Worldwide 1,470,900 women are diagnosed yearly with a gynaecological cancer. Some women develop long-term changes in bowel function following treatment severely impacting on quality of life.Methods
A service evaluation collecting prospective data was approved by the organisation’s R and D department. Intestinal symptoms were measured using a modified GSRS and impact on QoL assessed by VAS score (0=worst QoL, 10=best QoL). The McNemar Chi-square and Wilcoxon signed rank tests were used to analyse changes in symptom burden between initial assessment to discharge from the service.Results
From April 2013 to March 2016, 235 women treated for gynaecological cancers attended the clinic, representing a fifth of those using the service. Fifteen declined further intervention and were excluded, leaving 220 for analysis. Women had been treated for cancer of the cervix (50%), endometrium (28%), ovary (15%), vagina or vulva (7%) cancer. Most women received multi-modal therapies: chemoradiation (28%), surgery +radiotherapy (27%), surgery +chemoradiation (22%), surgery +chemotherapy (10%). Median age was 57 years (range: 24–83). The median time between cancer diagnosis and referral to service was 4 years and 10 months (range: 6 m–47.5 y). Most troublesome symptoms at assessment were bowel frequency of 4 or more times a day (88%), type 6 or 7 stool consistency (36%), urgency to defaecate (31%), faecal incontinence (21%) and fatigue (25%). Some women also reported urinary problems (17%) and sexual concerns (12%). Following a published algorithm, a median of 8 investigations were requested (range: 1–14): blood screen (97%), gastroscopy (75%), glucose hydrogen methane breath test (77%), SeHCAT scan (71%), faecal elastase (69%), flexible sigmoidoscopy (52%), colonoscopy (25%) and abdominal Xray (18%). A median of four factors contributing to symptoms were found (range: 1–9) and 68% of women had more than three. The most common diagnoses were vitamin D deficiency (60%), treated with replacement; SIBO (54%), treated with antibiotics and bile acid malabsorption (52%), treated with bile acid sequestrants and low fat diet. The median number of consultations was 4 (range: 1–17). Median quality of life improved from 4 at first assessment to 6 at discharge (p<0.001); the reduction in urgency, incontinence, tenesmus, frequency, diarrhoea and fatigue was statistically significant (p<0.05).Conclusions
Bowel symptoms after cancer treatment affect many women. They can be discharged with symptom improvement using a systematic investigational and treatment approach. Earlier referral to specialist services is recommended.