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Original research
Gastrointestinal consequences of cancer treatment: evaluation of 10 years’ experience at a tertiary UK centre
  1. Radha Gadhok,
  2. Emma Paulon,
  3. Chehkuan Tai,
  4. Tomisin Olushola,
  5. John Barragry,
  6. Farooq Rahman,
  7. Simona Di Caro,
  8. Shameer Mehta
  1. Department of Gastrointestinal Services, University College London Hospitals, NHS Foundation Trust, London, UK
  1. Correspondence to Dr Shameer Mehta, GI Services, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK; shameer.mehta{at}nhs.net

Abstract

Objective Up to 90% of patients treated for pelvic cancers experience chronic gastrointestinal (GI) symptoms. This study characterises this patient cohort at a single centre, addressing a paucity of publications reporting ‘real-world’ experiences.

Method Outpatient referrals, from oncology to the gastroenterology and nutrition services, at a tertiary London hospital from 2006 to 2016, were retrospectively identified. Patient characteristics, reported symptoms, investigations, diagnoses, response to therapeutics and follow-up were recorded.

Results Of 269 patients referred, 81% were within the latter 5 years. A total of 260 patients had diagnoses of pelvic cancers (prostatic (52%), cervical (19%) and endometrial (19%)). Among 247 treated with radiotherapy, the median time from radiotherapy to symptom onset was 8 months. Common symptoms were rectal bleeding (51%), diarrhoea (32%), faecal urgency (19%) and pain (19%). Patients underwent a median of three investigations including lower GI endoscopy (86%), thyroid function tests (33%) and glucose hydrogen breath test (30%). Diagnoses included radiation proctopathy (39%), colonic polyps (16%), pelvic floor dysfunction (12%), bile acid malabsorption (BAM) (8%), small intestinal bacterial overgrowth (SIBO) (8%), vitamin D deficiency (7%) and iron deficiency (7%). Among 164 discharged patients, the time to discharge was 7 months, after a median of two appointments.

Conclusions This unique patient group reports a complex mix of symptoms and requires specialist review and consideration of often uninvestigated diagnoses (pelvic dysfunction, BAM, SIBO and nutritional deficiencies). Such patients are often overlooked, compared with those suffering many other chronic GI disorders. Further reports from non-dedicated centres treating patients with pelvic radiation disease will aid in understanding of secondary GI diagnoses and variation in practice.

  • radiation enteritis
  • enteropathy
  • cancer
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Footnotes

  • Contributors RG, EP, SDC and SM: study concept and design. RG, EP, CT, TO, JB and SM: acquisition of data. RG and SM: analysis and interpretation of data. RG, FR, SDC and SM: drafting of manuscript. FR, SDC and SM: critical revision of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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