Pelvic radiotherapy used in cancer treatment often results in long-term changes in bowel functioning as well as a host of other chronic gastrointestinal (GI) symptoms. Given the effect this can have on quality of life, such patients require a holistic approach to cancer survivorship, not merely tumor surveillance. Researchers in the United Kingdom have developed an algorithm for identifying and managing the 23 most prominent GI symptoms. In a recent study they evaluated the algorithm by enrolling 218 patients who had received radiation for urologic, gynecologic, or GI tumors and who had persistent GI symptoms. Patients were randomized to receive either a detailed self-help booklet (usual care) or management via the algorithm by either a gastroenterologist or a specially trained nurse.

At baseline a significant percentage (63% to 69%) of patients in each group had Modified Inflammatory Bowel Disease Questionnaire-Bowel Subset (IBDQ-B) scores lower than 60, indicating moderate-to-severe symptoms. At six months, patients in the usual care group had nonclinically significant changes in IBDQ-B scores of a mean of -4.9 points; at that time, 44% of those patients, particularly those showing the least improvement, requested gastroenterologist review. In contrast, both algorithm groups demonstrated clinically and statistically significant improvements in IBDQ-B scores, which fell a mean of 10.4 points in the gastroenterologist group and 9.1 points in the nurse group. At 12 months the improvements had been maintained in both algorithm groups. The similar scores in the nurse and gastroenterologist groups suggest comparable care and results from both types of provider.

The authors note that even though their algorithm proved effective, half of the patients in the booklet group improved as well; they suggest that offering the booklet to patients when they first experience symptoms and then using the algorithm to guide treatment in those whose symptoms worsen would cost less, although they point out that the simple tests used in the algorithm can be performed at minimal cost, too.

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