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Cai L, Wu Y, Xu X, Cao J, Li D. Pelvic floor dysfunction in gynecologic cancer survivors. Eur J Obstet Gynecol Reprod Biol 2023; 288:108-113. [PMID: 37499277 DOI: 10.1016/j.ejogrb.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/06/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
Pelvic floor dysfunction (PFD) is a common complication in gynecologic cancer survivors (GCS) and is now a worldwide medical and public health problem because of its great impact on the quality of life of GCS. PFD after comprehensive gynecologic cancer treatment is mainly reflected in bladder function, rectal function, sexual dysfunction and pelvic organ prolapse (POP), of which different types of gynecologic cancer correspond to different disease incidence. The prevention strategies of PFD after comprehensive gynecologic cancer treatment mainly included surgical treatment, physical therapy and behavioral guidance, etc. At present, most of them still focus on physical therapy, mostly using Pelvic Floor Muscle Training (PFMT) and multi-modal PFMT treatment of biofeedback combined with electrical stimulation, which can reduce the possibility of PFD after surgery in GCS to some extent. This article reviews the clinical manifestations, causes and current research progress of prevention and treatment methods of PFD after comprehensive treatment for GCS.
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Affiliation(s)
- Linjuan Cai
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Yue Wu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Xuyao Xu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Jian Cao
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China.
| | - Dake Li
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China.
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Maturen KE, Martin MF, Chapman CH, McLean K, Michaels BN, Uppal S, Prisciandaro JI, Wittmann DA, Jolly S. Pelvic Recovery After Endometrial Cancer Treatment: Patient-Reported Outcomes and MRI Findings. Acad Radiol 2023; 30 Suppl 2:S202-S210. [PMID: 37100674 DOI: 10.1016/j.acra.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2023]
Abstract
RATIONALE AND OBJECTIVES Most women with endometrial cancer (EC) have an excellent prognosis and may be cured. However, treatment-related pelvic functional impacts may affect long-term quality of life. To better understand these concerns, we explored correlations between patient-reported outcomes and pelvic magnetic resonance imaging (MRI) features in women treated for EC. MATERIALS AND METHODS Women with histologic diagnosis of EC were consented preoperatively and completed the validated Female Sexual Function Index (FSFI) and Pelvic Floor Dysfunction Index (PFDI) questionnaires at preoperative, 6-week, and 6-month follow-up visits. Pelvic MRIs with dynamic pelvic floor sequences were performed at 6 weeks and 6 months. RESULTS A total of 33 women participated in this prospective pilot study. Only 53.7% had been asked about sexual function by providers while 92.4% thought they should have been. Sexual function became more important to women over time. Baseline FSFI was low, declined at 6 weeks, and climbed above baseline at 6 months. Hyperintense vaginal wall signal on T2-weighted images (10.9 vs. 4.8, p = .002) and intact Kegel function (9.8 vs. 4.8, p = .03) were associated with higher FSFI. PFDI scores trended toward improved pelvic floor function over time. Pelvic adhesions on MRI were associated with better pelvic floor function (23.0 vs. 54.9, p = .003). Urethral hypermobility (48.4 vs. 21.7, p = .01), cystocele (65.6 vs. 24.8, p < .0001), and rectocele (58.8 vs. 18.8, p < .0001) predicted worse pelvic floor function. CONCLUSION Use of pelvic MRI to quantify anatomic and tissue changes may facilitate risk stratification and response assessment for pelvic floor and sexual dysfunction. Patients articulated the need for attention to these outcomes during EC treatment.
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Affiliation(s)
- Katherine E Maturen
- University of Michigan Department of Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109 (K.E.M., M.F.M.); University of Michigan Department Obstetrics and Gynecology, 1500 E Medical Center Drive, Ann Arbor, MI 48109 (K.E.M., B.N.M., S.U.).
| | - Marisa F Martin
- University of Michigan Department of Radiology, 1500 E Medical Center Drive, Ann Arbor, MI 48109 (K.E.M., M.F.M.).
| | - Christina H Chapman
- Baylor College of Medicine Radiation Oncology, 1 Moursund St, Houston, TX 77030 (C.H.C.).
| | - Karen McLean
- Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263 (K.M.M.).
| | - Brandy N Michaels
- University of Michigan Department Obstetrics and Gynecology, 1500 E Medical Center Drive, Ann Arbor, MI 48109 (K.E.M., B.N.M., S.U.).
| | - Shitanshu Uppal
- University of Michigan Department Obstetrics and Gynecology, 1500 E Medical Center Drive, Ann Arbor, MI 48109 (K.E.M., B.N.M., S.U.).
| | - Joann I Prisciandaro
- University of Michigan Department Radiation Oncology, 1500 E Medical Center Drive, Ann Arbor, MI 48109 (J.I.P., S.J.).
| | - Daniela A Wittmann
- University of Michigan Department Urology, 1500 E Medical Center Drive, Ann Arbor, MI 48109 (D.A.W.).
| | - Shruti Jolly
- University of Michigan Department Radiation Oncology, 1500 E Medical Center Drive, Ann Arbor, MI 48109 (J.I.P., S.J.).
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Robison K, Wohlrab K, Howe CJ, Richter HE, Sung V, Bevis KS, Luis C, McCourt C, Lowder J, Occhino J, Glaser G, Lokich E, Dunivan G, Brown A, Tunitsky-Bitton E, Wethington S, Chen CCG, Rahn D, Carlson M, Cram R, Raker C, Clark MA. Endometrial Cancer Surgery With or Without Concomitant Stress Urinary Incontinence Surgery. Obstet Gynecol 2023; 141:642-652. [PMID: 36897162 DOI: 10.1097/aog.0000000000005059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To compare quality of life (QOL) among patients with endometrial intraepithelial neoplasia or early-stage endometrial cancer and stress urinary incontinence (SUI) who chose to have concomitant surgery with cancer surgery alone. METHODS A multicenter, prospective cohort study was conducted across eight U.S. sites. Potentially eligible patients were screened for SUI symptoms. Those who screened positive were offered referral to urogynecology and incontinence treatment, including concomitant surgery. Participants were categorized into two groups: 1) concomitant cancer and SUI surgery or 2) cancer surgery alone. The primary outcome was cancer-related QOL as measured by the FACT-En (Functional Assessment of Cancer Therapy-Endometrial) (range 0-100; higher score indicates better QOL). The FACT-En and questionnaires assessing urinary symptom-specific severity and effects were assessed before surgery and 6 weeks, 6 months, and 12 months after surgery. Adjusted median regression accounting for clustering was used to examine the relationship between SUI treatment group and FACT-En scores. RESULTS Of 1,322 (53.1%) patients, 702 screened positive for SUI with 532 analyzed; 110 (21%) chose concomitant cancer and SUI surgery, and 422 (79%) chose cancer surgery alone. FACT-En scores increased for both the concomitant SUI surgery and cancer surgery-only groups from the preoperative to the postoperative period. After adjustment for timepoint and preoperative covariates, the median change in FACT-En score (postoperative-preoperative) was 1.2 points higher (95% CI -1.3 to 3.6) for the concomitant SUI surgery group compared with the cancer surgery-only group across the postoperative period. Median time until surgery (22 days vs 16 days; P <.001), estimated blood loss (150 mL vs 72.5 mL; P <.001), and operative time (185.5 minutes vs 152 minutes; P <.001) were all greater for the concomitant cancer and SUI surgery group compared with the cancer-only group, respectively. CONCLUSION Concomitant surgery did not result in improved QOL compared with cancer surgery alone for endometrial intraepithelial neoplasia and patients with early-stage endometrial cancer with SUI. However, FACT-En scores were improved in both groups.
