larsen HM, Lauritzen MB, Thorlacius-Ussing O, Laurberg S, Krogh K, Drewes AM, Christensen P, Juul T. Bowel dysfunction following pelvic organ cancer: a prospective study on the treatment effect in nurse-led late sequelae clinics. Acta Oncol. 2023 Jan;62(1):70-79. doi: 10.1080/0284186X.2023.2168214. Epub 2023 Feb 9. PMID: 36757368.