Patientsʼ Perspectives on Fecal Incontinence After Brachytherapy for Localized Prostate Cancer

BACKGROUND:When a patient is deciding between treatment options for localized prostate cancer, brachytherapy is commonly chosen for its perceived low complication profile. Brachytherapy can frequently be complicated by the development of fecal incontinence. The potential long-term impact of this dysfunction on a patientʼs life should be discussed. OBJECTIVE:This study aimed to assess the long-term impact of brachytherapy for localized prostate cancer on fecal incontinence and to determine the impact and severity of the incontinence on patientsʼ ability to engage in activities of daily living. DESIGN:A retrospective observational study was performed. A questionnaire packet was mailed to patients who had received brachytherapy treatment for localized prostate cancer and were now more than 2 years out from initial seed implantation. Each packet contained the Colon and Ano-Rectal Impact Questionnaire (assessing quality of life), the Colon and Ano-Rectal Distress Inventory, and the Cleveland Clinic Fecal Incontinence Score (both measured existence and severity of fecal incontinence). SETTINGS:This study was conducted at Caritas Christi St. Elizabethʼs Medical Center, a tertiary referral center in Boston, Massachusetts from January 1, 1998 to December 31, 2007. PATIENTS:One hundred forty-three of 568 patients (a 25% response rate) responded and were analyzed. INTERVENTIONS:No interventions were performed. MAIN OUTCOME MEASURES:The main outcome was impact of fecal incontinence on quality of life. RESULTS:Of the responses to the Colon and Ano-Rectal Impact Questionnaire, 13.2% (19 patients) (P < .001) stated that fecal incontinence was impacting their ability to participate in their daily activities. Sixty-three percent (12 patients) (P < .001) of patients described the impact of the incontinence as slight, 21% (4 patients) (P < .001) described it as moderate, and 15.8% (3 patients) (P < .001) described it as severe. LIMITATIONS:There were no case-matched controls and the response rate to the surveys was low. CONCLUSIONS:Postbrachytherapy fecal incontinence leaves a long-term impact on patientsʼ ability to engage in activities of daily living.