Patient-reported quality of life after chemoradiotherapy in patients with non-metastatic anal squamous cell carcinoma: A cross-sectional cohort study

Abstract

BACKGROUND AND PURPOSE: For most patients with non-metastatic anal squamous cell carcinoma (ASCC), chemoradiotherapy (CRT) is the standard treatment. Data on long-term health-related quality of life (HRQoL) following CRT are limited. This study evaluated HRQoL and functioning of patients with ASCC after CRT and compared outcomes with a normative population. MATERIALS AND METHODS: In this cross-sectional cohort study, patient-reported outcome measures (PROMs) from the Prospective Dutch ColoRectal Cancer (PLCRC) cohort were linked to clinical data from the Netherlands Cancer Registry. Patients with stage I-III ASCC diagnosed between 2016 and 2025 who completed the EORTC-QLQ-C30, EORTC-QLQ-CR29, Low Anterior Resection Syndrome (LARS) and/or Stoma Quality of Life (SQOLS) questionnaire ≥ 6 months after CRT were included. The C30 scores were compared to a sex-, age-, and comorbidity matched (1:3) Dutch normative population. RESULTS: A total of 72 patients were included (67% female; median age 65 years, 49% stage III). The median interval between end of CRT and C30 and CR29 questionnaire completion was 21.7 months. Compared with the normative population, patients reported lower overall HRQoL, lower functioning across all domains, and higher levels of fatigue and diarrhoea. Prominent CR29-reported symptoms included flatulence (mean 43.3), urinary frequency (mean 33.1), and embarrassment by defecation pattern (mean 31.8). Among patients without stoma, 62% (n = 32) reported major LARS. CONCLUSION: Patients with ASCC report reduced HRQoL after CRT compared to a normative population. These findings underscore the importance of post-treatment supportive care and insight into PROMs during routine follow-up may help tailor individualised guidance of patients.