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Affiliation(s)
- Katina Robison
- Women & Infants Hospital and Brown University, Providence, Rhode Island; the University of Alabama at Birmingham, Birmingham, Alabama; Washington University of St. Louis Hospital, St. Louis, Missouri; Mayo Clinic, Rochester, Minnesota; the University of New Mexico Hospital, Albuquerque, New Mexico; Hartford Hospital, Hartford, Connecticut; Johns Hopkins Hospital, Baltimore, Maryland; and the University of Texas Southwestern Medical Center, Dallas, Texas
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Hines K, Nieto K, Dezarn W, Greven K, Krol B, Matthews C, Parker-Autry C. An assessment of urethral radiation exposure in the treatment of endometrial and rectal cancers. Int Urogynecol J 2023; 34:929-935. [PMID: 36181547 DOI: 10.1007/s00192-022-05363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/03/2022] [Indexed: 10/06/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Female survivors of endometrial and rectal cancers have increased risk of urinary incontinence. Survivors with prior radiation therapy are counseled against mesh incontinence surgery. We hypothesize that urethral radiation dose varies based on modality which may influence surgical risks. We aimed to demonstrate urethral radiation dose differences between vaginal brachytherapy (VBT) and external beam radiation therapy (EBRT). METHODS This is a retrospective cohort study of women exposed to VBT for endometrial cancer and EBRT for rectal cancer. The urethra was contoured on CT imaging to calculate radiation doses in centigray (cGy). The primary outcome was the percent of treatment radiation dose estimated to be received by the urethra based on the volume dose to 0.2 cc of urethra. Secondary outcomes were point doses to the bladder neck, mid-urethra, and total mean urethral dose. Descriptive statistics described demographic characteristics. Bivariate analyses compared urethral radiation dose based on radiation modality. RESULTS Between 2014-2017, 32 women treated were included: 18 with VBT and 14 with EBRT. Mean ± SD urethral volume doses were lower in VBT (1266 cGy ± 533, 42.2% of prescribed treatment dose) compared to EBRT (5051 cGy ± 192, 100.2% of prescribed treatment dose), p < 0.0001. VBT also had significantly lower mean total urethral dose and point doses to bladder neck and mid- urethra compared to EBRT (p < 0.0001). CONCLUSIONS The female urethra is exposed to significantly less radiation in VBT compared to EBRT. These data highlight that modality of pelvic radiation should be considered in treatment counseling on urinary incontinence in women.
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Affiliation(s)
- Katherine Hines
- Wake Forest Department of Urology, Division of Female Pelvic Health, Winston-Salem, NC, USA
| | - Karina Nieto
- Wake Forest Department of Radiation Oncology, Winston-Salem, NC, USA
| | - William Dezarn
- Wake Forest Department of Radiation Oncology, Winston-Salem, NC, USA
| | - Kathryn Greven
- Wake Forest Department of Radiation Oncology, Winston-Salem, NC, USA
| | - Bridget Krol
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Catherine Matthews
- Wake Forest Department of Urology, Division of Female Pelvic Health, Winston-Salem, NC, USA
| | - Candace Parker-Autry
- Wake Forest Department of Urology, Division of Female Pelvic Health, Winston-Salem, NC, USA.
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Bernard S, Tandon P, Waters A, Selmani S, Wiebe E, Turner J, Dufour S, McNeely ML. Preferences, barriers and facilitators regarding virtual pelvic healthcare in individuals with gynaecological cancers: protocol for a patient-oriented, mixed-methods study. BMJ Open 2023; 13:e067606. [PMID: 36697045 PMCID: PMC9884898 DOI: 10.1136/bmjopen-2022-067606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Vaginal pain during intercourse and urinary incontinence are common complaints after gynaecological cancer treatments. Pelvic health physiotherapy treatments aim at optimising function through education on the use of vaginal moisturisers, dilation therapy programme and pelvic floor muscle training. Given that barriers such as time, travel, and costs are known to limit access to physiotherapy services, a virtual pelvic health physiotherapy programme may help to facilitate access. The primary objective of this study is to identify preferences, barriers and facilitators from individuals with gynaecological cancer regarding virtual pelvic healthcare survivorship care. METHODS AND ANALYSIS This patient-oriented, mixed-methods study will involve an online cross-sectional survey data (phase I) and qualitative data from a series of virtual focus groups (phase II). PHASE I an anonymous survey will be used to assess the demographics, health status, prevalence of urogenital symptoms, as well as knowledge, barriers and facilitators to pelvic health services of people with gynaecological cancer. A total of N=50 participants from Canada will be recruited through convenience and self-selection sampling. PHASE II a series of virtual semi-structured focus groups will be conducted with 10-15 participants on key topics related to virtual pelvic healthcare. Interviews will be audio-recorded and transcribed, from which key themes and quotes will be identified. An interpretive description qualitative method will guide analysis and implementation of results. ETHICS AND DISSEMINATION Approval from the Health Research Ethics Board of Alberta-Cancer Committee (HREBA.CC-21-0498) and of the CISSS Bas-Saint-Laurent (CISSSBSL-2021-10) have been obtained. Informed, electronically signed consent will be required from all participants. Results from this work will be published in a peer-reviewed journal and will be used to inform the development and implementation of a new Pelvic eHealth Module for individuals treated for gynaecological cancers. This module will be incorporated into a comprehensive educational and exercise programme offered by a web-based application.
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Affiliation(s)
- Stéphanie Bernard
- Department of Physical Therapy, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Alexandra Waters
- Département de radio-oncologie, Centre Intégré de Santé et de Services Sociaux du Bas-St-Laurent, Rimouski, Québec, Canada
| | - Sabrina Selmani
- Département de radio-oncologie, Centre Intégré de Santé et de Services Sociaux du Bas-St-Laurent, Rimouski, Québec, Canada
| | - Ericka Wiebe
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jill Turner
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Sinead Dufour
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
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Zafarnia M, Kennes LN, Stickeler E, Hoff J, Najjari L. Evaluation of urinary continence status and its influence on quality of life after gyneco-oncological treatment of female pelvic malignancies at an oncological center. BMC Womens Health 2022; 22:422. [PMID: 36284341 DOI: 10.1186/s12905-022-01999-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Urinary incontinence (UI) could negatively affect a person's quality of life (QoL). This study investigates the association among gynecological cancers, their treatments, UI, and its effect on the QoL of survivors of gynecological cancer. This cross-sectional questionnaire-based study included 121 cases from 405 patients who had undergone gyneco-oncological therapy. The participants were asked whether they experienced any form of UI and whether it impacted their QoL. The following therapies were used to treat the 12 gynecologic tumor types found in the participants: surgery (n = 116, 95.87%), chemotherapy (CTx) (n = 51, 42.2%), radiotherapy (RTx) (n = 31, 25.6%), and antibody therapy (ABT) (n = 11, 9.1%). No significant association was determined between tumor type and UI. However, body mass index (BMI), radical hysterectomy, vulvar or vaginal surgery, and presence of UI before treatment had significant impacts on the presence of UI. The surgical access routes, CTx, ABT, and hysterectomy had significant impacts on the severity of UI after treatment. Among all patients, 55.4% reported very good QoL. These reports of good QoL by patients could be due to their very good adjustment to the situation, with regard to being diagnosed with and receiving treatment for cancer, or due to the patients considering UI to not be much of an issue. Additionally, 34% of patients reported they had not been informed about the risk of UI before treatment. Informing patients about UI as one of the risks of therapy before initiating the treatment is crucial as patients who had been informed beforehand coped with UI far better than those who were not informed. Hence, the treatment of UI is often successful, so patients should be encouraged to receive urogynecological consultation.
