# A nurse-led clinic for bowel problems after pelvic radiotherapy in every cancer centre

Source: https://onco.cc/ideas/idea-pu-nurse-led-pelvic-radiation-disease-clinic/  
OnCo record `idea-pu-nurse-led-pelvic-radiation-disease-clinic` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Bowel problems lasting months or years after radiotherapy to the pelvis are common and often treatable once their causes are found. In a randomised trial, a trained nurse following a step-by-step plan helped as much as a specialist doctor, and both helped more than a self-help booklet. Specialist services exist in some places and not others.

## Summary

The trial. ORBIT randomised 218 people in London with new bowel symptoms persisting 6 months after pelvic radiotherapy to a detailed self-help booklet, algorithm-based care led by a gastroenterologist, or the same algorithm led by a nurse. At 6 months, bowel symptom scores (IBDQ-B) improved more with the nurse than the booklet (mean difference 4.12, 95 per cent confidence interval 0.04 to 8.19) and with the gastroenterologist than the booklet (5.47, 1.14 to 9.81), and the nurse group was not inferior to the gastroenterologist group. The authors concluded that for most patients the care can be given by a trained nurse. The algorithm is published as guidance (Andreyev 2015).

In practice. The EAGLE study set up two nurse-led and one doctor-led service in three UK cancer centres for men after prostate radiotherapy: of 339 men recruited, 91 screened positive and 58 accepted referral; diagnoses included radiation proctopathy, bile acid malabsorption, food intolerances or bacterial overgrowth, and vitamin B12 or D deficiency. Staff costs were estimated at 117 to 185 pounds per patient depending on the model, and staff worried about funding beyond the study.

The gap. No survey OnCo found counts how many centres run such a clinic. A 2025 qualitative study of 28 survivors and 19 professionals in England described geographical disparity in late-effects services and survivors feeling "cast adrift".

## Fields

- Kind: Idea
- Last checked: 2026-11-11
- Tags: protocol-upgrade; upgrade:proven-unevenly-used; evidence:moderate
- Hypothesis: A nurse-led pelvic radiation disease clinic in each radiotherapy centre, with routine screening for bowel symptoms at follow-up, improves bowel-specific quality of life at a population level and finds treatable causes in most people referred.
- Rationale: One randomised trial shows the model works with nurses, an implementation study shows it can be set up in ordinary centres at modest staff cost, and qualitative work shows people are left without it.
- Proposed test: A stepped-wedge rollout across radiotherapy networks with routine screening, uptake, diagnoses made and change in bowel-specific quality of life as outcomes, and a national survey of service provision as the baseline.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Andreyev et al., Algorithm-based management of patients with gastrointestinal symptoms in patients after pelvic radiation treatment (ORBIT): a randomised controlled trial (Lancet 2013): https://doi.org/10.1016/S0140-6736(13)61648-7
- Andreyev et al., Guidance: the practical management of the gastrointestinal symptoms of pelvic radiation disease (Frontline Gastroenterology 2015): https://doi.org/10.1136/flgastro-2014-100468
- Staffurth et al., The impact of specialised gastroenterology services for pelvic radiation disease (PRD): results from the prospective multi-centre EAGLE study (PLoS One 2025): https://doi.org/10.1371/journal.pone.0303356
- Biran et al., Healthcare provision for cancer survivors with chronic bowel symptoms post pelvic radiotherapy: a qualitative study (European Journal of Oncology Nursing 2025): https://doi.org/10.1016/j.ejon.2025.102895

## Connected records

- cancers: [Anal cancer (squamous cell carcinoma)](https://onco.cc/cancers/anal/), [Cervical cancer](https://onco.cc/cancers/cervical/), [Endometrial cancer](https://onco.cc/cancers/endometrial/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- protocols: [Bowel effects after pelvic radiotherapy (pelvic radiation disease): assessment and management](https://onco.cc/protocols/pelvic-radiation-disease-bowel-symptoms/)

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