A modified Inflammatory Bowel Disease questionnaire and the Vaizey Incontinence questionnaire are simple ways to identify patients with significant gastrointestinal symptoms after pelvic radiotherapy

After radiotherapy for pelvic cancer, chronic gastrointestinal problems may affect quality of life (QOL) in 6–78% of patients. This variation may be due to true differences in outcome in different diseases, and may also represent the inadequacy of the scales used to measure radiotherapy-induced gastrointestinal side effects. The aim of this study was to assess whether outcome measures used for nonmalignant gastrointestinal disease are useful to detect gastrointestinal morbidity after radiotherapy. Results obtained from a Vaizey Incontinence questionnaire and a modified Inflammatory Bowel Disease questionnaire (IBDQ) – both patient completed – were compared to those from a staff administered Late Effects on Normal Tissue (LENT) – Subjective, Objective, Management and Analytic (SOMA) questionnaire in patients who had completed radiotherapy for a pelvic tumour at least 3 months previously. In all, 142 consecutive patients were recruited, 72 male and 70 female, median age 66 years (range 26–90 years), a median of 27 (range 3–258) months after radiotherapy. In total, 62 had been treated for a gynaecological, 58, a urological and 22, a gastrointestinal tract tumour. Of these, 21 had undergone previous gastrointestinal surgery and seven suffered chronic gastrointestinal disorders preceding their diagnosis of cancer. The Vaizey questionnaire suggested that 27% patients were incontinent for solid stools, 35% for liquid stools and 37% could not defer defaecation for 15 min. The IBDQ suggested that 89% had developed a chronic change in bowel habit and this change significantly affected 49% patients: 44% had more frequent or looser bowel movements, 30% were troubled by abdominal pain, 30% were troubled by bloating, 28% complained of tenesmus, 27% were troubled by their accidental soiling and 20% had rectal bleeding. At least 34% suffered emotional distress and 22% impairment of social function because of their bowels. The small intestine/colon SOMA median score was 0.1538 (range 0–1) and the rectal SOMA median score was 0.1428 (range 0–1). Pearson's correlations for the IBDQ score and small intestine/colon SOMA score was −0.630 (P<0.001), IBDQ and rectum SOMA −0.616 (P<0.001), IBDQ and Vaizey scores −0.599 (P<0.001), Vaizey and small intestine/colon SOMA 0.452 (P<0.001) and Vaizey and rectum SOMA 0.760 (P<0.001). After radiotherapy for a tumour in the pelvis, half of all patients develop gastrointestinal morbidity, which affects their QOL. A modified IBDQ and Vaizey questionnaire are reliable in assessing new gastrointestinal symptoms as well as overall QOL and are much easier to use than LENT SOMA

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Alleviation of Gastrointestinal Mucosal Toxicity Related to Chemotherapy and Radiation Therapy: The NCCTG Experience.

Purpose. Cancer patients undergoing chemotherapy and radiation therapy may experience substantial mucosal toxicity. The North Central Cancer Treatment Group (NCCTG) has developed a series of Phase III clinical trials to study agents to alleviate mucosal injury. This manuscript will review this experience. Results. An NCCTG trial demonstrated that oral cryotherapy for 30 minutes is able to decrease 5-FU stomatitis by approximately 50%. This result was replicated in an independent trial. Other NCCTG trials evaluating means of reducing 5-FU-induced stomatitis have demonstrated lack of efficacy for allopurinol mouthwashes, chamomile mouthwashes, a sucralfate slurry, and oral glutamine. Trials evaluating means of alleviating radiation-induced oral mucositis have demonstrated that a chlorhexidine mouthwash is detrimental while oral non-absorbable antibiotic lozenges may provide some marginal benefit, but not enough to recommend it for standard clinical practice. A single trial evaluating radiation-induced esophagitis failed to demonstrate any benefit for a sucralfate slurry. Three trials have been developed to evaluate means for alleviating radiation-induced proctitis. The first trial demonstrated that olsalazine was detrimental in this situation. A second trial, evaluating sucralfate, closed in June 1997. A third trial, designed to evaluate glutamine, is being readied to initiate patient entry. Conclusions. The NCCTG, through a program of randomized, placebo-controlled, clinical trials, has been able to evaluate whether purported treatment options are beneficial for the alleviation of mucosal injury from cancer treatment