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Anderson C, Olshan AF, Park J, Bae-Jump VL, Brewster WR, Lund JL, Nichols HB. Adverse Urinary System Diagnoses among Older Women with Endometrial Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1368-1375. [PMID: 35545287 DOI: 10.1158/1055-9965.epi-22-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endometrial cancer and its treatment may impact urinary system function, but few large-scale studies have examined urinary diagnoses among endometrial cancer survivors. We investigated the risk of several urinary outcomes among older women with endometrial cancer compared with similar women without a cancer history. METHODS Women aged 66+ years with an endometrial cancer diagnosis during 2004-2017 (N = 44,386) and women without a cancer history (N = 221,219) matched 1:5 on exact age, race/ethnicity, and state were identified in the Surveillance, Epidemiology, and End Results-Medicare linked data. ICD-9 and -10 diagnosis codes were used to define urinary outcomes in the Medicare claims. HRs for urinary outcomes were estimated using multivariable Cox proportional hazards regression models. RESULTS Relative to women without cancer, endometrial cancer survivors were at an increased risk of several urinary system diagnoses, including lower urinary tract infection [HR, 2.36; 95% confidence interval (CI), 2.32-2.40], urinary calculus (HR, 2.22; 95% CI, 2.13-2.31), renal failure (HR, 2.28; 95% CI, 2.23-2.33), and chronic kidney disease (HR, 1.85; 95% CI, 1.81-1.90). Similar associations were observed in sensitivity analyses limited to 1+ and 5+ years after endometrial cancer diagnosis. Black race, higher comorbidity index, higher stage or grade cancer, non-endometrioid histology, and treatment with chemotherapy and/or radiation were often significant predictors of urinary outcomes among endometrial cancer survivors. CONCLUSIONS Our results suggest that, among older women, the risk of urinary outcomes is elevated after endometrial cancer. IMPACT Monitoring for urinary diseases may be a critical part of long-term survivorship care for older women with an endometrial cancer history.
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Affiliation(s)
- Chelsea Anderson
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Jihye Park
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Victoria L Bae-Jump
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Wendy R Brewster
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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Oplawski M, Średnicka A, Dutka A, Tim S, Mazur-Bialy A. Functional Changes of the Genitourinary and Gastrointestinal Systems before and after the Treatment of Endometrial Cancer-A Systematic Review. J Clin Med 2021; 10:5579. [PMID: 34884279 DOI: 10.3390/jcm10235579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary Endometrial cancer is currently one of the most common gynecological cancer and accounts for around 5% of all female cancers. The treatment strategy most often includes surgery and adjuvant radiation therapy. Thanks to the high effectiveness of used treatment methods, the patients can live longer lives. Unfortunately their quality of life can be negatively affected by side effects resulting from weakening pelvic floor such as urinary incontinence, pelvic organ prolapse and fecal incontinence. In our paper we analyzed the studies published between 2010 and 2020 that touch upon the prevalence and management of pelvic floor dysfunction in endometrial cancer patients. Our results show increase in the incidence of pelvic floor disorders after various forms of endometrial cancer treatment and the need for more good quality research in the subject to be able to provide patients with holistic care focused on minimizing treatment side effects and prioritizing their quality of life. Abstract The incidence of endometrial cancer (EC), which coexists with such civilization diseases as diabetes, obesity or hypertension, is constantly increasing. Treatment includes surgery as well as brachytherapy, teletherapy, rarely chemotherapy or hormone therapy. Due to the good results of the treatment, the occurrence of side effects of therapy becomes a problem for the patients. One of the large groups of side effects includes the pelvic organ prolapse, urinary and fecal incontinence. The aim of this study was to present current knowledge on the occurrence of pelvic floor dysfunction in women treated for EC. A literature review was conducted in the PubMED and WoS databases, including articles on pelvic floor dysfunction in women with EC. PRISMA principles were followed in the research methodology. A total of 1361 publications were retrieved. Based on the inclusion and exclusion criteria, 24 papers were eligible for the review. Mostly retrospective studies based on different questionnaires were evaluated. No prospective studies were found in which, in addition to subjective assessment, clinical examination and objective assessment of urinary incontinence were used. Studies show a significant increase in the incidence of pelvic floor disorders, including urinary incontinence, after various forms of EC treatment. We believe that assessment of complications after endometrial cancer treatment is clinically relevant. The review emphasizes the importance of programming prospective studies to prevent and address these disorders at each stage of oncologic treatment.
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Ziętek-Strobl A, Futyma K, Kuna-Broniowska I, Wojtaś M, Rechberger T. Urogynaecological Symptoms among Oncological Survivors and Impact of Oncological Treatment on Pelvic Floor Disorders and Lower Urinary Tract Symptoms. A Six-Month Follow-Up Study. J Clin Med 2020; 9:E2804. [PMID: 32872660 DOI: 10.3390/jcm9092804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022] Open
Abstract
It has been widely underlined that both gynaecological malignancies and urogynaecological disorders are often associated with high stress and have a negative impact on the quality of life and psychological well-being of women affected. Knowledge of the pelvic anatomy is crucial in recommending and carrying out the least harmful although successful treatment. Subsequent chemoradiation may also induce or exaggerate troublesome symptoms. The aim of the study was to establish the frequency of urogynaecological symptoms (stress urinary incontinence, urgency, pelvic organ prolapse) and to assess the impact of surgical treatment and additional oncological therapy: pelvic radiation, chemoradiation, chemotherapy, on the prevalence of pelvic floor dysfunctions (PFD) and lower urinary tract symptoms (LUTS) in patients suffering from gynecological malignancies. The study group consisted of 160 women, diagnosed with gynaecological malignancy, who underwent surgical treatment and additional adjuvant treatment as necessary. To establish the QoL and prevalence of PFD Urinary Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire 7 (II-Q7), King’s Health Questionnaire (KHQ) and the SF-36 Questionnaire were used. Herein, 69 patients reported urinary incontinence (UI) and 67 reported symptoms of pelvic organ prolapse (POP). After the six months follow-up UI was found in 78 patients, 25 patients showed de novo symptoms, 65 patients reported POP and 10 patients demonstrated de novo POP. Our data show that urogynaecological symptoms are not correlated with the type of malignancy, but with the extensiveness of surgery.
