Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers

The findings of a new Cochrane Review show that the effect of radiotherapy on gastrointestinal symptoms and quality of life has been a much-neglected area of research.

Cancer treatments are incredibly more effective, and more people are alive than ever before who have had cancer - currently 2 million, with 4 million projected by 2030. This milestone has been achieved through a huge amount of research to define effective new therapies to treat cancer. However, research into the side effects caused by cancer treatments has not been pursued with any vigour, and one of the most common complications, bowel problems, has few experts available. As a result, some people are forced to either stop treatment entirely or receive reduced intensity treatment because of side effects, and this may reduce their chance of a lasting response to the cancer/cure.

Other people may not be able to be fully cured of cancer, but increasingly cancers can be held in check by ongoing treatments - sometimes for years. If these treatments cause side effects which are not well understood, the effects may crease adverse impacts on patients' quality of life. Still others may be able to be cured of cancer by modern treatments, but then experience long-lasting side effects from those treatments - such that, even though they are able to survive cancer, their quality of life may be very poor.  This happens to one in four patients cured of their cancer.

Dr Jervoise Andreyev, consultant gastroenterologist in pelvic Radiation Disease at The Royal Marsden and one of the authors of this Cochrane Review, commented, "Decision-making around new (and existing) treatments largely focuses on increasing life expectancy, but now that so many effective treatments exist to treat so many cancers, much more emphasis must go on improving quality of life for cancer patients during and after treatment and not ignoring the problems. This inadequately untreated gastrointestinal toxicity costs the healthcare system in the UK many millions annually. With other toxicities, such as nausea and vomiting, or bone marrow suppression, huge investment in research has largely eliminated these problems, but gastrointestinal side effects have largely been ignored."

Dr Jervoise Andreyev and Tess Lawrie, two of the authors who worked on this review with Cochrane Gynaecological, Neuro-oncology, and Orphan Cancers, also took part in a Q&A session which provided additional information about the review and its place within the debate about research on cancer treatments and their side effects.