Table 1

Cancer stages at diagnosis, primary treatment modalities and corresponding long-term health state descriptions*

CancerStage at diagnosis and primary treatmentHealth state descriptionsNot included
Cancer stage and treatmentLong-term health state in ≥50% patients and patient follow-up for 5 years from primary treatment
Anal90% Cases stages I–III.8 Chemoradiation is the only primary treatment for anal cancer.9 Anal cancer stages I–III. Treated with chemoradiation.
  • Diarrhoea, tiredness and nausea; impact on usual activities; decreased sexual functioning and enjoyment.

  • Review 2–3 times per year (digital rectal examination and anoscopy).

Stage IV. Patients with abdominoperitoneal resection and stoma. Patients treated with surgical excision.
Oropharyngeal90% Cancers present as stage II/III.10 Most patients have surgery followed by radiotherapy.11 Oropharyngeal cancer stages II–III. Treated with neck dissection and chemotherapy and/or radiotherapy and/or surgery.
  • Occasional pain; difficulty chewing and swallowing affecting diet/eating; dry throat affecting speech; reduced neck mobility; tiredness; impact on usual activities.

  • Review 2–3 times per year.

Stage I and stage IV. Disfiguring effects of surgery. Patients who require feeding tubes.
Penile62% Cases local12; 70% penile-preserving treatment is laser therapy.13 Penile cancer stage I. Treated with laser therapy only—no disfigurement.
  • Recovered well and satisfied with surgery; no impairment of sexual functioning/satisfaction.

  • Frequent self-inspection and review 2–4 times per year.

Stages II–IV. Patients requiring partial or complete penectomy.
Vulval∼66% Vulval cancers are localised—predominantly stages I–II.14 Treatment is radical wide excision where possible + lymph node dissection.14 Vulval cancer stage I. Treated with radical wide excision and lymph node dissection.
  • Vigilance because of risk of lymphoedema; clitoris intact and can still reach orgasm but reduced sexual satisfaction because of disfigurement.

  • Review 2–3 times per year.

Stages II–IV. Patients with radical vulvectomy and/or compromised bowel or urinary function.
Vaginal∼50% cases localised—predominantly stage 1.15 Radiotherapy + lymph node dissection is standard treatment.16 Vaginal cancer stage I. Treated with chemoradiation and lymph node dissection.
  • Vigilance because of risk of lymphoedema; menopause; sexual problems related to vaginal dryness and scar tissue; bowel and bladder irritation.

  • Review 2–3 times per year (vaginal exam).

Stages II–IV.
  • * Full details in online technical appendix.

  • Data on 548 patients with stage I–IV oropharyngeal squamous cell carcinoma from 10 Australian centres: 55.8% surgery followed by postoperative radiotherapy, 18.9% chemoradiation, 10.8% surgery alone and 14% radiotherapy alone (A Hong, personal communication).