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Strauchon CJ, Dengler KL, Gruber DD, Katebi Kashi P, Aungst MJ, Trikhacheva A, Bicher A, Von Pechmann W. Urinary symptoms in women receiving carboplatin/paclitaxel for treatment of gynecologic cancers. Int J Gynecol Cancer 2020; 30:1418-1423. [PMID: 32655011 DOI: 10.1136/ijgc-2020-001529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Urinary incontinence is estimated to affect up to 34% of women with gynecologic cancers. Chemotherapeutic effects on urinary symptoms have been scarcely studied. The aim of our study was to examine the impact of carboplatin/paclitaxel chemotherapy on urinary symptoms. METHODS This was a prospective cohort study of all women undergoing adjuvant chemotherapy with carboplatin/paclitaxel after their primary debulking surgery for ovarian, fallopian tube, peritoneal, or endometrial cancers performed at a tertiary medical center by board certified gynecologic oncologists. We used validated questionnaires (incontinence impact questionnaire (IIQ-7), medical, epidemiologic, and social aspects of aging (MESA), urogenital distress inventory (UDI-6), the Sandvik severity index, and functional assessment of cancer therapy/GynecologicOncology Group-neurotoxicity (FACT/GOG-Ntx)) to assess the effects of carboplatin/paclitaxel therapy on the incidence and severity of urinary incontinence at three time points during the participants' chemotherapy regimen: start of chemotherapy (pretreatment), during the fifth chemotherapy cycle (mid-cycle), and during the 6-12 week post-chemotherapy visit (post-treatment). RESULTS We identified 62 women with ovarian, fallopian, peritoneal, and endometrial cancer who received carboplatin/paclitaxel therapy between May 2009 and December 2012 who met all of the inclusion criteria. Analysis of median IIQ-7 scores, across all time points, showed a statistically significant difference (0.0 (0.0 to 4.8), 0.0 (0.0 to 7.1), 0.0 (0.0 to 0.0), p=0.002, respectively). Examining pairwise differences between two treatment points, IIQ-7 pretreatment versus mid-treatment and pretreatment versus post-treatment, did not achieve significance (0.0 (0.0 to 2.4), p=0.13 and 0.0 (0.0 to 0.0), p>0.999, respectively), but the decrease in IIQ-7 mid-treatment versus post-treatment was statistically significant (0.0 (-2.4 to 0.0), p=0.003). Generalized estimating equation model analysis also showed significant changes in both median MESA for urge urinary incontinence (MESA-UUI) and median MESA for stress urinary incontinence (MESA-SUI) across all time points (p=0.003 and p=0.009, respectively). MESA-UUI and MESA-SUI pretreatment versus mid-treatment analysis achieved significance (2.0 (0.0 to 4.0), p=0.003 and 0.0 (0.0 to 2.0), p=0.01, respectively), demonstrating an increase in the incidence of stress urinary incontinence and urge urinary incontinence. There was a statistically significant association between the changes in FACT and UDI-6 scores from pretreatment versus mid-treatment, with a correlation coefficient of 0.37 (95% CI 0.08 to 0.61, p=0.005). CONCLUSION The study achieved its primary aim in demonstrating an impact of carboplatin/paclitaxel therapy on urinary incontinence severity and suggests if may be a factor leading to new onset or worsening urinary incontinence. As quality of life can be significantly impacted by these chemotherapeutic changes, further investigation is warranted to determine if the effects on urinary incontinence and neuropathy are transient or permanent.
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Affiliation(s)
| | - Katherine L Dengler
- Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Daniel D Gruber
- Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Payam Katebi Kashi
- Division of Gynecologic Oncology, Department of Ob/Gyn, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Mattew J Aungst
- Division of Urogynecology, Department of Obstetrics and Gynecology, Geisinger Health, Danville, Pennsylvania, USA
| | - Ann Trikhacheva
- Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Annette Bicher
- Division of Gynecology Oncology, Mid Atlantic Gynecology Oncology and Pelvic Surgery Associates, Fairfax, Virginia, USA
| | - Walter Von Pechmann
- Division of Urogynecology and Pelvic Surgery, Mid-Atlantic Urogynecology and Pelvic Surgery, Annandale, Virginia, USA
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Bochenska K, Mueller M, Geynisman-Tan J, Leader-Cramer A, Davé B, Lewicky-Gaupp C, Kenton K. Concomitant Repair of Pelvic Floor Disorders in Women Undergoing Surgery for Gynecologic Malignancies. Female Pelvic Med Reconstr Surg 2019; 25:362-4. [PMID: 29621040 DOI: 10.1097/SPV.0000000000000579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of this study were to determine the rate and describe 30-day postoperative complications of concomitant pelvic organ prolapse and/or urinary incontinence (POPUI) procedures in women undergoing surgery for a gynecologic malignancy. METHODS Women who underwent surgical intervention for a gynecologic malignancy between 2010 and 2014 were identified using postoperative International Classification of Diseases, Ninth Revision codes 179.0 to 184.9 in the American College of Surgeons National Surgical Quality Improvement Program database. Women who underwent POPUI procedures were identified using Current Procedural Terminology codes between 51840 and 58294. Infectious, pulmonary, cardiac, and venous thromboembolism complication rates were calculated. Patient demographics and postoperative complication rates were analyzed using Student t, χ, and Fisher exact tests and compared between women with a gynecologic malignancy who did and did not undergo concomitant POPUI procedures. RESULTS We identified 23,501 women with a diagnosis of a gynecologic malignancy. The most common included uterine (63%), ovarian (25%), and cervical cancer (8%). Only a small proportion of the women undergoing gynecologic cancer surgery (n = 556 [2.4%]) had concomitant POPUI procedures. The most commonly performed POPUI procedures included anterior and/or posterior colporrhaphy (n = 205 [32%]), laparoscopic colpopexy (n = 181 [28.2%]), and midurethral sling (n = 70 [10.9%]). There were no differences in 30-day reoperation; infectious, pulmonary, and cardiac complications; or venous thromboembolic events between women who did and did not have concomitant POPUI surgery. CONCLUSIONS Using a large national surgical database, only 2.4% of women undergoing gynecologic cancer surgery had a concomitant POPUI procedure. Our data suggest that postoperative complications may not increase when concomitant surgery for POPUI is done at the time of gynecologic cancer surgery.
