History Of Gynecologic Cancer Research Articles

Experience of healthcare discrimination among individuals with a history of gynecologic cancer in the All of Us research program

Experience of healthcare discrimination among individuals with a history of gynecologic cancer in the All of Us research program

Analysis of assisted reproductive outcomes for gynecologic cancer survivors: a retrospective study

ObjectiveTo examine the reproductive outcomes of assisted reproductive technology (ART) in gynecologic cancer patients and to assess maternal and neonatal complications.MethodsWomen diagnosed with gynecologic cancer who underwent their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment between 2013 and 2021 at Shanghai Ji Ai Genetics and IVF Institute were included in this study. Infertile women without any history of cancer were matched to the cancer group. The primary outcome was the cumulative live birth rate. Baseline and follow-up data were compared between groups using Student’s t-tests for normally distributed variables and with Chi-square test for categorical variables. A propensity score-based patient-matching approach was adopted to ensure comparability between individuals with and without specific cancer type.ResultsA total of 136 patients with a history of gynecologic cancer and 241 healthy infertile controls were included in this study. Endometrial cancer constituted 50.70% of the cases and cervical cancer constituted 34.60% of the cases. The cancer group exhibited significantly shorter duration of stimulation, lower levels of estradiol, lower number of retrieved oocytes, day-3 embryos, and blastocysts compared to the control group (P < 0.05). The cumulative live birth rate of the gynecologic cancer group was significantly lower than that of the control group (36.10% vs. 60.50%, P < 0.001). Maternal and neonatal complications did not significantly differ between the groups (P > 0.05). The endometrial cancer and cervical cancer groups showed significantly lower cumulative live birth rates than their matched controls (38.60% vs. 64.50%, P = 0.011 and 24.20% vs. 68.60%, P < 0.001, respectively).ConclusionsThese findings highlight the decreased occurrence of pregnancy and live birth in female gynecologic cancer patients undergoing ART, particularly in endometrial cancers and cervical cancers. These findings have important implications for counseling and managing gynecologic cancer patients undergoing ART.

Menopausal hormone therapy in patients with a history of gynecologic cancer.

Menopausal hormone therapy in patients with a history of gynecologic cancer.

The impact of cancer-related lower extremity lymphedema on patient quality of life: a qualitative meta-synthesis

Abstract Lower extremity lymphedema (LEL) is a common and potentially debilitating chronic condition associated with cancer treatment. Research has outlined the substantial psychosocial and quality-of-life (QOL) sequelae associated with lymphedema, primarily of the upper extremities and through the use of quantitative methods. The purpose of this systematic review was to summarize, synthesize, and appraise qualitative literature exploring the impact of LEL on patients' QOL and psychosocial well-being after cancer treatment. Nine databases were searched for qualitative research articles published before May 1, 2022. Six eligible articles were included. Four studies used individual semistructured interviews, one used open-ended survey questions, and one used structured interviews. There was a total of 248 participants (average age: 59.8 years) included in the reviewed articles, ranging from 13 to 178 participants. Most participants were women and had a history of gynecologic cancer. All studies described psychosocial challenges experienced by individuals with cancer-related LEL. Four key themes were identified: (1) physical burden and functional limitations, (2) psychologic and emotional impacts, (3) financial implications, and (4) relational and social sequelae. Despite available qualitative data suggesting that cancer-related LEL has negative consequences on patients' QOL, there is still a significant need for increased research to broaden our understanding of the cancer-related LEL experience to better inform policy and practical guideline development.

Outpatient cancer rehabilitation services for gynecologic cancer survivors: Who participates, and do they benefit?

e18793 Background: Women with gynecologic cancers are likely to experience acute, late, or lasting functional impairments that impact ability to complete activities of daily living and quality of life. While cancer rehabilitation interventions (physical or occupational therapy, PT/OT) treat functional impairment, the use, impact, and acceptability of these services in community-based settings is unknown. We describe outpatient PT/OT services used by gynecologic cancer survivors and evaluate the impact and acceptability of these services using patient-reported outcome measures (PROM). Methods: This retrospective study included women with history of gynecologic cancer (via ICD-10 code) who: (1) received community-based outpatient cancer PT/OT services provided by a single institution in 5 geographic regions of the United States in 2019, and (2) completed a PROM at evaluation and discharge. Data was extracted from PT/OT medical charts. We calculated descriptive statistics for all available patient and rehabilitation characteristics (including age, cancer type, complexity-level of rehabilitation, interventions provided and number of visits). To evaluate pre-post rehabilitation change for each PROM, we used paired samples t-tests, then calculated pre-post effect size (Hedge’s g) and the proportion who achieved the minimal detectable change (MDC). We calculated median Net Promotor Score (NPS, 0-10) to determine acceptability. Results: Women who received rehabilitation (N = 84) were 64.63 ± 11.04 (range = 40.82 – 90.82) years old with predominant diagnoses of ovarian (n = 35, 41.7%) or endometrial (n = 27, 32.1%) cancer. Most attended PT (vs. OT) and completed 13 sessions ( IQR= 8.0 – 19.0). Seventeen different PROM were used. From pre- to post- rehabilitation, a significant improvement was seen in four PROM: Lower Extremity Functional Scale (LEFS; n= 20, M∆ = 12.88 ± 12.31, t(19) = 4.68, p = .00), Modified Fatigue Impact Scale (MFIS; n= 14, M∆ = 6.55 ± 9.69, t(13) = 2.53, p = .03), Patient-Specific Functional Scale (PSFS; n= 14, M∆ = 2.93 ± 2.31, t(13) = 4.72, p = .00), and Lymphedema Life Impact Scale (LLIS; n= 12, M∆ = 20.50 ± 20.61, t(11) = 3.45, p = .01). A large pre-post effect size (g ≥ 0.80) was observed for three PROM (17.6%), including: The PSFS ( n= 14, g = 1.47), LLIS, ( n= 12, g = 1.18), and Activities-specific Balance Confidence (ABC6; n= 3, g = 1.77). Overall, 54.8% (n = 46) patients achieved the PROM MDC. Median acceptability was 10.0 out of 10.0 ( n= 64, IQR = 9.75 – 10.0). Conclusions: For women with gynecologic cancers and functional impairment, cancer rehabilitation improved patient-reported function and was highly acceptable. Future research is needed to understand diagnosis-specific considerations and to optimize timing of rehabilitation.

