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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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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.\n<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00520-025-09520-8","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T06:48:35Z","timestamp":1747291715000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Improving our understanding of the quality of life of patients with metastatic or recurrent\/persistent anal cancer: a systematic review"],"prefix":"10.1007","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8755-146X","authenticated-orcid":false,"given":"Samantha C.","family":"Sodergren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2600-4099","authenticated-orcid":false,"given":"Rowan","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Krishnatry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0593-0218","authenticated-orcid":false,"given":"Marianne G.","family":"Guren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5588-1007","authenticated-orcid":false,"given":"Kristopher","family":"Dennis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierfrancesco","family":"Franco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5119-8358","authenticated-orcid":false,"given":"Francesca","family":"de Felice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4387-7278","authenticated-orcid":false,"given":"Anne-Sophie","family":"Darlington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vassilios","family":"Vassiliou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"issue":"3","key":"9520_CR1","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1093\/ije\/dyw276","volume":"46","author":"F Islami","year":"2017","unstructured":"Islami F, Ferlay J, Lortet-Tieulent J, Bray F, Jemal A (2017) International trends in anal cancer incidence rates. 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