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Soisson S, Ganz PA, Gaffney D, Rowe K, Snyder J, Wan Y, Deshmukh V, Newman M, Fraser A, Smith K, Herget K, Hanson HA, Wu YP, Stanford J, Al-Sarray A, Werner TL, Setiawan VW, Hashibe M. Long-term Cardiovascular Outcomes Among Endometrial Cancer Survivors in a Large, Population-Based Cohort Study. J Natl Cancer Inst 2019; 110:1342-1351. [PMID: 29741696 DOI: 10.1016/j.ygyno.2017.12.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/20/2017] [Accepted: 03/16/2018] [Indexed: 12/24/2022] Open
Abstract
Background Endometrial cancer is the second most common cancer among female cancer survivors in the United States. Cardiovascular disease is the leading cause of death among endometrial cancer survivors. Studies that examine long-term cardiovascular outcomes among endometrial cancer survivors are critical. Methods Cohorts of 2648 endometrial cancer survivors diagnosed between 1997 and 2012 and 10 503 age-matched women from the general population were identified. Cardiovascular disease diagnoses were identified from electronic medical records and statewide ambulatory surgery and statewide inpatient data. Cox regression models were used to estimate hazard ratios (HRs) at one to five years, more than five to 10 years, and more than 10 years after cancer diagnosis. Results Between one and five years after diagnosis, increased cardiovascular risks among endometrial cancer survivors were observed for phlebitis, thrombophlebitis, and thromboembolism (HR = 2.07, 99% confidence interval [CI] = 1.57 to 2.72), pulmonary heart disease (HR = 1.74, 99% CI = 1.26 to 2.40), and atrial fibrillation (HR = 1.50, 99% CI = 1.07 to 2.11). At more than five to 10 years, some elevated risk persisted for cardiovascular diseases. Compared with patients who had surgery, patients who additionally had radiation therapy and/or chemotherapy were at increased risk for heart and circulatory system disorders between one and five years after cancer diagnosis. Older age and obesity were also risk factors for hypertension and heart disease among endometrial cancer survivors. Conclusions Endometrial cancer survivors are at higher risk for various adverse long-term cardiovascular outcomes compared with women from the general population. This study suggests that increased monitoring for cardiovascular diseases may be necessary for endometrial cancer patients for 10 years after cancer diagnosis.
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Affiliation(s)
- Sean Soisson
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Intermountain Healthcare, Salt Lake City, UT
| | - Yuan Wan
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Mike Newman
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Alison Fraser
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Ken Smith
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Heidi A Hanson
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Yelena P Wu
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ali Al-Sarray
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Theresa L Werner
- Division of Oncology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Veronica W Setiawan
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
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Lipetskaia L, Sharma S, Johnson MS, Ostergard DR, Francis S. Urinary incontinence and quality of life in endometrial cancer patients after robotic-assisted laparoscopic hysterectomy with lymph node dissection. J OBSTET GYNAECOL 2019; 39:986-990. [PMID: 31177880 DOI: 10.1080/01443615.2019.1584887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To determine the long-term effects of lymph node dissection on lower urinary tract symptoms in patients treated for endometrial cancer. We conducted a retrospective cohort study of 74 patients with International Federation of Gynaecology and Obstetrics (FIGO) Stage I endometrial cancer who underwent surgical intervention with and without lymph node dissection, and evaluated them with the Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Patients who underwent lymph node dissection reported higher but not statistically different rates of bother by lower urinary tract symptoms compared to those without lymph node dissection. The scores for the lymph node dissection group and the control group were a mean IIQ-7 score of 14.9 ± 23 and 10.5 ± 22.9 (p=.419) and a mean UDI-6 score of 30.0 ± 25.3 and 20.7 ± 22.9 (p=.104), respectively. Lymph node dissection at the time of robotic-assisted surgery did not have a significant effect on lower urinary tract symptoms nor did it affect patient responses on quality of life questionnaires. IMPACT STATEMENT What is already known on this subject? The aetiology of urinary incontinence is multifactorial and there has been debate on how a patient's surgical history affects their risk of developing urinary incontinence. Prior studies have highlighted the relationship between hysterectomy and urinary incontinence (Milsom et al. 1993 ). Additional research has also been done to elucidate the prevalence of pelvic floor disorders in patients who have been surgically treated for endometrial cancer (Erekson et al. 2009 ; Nosti et al. 2012 ). There is limited information on how robotic-assisted lymphadenectomy during surgical staging for endometrial cancer affects patients' urinary function and their quality of life. What do the results of this study add? In this manuscript, we demonstrate that patients who underwent robotic-assisted total laparoscopic hysterectomy (TLH) with lymphadenectomy neither had significant difference in lower urinary tract symptoms nor on quality of life questionnaires as compared to those who did not undergo lymphadenectomy. Worsening of quality of life in regards to urinary incontinence should not be considered a factor of long term surgical morbidity associated with lymph node dissection. What are the implications of these findings for clinical practice and/or further research? There is a need for further studies that focus on the prevalence of pelvic floor disorders in patients after undergoing surgical staging for endometrial cancer and potential interventions that may address these issues.
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Affiliation(s)
- Lioudmila Lipetskaia
- Department of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville , Lousiville , KY , USA
| | - Shefali Sharma
- Department of Female Pelvic Medicine & Reconstructive Surgery, Cooper University Hospital , Camden , NJ , USA
| | - Marian S Johnson
- Department of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville , Lousiville , KY , USA
| | - Donald R Ostergard
- Department of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville , Lousiville , KY , USA
| | - Sean Francis
- Department of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville , Lousiville , KY , USA
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Bretschneider CE, Sheyn D, Mahajan ST, Ferrando CA. Adverse Events After Concurrent Procedures for Gynecologic Malignancies and Pelvic Floor Disorders. Obstet Gynecol 2018; 132:274-80. [DOI: 10.1097/aog.0000000000002731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Higgs P, Janda M, Asher R, Gebski V, Forder P, Obermair A. Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer. Am J Obstet Gynecol 2018; 218:419.e1-419.e14. [PMID: 29305254 DOI: 10.1016/j.ajog.2017.12.233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/15/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer. OBJECTIVE We sought to evaluate pelvic floor function in women who have had surgical treatment for early-stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium trial and to compare patients' outcomes who had total abdominal vs total laparoscopic hysterectomy. STUDY DESIGN A multinational, phase III, randomized noninferiority trial compared disease-free survival of patients who had total abdominal hysterectomy vs total laparoscopic hysterectomy. This substudy analyzes the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory) administered preoperatively, and at follow-up visits 6, 18, 30, 42, and 54 months postoperatively. RESULTS Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy, n = 195; total laparoscopic hysterectomy, n = 186). At 6 months postsurgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor well-being (total abdominal hysterectomy: mean change -11.17; 95% confidence interval, -17.11 to -5.24; total laparoscopic hysterectomy: mean change -10.25; 95% confidence interval, -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months postsurgery. CONCLUSION These findings suggest that pelvic floor function in terms of urinary, bowel, and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early-stage endometrial cancer.
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Affiliation(s)
- Peta Higgs
- Department of Urogynecology, Buderim Private Hospital, Buderim, Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Center, University of Sydney, Sydney, Australia
| | - Val Gebski
- Research Center for Generational Health and Aging, University of Newcastle, Newcastle, Australia
| | - Peta Forder
- Research Center for Generational Health and Aging, University of Newcastle, Newcastle, Australia
| | - Andreas Obermair
- Queensland Center for Gynecological Cancer and Faculty of Medicine, University of Queensland, Brisbane, Australia.
