Reducing gastrointestinal effects of radiotherapy on primary pelvic cancer

Background Radiotherapy is an effective and key treatment for cancer, but pelvic radiotherapy can damage the gastrointestinal tract and result in distressing acute and long-term effects.1 Pelvic radiotherapy is used either alone, or in combination with surgery and/or chemotherapy as treatment for gynaecological, urological and gastrointestinal cancers. Inevitably, the normal tissues surrounding the cancer is exposed to radiation, with up to 90% of patients reporting a permanent change in bowel habits, and up to two-thirds of patients reporting negative symptoms including: sexual dysfunction; faecal incontinence, urgency, rectal bleeding and chronic pain. Given the high disease free survival rates now achievable in many cancers, addressing quality of life in survivorship for these patients is essential. A range of different strategies are proposed to reduce the effects of radiotherapy on normal tissue, and thus prevent or mitigate the adverse effects. These include technique to improve the delivery of radiotherapy to avoid normal tissues, using CT imaging to guide treatment, use of brachytherapy to place radioactive seeds within the tumour, and adjusting positions and timing the radiotherapy treatment. Other interventions are proposed such as surgically placing slings to transpose the small bowel, pharmacological agents that may protect the mucosal lining of the gastro-intestinal tract, and non-pharmacological interventions including dietary modifications. At the time of radiotherapy treatment, focus is often on disease control and patients may be unware of the potential long-term consequences, and the options that may be available to them. Informed nurses who are able to provide evidence based information at this time can make a pivotal contribution to their care