The Impact of Specialized Gastroenterology Services for Late Pelvic Radiation Disease: Results from the Prospective Multicenter EAGLE Study

Results of a mixed-methodology implementation study aiming to improve the well-being of men with gastrointestinal late effects following radical radiation therapy for prostate cancer. Men (n=339) from 3 UK cancer centers who had had radical radiation therapy for prostate cancer at least 6 months previously. All men completed a novel screening tool for late bowel effects (ALERT-B) and the Gastrointestinal Symptom Rating Score; men with a positive score on ALERT-B were referred to one of 3 new specialized services following a peer reviewed management algorithm for PRD. In addition, we assessed: health-related quality of life (HRQOL) at baseline/6 and 12 months; healthcare resource usage (HRU); patient, support giver, staff experience, and acceptability of staff training (qualitative analysis). Each center successfully implemented the service, with either a nurse specialist (n=2) or medically-led (n=1) model. Overall 58 participants (17.1%) had symptoms and accepted referral to gastroenterology, albeit fewer than expected. The range of diagnoses was similar to previous reports, including: radiation protopathy (n=18); adenomas (n=5); non-prostate cancers (n=3); bile acid malabsorption (n=15); fructose or lactose intolerance and/or small intestinal bacterial overgrowth (n=20); vitamin B12/D deficiency (n=20). We observed: increase in quality of life; reduction in specific symptoms (e.g., bowel-related or urinary); increase in sexual activity and/or sexual function between 6 and 12 months. The table shows selected results as the standardized difference from baseline. The strongest improvements occurred in the bowel domain. HRU modelling (limited due to low numbers) suggested staff costs of £117-£185, dependent on service model, and total costs including investigations and treatment of an average of £2393 per patient. The qualitative study found that the new service was welcomed by staff and patients, including gastroenterologists not directly involved in the service; but there was concern about long-term funding and sustainability beyond the time-frame of the study. Staff noticed increasing numbers of referrals, likely due to increasing awareness among oncologists. PRD is increasingly recognized in the UK as an ongoing consequence of curative pelvic radiation therapy across all tumor sites, despite widespread implementation of advanced radiation therapy techniques. Specialized services following national guidelines should be embedded within gastroenterology.Abstract 68; TableScaleMeasure(mean 6 months – mean baseline) ÷ SD baseline(mean 12 months – mean baseline) ÷ SD baselineEPICBowel scale0.440.53GSRSDiarrhea scale0.040.90EPICUrinary Irritative / Obstructive scale0.110.37EPICUrinary Incontinence-.0.070.22EQ-5D-5LPain0.03-0.06EPICSexual Scale0.160.23EPICHormonal Scale0.140.37EQ-5D-5LAnxiety / Depression-0.120.07Negative scores MEAN a decrease in QOL/symptoms; positive scores indicate an increase in QOL/symptoms Open table in a new tab