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Lunacek L, Gärtner M, Krhut J, Mika D, Sykora R, Zvara P. Evaluation of intra-individual test-re-test variability of uroflowmetry in healthy women and women suffering from stress, urge, and mixed urinary incontinence. Int Urogynecol J 2018; 29:1523-7. [PMID: 29478111 DOI: 10.1007/s00192-018-3571-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the intra-individual variability of uroflowmetry (UFM) in healthy control subjects and women suffering from stress, urge, and mixed urinary incontinence. METHODS A total of 35 healthy controls (group A) and 105 women suffering from urinary incontinence were enrolled in the study. Thirty-five women suffered from stress urinary incontinence (group B), 35 women suffered from mixed urinary incontinence (group C), and 35 women with overactive bladder both dry and wet (group D). All participants were asked to perform UFM measurement three times. The following parameters were analyzed: voided volume (VV), peak flow (Qmax), average flow (Qave), volume-corrected peak flow cQmax (cQmax = Qmax/2√ VV), volume-corrected average flow (cQave = Qave/2√ VV), and postvoid residual volume (PVR). Statistical analysis was performed using the analysis of variance on repeated measurements. Relative error was calculated using variation coefficients reported as a percentage of the average. All descriptive characteristics were reported as means ± standard deviation (SD). p values ≤0.05 were considered statistically significant. RESULTS No statistically significant intra-individual difference in any of the recorded parameters was identified among the three UFM recordings in groups A, C, and D. The intra-individual variability of the following parameters reached statistical significance in patients suffering from stress urinary incontinence (group B): Qmax (p = 0.0016), Qave (p = 0.0005), and cQave (p = 0.0389). A significant difference was only observed in comparison between the first and second consecutive recordings. CONCLUSIONS This study provides evidence supporting the high yield and good intra-individual reproducibility of UFM.
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Ramaseshan AS, Felton J, Roque D, Rao G, Shipper AG, Sanses TVD. Pelvic floor disorders in women with gynecologic malignancies: a systematic review. Int Urogynecol J 2017; 29:459-476. [PMID: 28929201 DOI: 10.1007/s00192-017-3467-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/18/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor disorders (PFDs) negatively affect quality of life in the general population, and their prevalence in gynecologic cancer survivors has not been systematically described. This study aimed to determine the prevalence of PFDs in cancer survivors. We hypothesized that the prevalence of PFDs in the gynecologic cancer population would be higher than in the general female population. METHODS We searched PubMed (1809 to present), EMBASE (1974 to present), and the Cochrane Central Register of Controlled Trials (CENTRAL) through May 2017. The search combined subject headings, title, and abstract words for gynecologic cancer, PFDs, and prevalence. Any studies evaluating the prevalence of PFDs in gynecologic malignancies were included. RESULTS A total of 550 articles met the designated search criteria and 31 articles were included in this review. In cervical cancer survivors, before treatment the prevalences of stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and fecal incontinence (FI) were 24-29%, 8-18% and 6%, respectively, and after treatment the prevalences of SUI, UUI, urinary retention, FI, fecal urge, dyspareunia and vaginal dryness were 4-76%, 4-59%, 0.4-39%, 2-34%, 3-49%, 12-58% and 15-47%, respectively. In uterine cancer survivors, before treatment the prevalences of SUI, UUI and FI were 29-36%, 15-25% and 3%, respectively, and after treatment the prevalences of urinary incontinence (UI) and dyspareunia were 2-44% and 7-39%, respectively. In vulvar cancer survivors, after treatment the prevalences of UI, SUI and FI were 4-32%, 6-20% and 1-20%, respectively. In ovarian cancer survivors, the prevalences of SUI, UUI, prolapse and sexual dysfunction were 32-42%, 15-39%, 17% and 62-75%, respectively. CONCLUSIONS PFDs are prevalent in gynecologic cancer survivors and this is an important area of clinical concern and future research.
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Affiliation(s)
- Aparna S Ramaseshan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, USA.
| | - Jessica Felton
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dana Roque
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, USA
| | - Gautam Rao
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, USA
| | - Andrea G Shipper
- Health Sciences & Human Services Library, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tatiana V D Sanses
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, USA
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Bernard S, Moffet H, Plante M, Ouellet MP, Leblond J, Dumoulin C. Pelvic-Floor Properties in Women Reporting Urinary Incontinence After Surgery and Radiotherapy for Endometrial Cancer. Phys Ther 2017; 97:438-448. [PMID: 28201796 DOI: 10.1093/ptj/pzx012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Endometrial cancer is the fourth most prevalent cancer in Canadian women. Radiotherapy (RT) is frequently recommended as an adjuvant treatment. There is a high prevalence (>80%) of urinary incontinence (UI) after RT. It is plausible that UI is associated, at least in part, with alterations of the pelvic-floor muscles (PFM). OBJECTIVE The aim of this exploratory study was to compare the PFM functional properties of women reporting UI after hysterectomy and RT for endometrial cancer with those of women with a history of hysterectomy but without UI. DESIGN A descriptive cross-sectional study was conducted. Eleven women were recruited for the affected group, and 18 were recruited for the comparison group. METHODS Urogenital and bowel functions were assessed using International Consultation on Incontinence Questionnaires, and PFM properties were evaluated using a Montreal dynamometer. Nonparametric tests were used for comparison of personal characteristics, functional status, and muscle properties. A correspondence analysis detailed the association between UI severity and PFM properties. RESULTS Maximal opening of dynamometer branches, maximal vaginal length, PFM maximum force and rate of force development in a strength test, and number of rapid contractions during a speed test were reduced in the affected group. No significant difference was found for the endurance test. The severity of UI was found to correspond to the rate of force development and the number of rapid contractions in a speed test, endurance, age, and vaginal length. LIMITATIONS The results are limited to the population studied. The small sample size limited the strength of the conclusions. CONCLUSIONS Some evidence of alterations in PFM properties were found in women with UI after hysterectomy and RT for endometrial cancer. These alterations appeared to be associated with UI, suggesting a possible role for rehabilitation.
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Segal S, John G, Sammel M, Andy UU, Chu C, Arya LA, Brown J, Schmitz K. Urinary incontinence and other pelvic floor disorders after radiation therapy in endometrial cancer survivors. Maturitas 2017; 105:83-88. [PMID: 28396018 DOI: 10.1016/j.maturitas.2017.03.313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate radiation therapy as a risk factor for urinary or fecal incontinence, pelvic organ prolapse, and sexual dysfunction in endometrial cancer survivors. STUDY DESIGN We performed a retrospective cohort study of endometrial cancer survivors. Data were collected using a mailed survey and the medical record. Validated questionnaires were used to generate rates of urinary incontinence and other pelvic floor disorders. The incidence rates of pelvic floor disorders were compared across groups with different exposures to radiation. RESULTS Of the 149 endometrial cancer survivors, 41% received radiation therapy. Fifty-one percent of women reported urine leakage. The rates of urinary incontinence in women exposed and not exposed to vaginal brachytherapy (VBT) or whole-pelvis radiation were 48% and 58%, respectively (p=0.47). The incidence of fecal incontinence did not differ between groups, but the score for overall sexual function was significantly higher in women who did not undergo radiation therapy. On multivariable analysis, significant risk factors for urinary incontinence were age (AOR 1.06 95% CI 1.02, 1.10) and BMI (AOR 1.07 95% CI 1.02, 1.11), but treatment with radiation was not significantly associated with urinary incontinence, or fecal incontinence (p>0.05). Age, BMI, and radiation exposure were independent predictors of decreased sexual function score (p<0.01). CONCLUSION Local or regional radiation is not associated with urinary or fecal incontinence, but may contribute to sexual dysfunction in endometrial cancer survivors.
