Search

This is the fourth and final article in a series on the gastrointestinal (GI) symptoms of pelvic radiation disease (PRD). Published studies and patient reports suggest that health professionals lack of awareness of PRD. This professional awareness can be improved with third-sector advocacy and provision of simple screening tools, such as Assessment of Late Effects of Radiotherapy-Bowel (ALERT-B). In South Wales, patients with suspected PRD are referred to a PRD specialist nurse in either a gastroenterology clinic or a gynae-oncology follow-up clinic. These two nurse-led clinics demonstrate different ways to identify, assess and manage patients with late GI effects of PRD. Data from these clinics suggest that systematic investigations based on appropriate guidance are effective in identifying these symptoms, many of which can be managed or treated. The rising incidence of PRD and lack of specialist services suggests that the NHS needs to provide more funding to care for patients beyond the end of their cancer treatment.

Introduction/Background Patients who receive pelvic radiotherapy may develop gastrointestinal (GI) symptoms which impact on their quality of life (QoL). A GI Specialist Nurse (CNS) has attended our gynaecological follow up clinic since January 2018. This is a new service in addition to a Late GI Effects Clinic based in the local Gastroenterology Department. Methodology From January 2018 to March 2019, 185 patients had received pelvic radiotherapy. 35% (65) of patients with GI symptoms were identified using the ALERT-B (Taylor et al 2016), a quick and simple screening tool. Those who answered yes to any question were seen by the GI CNS and investigated using the ‘Guidance: The Practical Management of Gastrointestinal Symptoms of Pelvic Radiation Disease’ (Andreyev et al 2014). Results Some of the 65 patients had also previously been investigated in the main Late Effects Clinic. The most common findings are shown in table 1 below. Many patients reported more than one symptom. Table 2 below shows the most common abnormal investigation results It was also identified that 22% (14) of patients required specialist dietary advice including certain carbohydrate avoidance, low fat and/or a low FODMAP diet. Conclusion Late GI effects are not uncommon following pelvic radiotherapy and can have a significant impact on the patients QoL. A GI Late Effects CNS in a gynaeoncology follow-up clinic quickly identifies, investigates and treats affected patients thus avoiding further clinic referral and speeding up the patients recovery. Disclosure Nothing to disclose