Shared Decision Making With Anal Cancer Patients on Radiation Dose

Patient Centered Radiation Treatment of Anal Cancer Using Shared Decision Making as to Dose Level

The purpose of this study is to maximize patient involvement in the treatment of anal cancer. Specifically, the investigators will investigate whether patients wish to take part in the decision making on radiation dose and whether they want a high or low radiation dose.

The study will also provide new knowledge on the effect and side effects of irradiation of anal cancer, and detailed data from the dose planning will be instrumental in optimizing future decision aids.

Inclusion Criteria:

• Squamous cell carcinoma of the anal duct or perianal (non-hairy skin, max 5 cm from the anal verge)

• T2-T4 N0-3

• Age ≥ 18 years

• Performance status 0-2

• Sufficient organ and bone marrow function defined as:

  • Neutrophils ≥ 1.5 x 10^9/L
  • Thrombocytes ≥ 100 x 10^9/L

• Curative intent radiation treatment deemed possible

• Patients chooses 1 of 3 options:

  • I do not wish to decide on details of my treatment, but I would like to receive the standard treatment
  • I want to receive the high radiation dose
  • I want to receive the low radiation dose

• Written and orally informed consent

Exclusion Criteria:

• Non-resectable metastases
• Tumor > 10 cm or the total tumor volume (incl. lymph node metastases) is too large to be included in an appropriate radiation field (after possible neoadjuvant chemotherapy)
• Pregnant or breastfeeding women
• Fertile women not willing to use effective contraception
• Serious co-morbidity that would hinder interfere with radiation treatment or hinder patient compliance (e.g. incapacity to understand or complete questionnaires)