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Affiliation(s)
- Saya Segal
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, and Division of Urology, Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| | - Gabriella John
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Mary Sammel
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Uduak Umoh Andy
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA, United States
| | - Christina Chu
- Division of Gynecologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Lily A Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA, United States
| | - Justin Brown
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Kathryn Schmitz
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Abstract
INTRODUCTION Rehabilitation after cancer is important, and efficient rehabilitation requires knowledge of patient's needs. This study aimed to identify short-term rehabilitation needs of women with endometrial and cervical cancer. METHODS Ninety-six women (82.6%) were included in an exploratory questionnaire study from Odense University Hospital from September 2011 to March 2012. Needs were assessed pre-treatment and 3 months later using the three-levels-of-needs questionnaire. Furthermore, 16 women participated in focus group interviews following the treatment. The interviews were audio-recorded, transcribed verbatim and analyzed thematically. RESULTS Forty-four of the included women were diagnosed with cervical cancer (median age 45 years). Of these, 22 had FIGO-stage 1 disease (50%) and 23 received radiation therapy (52.3%). The remaining 52 women (median age 66.5 years) were diagnosed with endometrial cancer. Of these, 38 had FIGO-stage 1 disease (73.1%) and 25 were treated with laparoscopic surgery (48.1%). Emotional functioning was significantly worse prior to treatment in both the cancers (p < 0.001 cervical and p = 0.002 endometrial) and worry constituted an unmet need in 70.7% of cervical and 34.7% of endometrial cancer patients. Both the patient groups experienced significant lymphedema post-treatment [endometrial cancer (p = 0.006) and cervical cancer (p = 0.002)]. Further, urological problems were more prevalent post-treatment in endometrial cancer patients (p = 0.018), while sexual problems were of specific concern for cervical cancer patients (p = 0.029). However, in both cancer groups, the mean problem intensity scores were comparable to normative data, suggesting that the majority of patients will not require extensive rehabilitation. Qualitative analysis indicated that treatment modality and marital status severely impacted on coping, suggesting that irradiated and single women are at higher risk of developing rehabilitation needs. Additionally, women younger than 55 years more often requested help dealing with sexual and psychological complications. DISCUSSION Women with endometrial and cervical cancer experience emotional problems prior to therapy and lymphedema, and urological and sexual problems following treatment. An awareness of these problems may facilitate early identification of women with unmet needs and enable individualized follow-up adjusted for such patient's needs. Interventions aimed at improving sexual and psychological functioning should be available.
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Affiliation(s)
- Mette Moustgaard Jeppesen
- a Department of Gynecology and Obstetrics, Faculty of Health Sciences , Odense University Hospital, Clinical Institute, University of Southern Denmark , Odense , Denmark
| | - Ole Mogensen
- a Department of Gynecology and Obstetrics, Faculty of Health Sciences , Odense University Hospital, Clinical Institute, University of Southern Denmark , Odense , Denmark
| | - Pernille Dehn
- a Department of Gynecology and Obstetrics, Faculty of Health Sciences , Odense University Hospital, Clinical Institute, University of Southern Denmark , Odense , Denmark
| | - Pernille Tine Jensen
- a Department of Gynecology and Obstetrics, Faculty of Health Sciences , Odense University Hospital, Clinical Institute, University of Southern Denmark , Odense , Denmark
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Robison K, Lokich E, Raman S, Luis C, Raker C, Clark MA, Wohlrab K. Cancer of the uterus and treatment of stress incontinence: a pilot study. Am J Obstet Gynecol 2016; 214:760-1. [PMID: 26884270 DOI: 10.1016/j.ajog.2016.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/24/2022]
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Greear G, Lefkowits C, Parrillo LM, Flynn BJ. Incontinence, Voiding Dysfunction, and Other Urologic Complications After Radiotherapy for Gynecologic Malignancies. Curr Bladder Dysfunct Rep 2016. [DOI: 10.1007/s11884-016-0354-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Zeleke BM, Bell RJ, Billah B, Davis SR. Symptomatic pelvic floor disorders in community-dwelling older Australian women. Maturitas 2016; 85:34-41. [DOI: 10.1016/j.maturitas.2015.12.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
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Krhut J, Martan A, Jurakova M, Nemec D, Masata J, Zvara P. Treatment of stress urinary incontinence using polyacrylamide hydrogel in women after radiotherapy: 1-year follow-up. Int Urogynecol J 2016; 27:301-5. [DOI: 10.1007/s00192-015-2834-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
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Flamos C, Bracken M. Utilization of the Acronym ALBUMINS to Screen Gynecologic Cancer Survivors. J Nurse Pract 2015; 11:430-435. [DOI: 10.1016/j.nurpra.2015.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Stress urinary incontinence (SUI) is a major problem affecting more than 20% of the nation's female population, with increasing prevalence as our population continues to age. Incontinence places a great burden on individuals, and the economic effect is large. Stress urinary incontinence occurs when there is involuntary leakage of urine during coughing, laughing, sneezing, or physical activity. It can be diagnosed during physical examination and by using low-cost office diagnostics. Although nonsurgical treatments provide some benefit, surgical interventions have demonstrated superiority with respect to subjective and objective cure and better long-term improvement. Corrective surgeries for SUI can be grouped into four categories: 1) slings (midurethral slings and slings placed at the ureterovesical junction), 2) retropubic urethropexy, 3) urethral bulking agents, and 4) artificial sphincters. The success and failure of each approach needs to be assessed in the context of individual patients and their circumstances. Slings and retropubic urethropexy are considered first-line surgical options. Since the advent of minimally invasive retropubic midurethral slings such as the tension-free vaginal tape, transobturator tension-free vaginal tape, and single-incision sling, retropubic urethropexy have fallen out of favor. Warnings about mesh use may contribute to a resurgence of retropubic urethropexy procedures such as the Burch procedure. A Burch procedure should still be considered for patients who have an aversion to mesh or if they are undergoing concurrent abdominal approach surgery. Urethral bulking agents are usually reserved for patients with a fixed, nonmobile urethra who cannot tolerate an operative experience or have failed previous antiincontinence procedures. Artificial sphincters should be considered an operation of last resort.
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Mirabeau-beale KL, Viswanathan AN. Quality of life (QOL) in women treated for gynecologic malignancies with radiation therapy: A literature review of patient - reported outcomes. Gynecol Oncol 2014; 134:403-9. [DOI: 10.1016/j.ygyno.2014.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 11/21/2022]
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Donovan KA, Boyington AR, Judson PL, Wyman JF. Bladder and bowel symptoms in cervical and endometrial cancer survivors. Psychooncology 2014; 23:672-8. [PMID: 24481859 DOI: 10.1002/pon.3461] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 11/04/2013] [Accepted: 11/14/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies likely underestimate the prevalence of bowel and bladder symptoms in gynecologic cancer survivors. We sought to estimate the prevalence of these symptoms in cervical and endometrial cancer survivors who had completed treatment 1 year previously compared with non-cancer controls, and to examine factors associated with more severe symptoms in survivors. METHODS As part of a larger quality of life study, survivors who were 1-year posttreatment for cervical or endometrial cancer (n = 104) completed measures of bladder and bowel symptoms. An age-matched and race/ethnicity-matched sample of women with no history of cancer was recruited for comparison purposes. RESULTS Survivors reported a higher prevalence of bladder symptoms, specifically storage and incontinence symptoms, than non-cancer controls. Prevalence rates for bowel symptoms in survivors were higher than those reported in previous studies. Greater symptom severity was associated with younger age, lower annual incomes, and less education. Other correlates included higher body mass index and history of smoking. As hypothesized, more severe symptoms were associated with radical hysterectomy and pelvic radiation. CONCLUSIONS Bladder and bowel symptoms are more prevalent in cervical and endometrial cancer survivors than non-cancer controls. Future research should replicate these findings in a larger, prospective study.
