Improving our understanding of the quality of life of patients with metastatic or recurrent/persistent anal cancer: a systematic review.

Purpose: Chemoradiation (CRT) is used to treat anal carcinomas which, for most patients with loco-regional disease, results in a cure but is associated with acute and chronic complications impairing quality of life (QoL). Patients with metastatic disease or recurrence are likely to experience additional QoL concerns. This paper identifies the QoL issues of these patients and determines whether the EORTC QLQ-ANL27 (QLQ-ANL27), a measure of QoL of patients treated with CRT for anal cancer used alongside the core EORTC QLQ-C30 (QLQ-C30), is suitable or needs adapting.

Methods: A systematic review was conducted of studies published between 2014 and 2024 reporting QoL of patients with metastatic or recurrent/persistent anal cancer or follow-up data of patients treated with CRT for anal cancer.

Results: This review included 23 papers, only three focused exclusively on metastatic and/or recurrent anal cancer. Most of the 53 reported symptoms related to bowel, urinary, and sexual functioning, with 60% covered by the QLQ-ANL27 or the QLQ-C30. Issues not captured include, for example, neuropathy, hair loss, musculoskeletal problems, urinary incontinence, and embarrassment.

Conclusion: There is a paucity of research looking specifically at QoL outcomes of patients with metastatic or recurrent anal cancer. Whilst the QLQ-ANL27 captures most QoL issues affecting these patients, it might require adapting to improve its sensitivity.