Identifying radiation-induced survivorship syndromes affecting bowel health in a cohort of gynecological cancer survivors
Artikel i vetenskaplig tidskrift, 2017

Background: During radiotherapy unwanted radiation to normal tissue surrounding the tumor triggers survivorship diseases; we lack a nosology for radiation-induced survivorship diseases that decrease bowel health and we do not know which symptoms are related to which diseases. Methods: Gynecological-cancer survivors were followed-up two to 15 years after having undergone radiotherapy; they reported in a postal questionnaire the frequency of 28 different symptoms related to bowel health. Population-based controls gave the same information. With a modified factor analysis, we determined the optimal number of factors, factor loadings for each symptom, factor-specific factor-loading cutoffs and factor scores. Results: Altogether data from 623 survivors and 344 population-based controls were analyzed. Six factors best explain the correlation structure of the symptoms; for five of these a statistically significant difference (P< 0.001, Mann-Whitney U test) was found between survivors and controls concerning factor score quantiles. Taken together these five factors explain 42 percent of the variance of the symptoms. We interpreted these five factors as radiation-induced syndromes that may reflect distinct survivorship diseases. We obtained the following frequencies, defined as survivors having a factor loading above the 95 percent percentile of the controls, urgency syndrome (190 of 623, 30 percent), leakage syndrome (164 of 623, 26 percent), excessive gas discharge (93 of 623, 15 percent), excessive mucus discharge (102 of 623, 16 percent) and blood discharge (63 of 623, 10 percent). Conclusion: Late effects of radiotherapy include five syndromes affecting bowel health; studying them and identifying the underlying survivorship diseases, instead of the approximately 30 long-term symptoms they produce, will simplify the search for prevention, alleviation and elimination. © 2017 Steineck et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Gunnar Steineck

Göteborgs universitet

Viktor Skokic

Göteborgs universitet

Fei Sjöberg

Göteborgs universitet

Cecilia Bull

Göteborgs universitet

Eleftheria Alevronta

Göteborgs universitet

Gail Dunberger

Ersta Sköndal Bräcke högskola

Karin Bergmark

Göteborgs universitet

Ulrica Wilderäng

Göteborgs universitet

Jung Hun Oh

Memorial Sloan-Kettering Cancer Center

Joseph O. Deasy

Memorial Sloan-Kettering Cancer Center

Rebecka Jörnsten

Chalmers, Matematiska vetenskaper, Tillämpad matematik och statistik

Göteborgs universitet


1932-6203 (ISSN) 19326203 (eISSN)

Vol. 12 2 Article no e0171461- e0171461


Hållbar utveckling



Cancer och onkologi



Mer information

Senast uppdaterat