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Affiliation(s)
- Kristine A Donovan
- Health Outcomes and Behavior Program, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Thomas SG, Sato HRN, Glantz JC, Doyle PJ, Buchsbaum GM. Prevalence of Symptomatic Pelvic Floor Disorders Among Gynecologic Oncology Patients. Obstet Gynecol 2013; 122:976-80. [DOI: 10.1097/aog.0b013e3182a7ef3c] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rutledge TL, Rogers R, Lee SJ, Muller CY. A pilot randomized control trial to evaluate pelvic floor muscle training for urinary incontinence among gynecologic cancer survivors. Gynecol Oncol 2013; 132:154-8. [PMID: 24183730 DOI: 10.1016/j.ygyno.2013.10.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 10/07/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We previously reported high rates of urinary incontinence among gynecologic cancer survivors and aimed to evaluate the effectiveness of a simple intervention for treatment of urinary incontinence in this population. METHODS We recruited 40 gynecologic cancer survivors who reported urinary incontinence on a validated questionnaire. Women were randomized to either pelvic floor muscle training/behavioral therapy (treatment group) or usual care (control group). The primary outcome measure, assessed at 12 weeks post intervention, was a 40% difference in the validated Patient Global Impression of Improvement (PGI-I) score. Fisher's exact test was used to identify differences between groups for frequency data; two-sample t-test was conducted for continuous measurements. RESULTS Mean age of this cohort was 57 (range: 37-79). The majority of the survivors had uterine cancer (60%), 18% had received radiation therapy, 95% had received surgical therapy, and 35% had received chemotherapy. At three months, 80% of the treatment and 40% of the control group reported that their urinary incontinence was "much better" or "very much better" as evaluated by the Patient Global Impression of Improvement scale (p=0.02). Brink's scores were significantly improved in the treatment group as compared to those of the controls (p<0.0001). Treatment group adherence was high; the treatment group performed exercises with an average of 22 days/month. CONCLUSIONS Urinary incontinence negatively affects quality of life, and despite a high prevalence among gynecologic cancer survivors, it is often under-assessed and undertreated. We found a simple intervention that included pelvic floor muscle training and behavioral therapy, which significantly improved cancer survivor's urinary incontinence.
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Affiliation(s)
- Teresa L Rutledge
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - Rebecca Rogers
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Sang-Joon Lee
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Statistics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Carolyn Y Muller
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Wilailak S, Lertkhachonsuk AA, Lohacharoenvanich N, Luengsukcharoen SC, Jirajaras M, Likitanasombat P, Sirilerttrakul S. Quality of life in gynecologic cancer survivors compared to healthy check-up women. J Gynecol Oncol 2011; 22:103-9. [PMID: 21860736 PMCID: PMC3152750 DOI: 10.3802/jgo.2011.22.2.103] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 01/24/2011] [Accepted: 02/28/2011] [Indexed: 11/30/2022] Open
Abstract
Objective The primary objective of this study was to compare quality of life of disease-free patients after therapy for gynecologic malignancies at follow-up in comparison with healthy check-up patients. Our second objective was to assess correlation between demographic data, disease and treatment factors and quality of life scores. Methods Patients completed the Functional Assessment of Cancer Therapy-General (FACT-G) quality of life questionnaire at least 6 months after treatment for a gynecologic malignancy. Responses were compared to unmatched healthy women who were seen for standard gynecologic screening examinations. Statistical calculation was done using chi-squared tests, Wilcoxon rank-sum, and Kruskal-Wallis one-way analysis and Spearman rank correlations. Factors associated with FACT-G scores were evaluated using univariate and multivariate analyses. Results Eight hundred and seventy patients were recruited. The median time since therapy was 61 months (range, 6 to 173 months). The overall FACT-G scores were higher in the patient group than in the healthy group (p<0.05). The scores of each subscale measuring physical, functional, social/family and emotional well-being were also higher in the patient group (p<0.05). Multivariate analysis revealed correlation between Eastern Cooperative Oncology Group performance status, educational level, care giver, presence of economic problems and FACT-G scores. Conclusion The quality of life scores were higher in gynecologic cancer patients after treatment. And the factors that associated with the higher score in the patient group are having husband as a caregiver, no financial problem, Eastern Cooperative Oncology Group score 0 or 1 and having high school or higher education.
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Affiliation(s)
- Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
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Cam C, Celik C, Yildirim G, Tug N, Cam M, Karateke A. Responsiveness of urogynecologic quality of life measurements to change after radical gynecologic surgery. Arch Gynecol Obstet 2010; 284:1259-63. [PMID: 21188400 DOI: 10.1007/s00404-010-1823-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 11/23/2010] [Indexed: 11/25/2022]
Abstract
AIM In order to assess the responsiveness of short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) in a subset of women undergoing radical operations for gynecologic cancer. MATERIALS AND METHODS Women with cervical cancer without any abnormal urodynamic abnormalities who had undergone Class III hysterectomy were included in the study. All women underwent urodynamic investigation and completed the IIQ-7 and UDI-6 questionnaires pre-operatively and post-operatively in the sixth month. Twenty-eight patients were enrolled and general and subscale scores of the questionnaire were calculated in the study between February 2008 and September 2008. RESULTS Class III hysterectomy was performed in 28 women with stage Ib cervical carcinoma. Scores of IIQ-7 and the irritative and obstructive subscales of UDI-6 in the sixth post-operative month were significantly higher than the pre-operative scores. The Cronbach's α was 0.84. Cystometric parameters were in concordance with these changes in the questionnaire scores. CONCLUSION The IIQ-7 and UDI-6 questionnaires are sensitive to changes in patients who have undergone radical oncologic operations because their life impact of incontinence may be affected. Validated questionnaires are reasonable measures to detect these changes, which are confirmed by urodynamic findings.
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Affiliation(s)
- Cetin Cam
- Department of Obstetrics and Gynecology, Zeynep Kamil teaching hospital, Ahcibasi mahallesi, Arakiyeci sokak 45/8 Uskudar, Istanbul, Turkey.
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Walsh CA, Allen W, Moore KH. ‘Urinary incontinence’ post-radiotherapy: A diagnostic conundrum. J OBSTET GYNAECOL 2010; 30:424-5. [DOI: 10.3109/01443611003725464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- C. A. Walsh
- Pelvic Floor Unit, St George Hospital, University of New South Wales, Sydney, Australia
| | - W. Allen
- Pelvic Floor Unit, St George Hospital, University of New South Wales, Sydney, Australia
| | - K. H. Moore
- Pelvic Floor Unit, St George Hospital, University of New South Wales, Sydney, Australia
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:46-51. [DOI: 10.1097/spc.0b013e3283372479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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