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Title: Optimising the management of gastrointestinal symptoms following pelvic radiotherapy
Author: Henson, Caroline Claire
ISNI:       0000 0004 5355 9289
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2014
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Background: Pelvic radiotherapy is a well-established treatment for pelvic malignancies, with 30,000 patients per year in the UK receiving radical pelvic radiotherapy either alone or in combination with other oncological treatments. 80% develop acute gastrointestinal (GI) symptoms and 50% develop chronic GI symptoms and in parallel to improvements in survival, increasing numbers of patients are living to develop the long term consequences of treatment. Despite this, less than 20% of patients who develop chronic GI symptoms are ever referred to a gastroenterologist. Aims: 1. To determine the current practice of clinical oncologists and gastroenterologists with respect to management of chronic GI symptoms following pelvic radiotherapy in 2 parallel national surveys. 2. To determine whether specialist gastroenterological management of chronic GI symptoms following pelvic radiotherapy based on a structured algorithmic approach identifies GI diagnoses and improves outcomes. 3. To determine whether a GI care bundle comprising nutritional assessment and intervention and investigation of GI symptoms and subsequent treatment of diagnoses found is feasible and acceptable to patients. Findings: There is no formal robust screening for GI symptoms, low referral rates, patchy services, use of ineffective treatments and inadequate expertise. Oncologists underestimate the problem and under refer. Gastroenterologists are seeing low numbers of patients and lack expertise. Both groups state that a regional multidisciplinary service for patients with GI symptoms following pelvic radiotherapy would be desirable. Patients who develop GI symptoms following pelvic radiotherapy present with multiple symptoms (median 8) and thorough structured evaluation identified multiple potentially treatable diagnoses, with 28 patients (55%) having ≥2 causes for their GI symptoms. Half of diagnoses were unrelated to previous cancer treatment. Common diagnoses included radiation proctopathy, bile acid malabsorption, diverticulosis and colonic polyps. A clinically and statistically significant improvement in GI symptoms was found in parallel to GI intervention using inflammatory bowel disease questionnaire (IBDQ) (p=0.014), Vaizey incontinence questionnaire (VIQ) (p<0.0005) and the Common Terminology Criteria for Adverse Events (CTCAE) pelvic symptom questionnaire rectum-bowel subset (p=0.001). Initial data show that GI and nutritional intervention during pelvic chemoradiotherapy is both feasible and acceptable to patients. Conclusions: There is inadequate care and services for this patient group in the UK. GI intervention using a structured algorithmic approach is of benefit in terms of identifying potentially treatable diagnoses and improving symptoms. GI intervention during pelvic radiotherapy is feasible and acceptable to patients and ongoing work will determine the benefit of this intervention in terms of symptom control in the short and long term and cost benefit. A programme of mechanistic and clinical research is required to improve the understanding of this scenario.
Supervisor: Mclaughlin, John; Davidson, Susan Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Gastrointestinal ; Pelvic radiotherapy ; Pelvic radiation disease