Gynecologic Survivorship Tool: Development, Implementation, and Symptom Outcomes.

To describe the development and implementation of a new digital health clinical tool (Gynecologic Survivorship Tool [GST]) for symptom management of women surgically treated for gynecologic cancer; to assess its feasibility; and to conduct a retrospective review of the data. The GST was developed on the basis of a comprehensive review of the literature, multidisciplinary expert opinion, and feedback from women with a history of gynecologic cancer. It is composed of 17 questions addressing six main categories-gynecologic health (abnormal bleeding/pain), lymphedema, vaginal/vulvar dryness, sexual health, menopause (hot flushes/sleep difficulties), and bowel/urinary issues. An electronic version using the Memorial Sloan Kettering Cancer Center Engage platform was piloted in two clinics for patients with endometrial or cervical cancer. Health information was generated into clinical summaries and identified concerns for actionable response. Associations of symptom and survey time point were assessed by longitudinal models using generalized estimating equations. From January 1, 2019, to February 29, 2020, 3,357 GST assessments were assigned to 1,405 patients, with a 71% completion rate (90% within 5 minutes). Sixty-eight percent were performed at home via a patient portal, 32% at follow-ups using a clinic iPad. The most common symptoms were bowel problems, swelling/fluid, pain during examination, vaginal or vulvar dryness, and vaginal bleeding. Implementation challenges included improving patient compliance and ensuring that reports were reviewed by all clinical teams. We developed screening e-mails detailing patients whose assessments were due, planned training sessions for multidisciplinary teams, and incorporated feedback on methods for reviewing symptoms reports. The GST demonstrated feasibility, a high completion rate, and minimal time commitment. It was an effective electronic reporting mechanism for patients, enabling the medical team to develop specific strategies for alleviating bothersome symptoms during follow-up.

Attitudes of women toward for early diagnosis of cervical cancer: health responsibility and associated factors

Purpose: This study was conducted to determine the attitudes of women toward early diagnosis of cervical cancer, and the relationship between these attitudes, and health responsibility and some factors. Materials and Methods: This study was performed with 662 women aged 21 to 65. The Descriptive Characteristics Form, Attitude Scale for Early Diagnosis of Cervical Cancer and Healthy Lifestyle Behaviors Scale II-Health Responsibility Subscale were used for data collection.Results: In the present study, it was detected that perceived susceptibility of women were at moderate levels while their perceived severity, barriers and benefits were at low levels. A negative correlation was detected between Health Responsibility and Perceived Susceptibility Among the significant variables that impact attitudes toward early diagnosis of cervical cancer are women’s individual and some obstetric characteristics, their health responsibility. Conclusion: The participating women’s perceived susceptibility of attitudes toward early diagnosis of cervical women was at a moderate level while their perceived severity, barriers and benefits were at a low level. Age, educational attainment, income level, presenting to the clinic for regular gynecological examinations and history of gynecological cancer in the family were some factors that had an impact on the health responsibility and attitudes of the participating women toward early diagnosis of cervical cancer. In the light of these findings, evidence-based, individualized nursing services such as physical and psychosocial care, training and consultancy can be planned to improve women’s attitudes toward early diagnosis of cervical cancer.

HPV knowledge and child vaccination rates among mothers with a personal history of gynecologic cancer

HPV knowledge and child vaccination rates among mothers with a personal history of gynecologic cancer

The Safety and Immune-efficacy of Fucoidan from Gagome Kombu (Kjellmaniella crassifolia) on Women with the History of Gynecological Cancer

The Safety and Immune-efficacy of Fucoidan from Gagome Kombu (Kjellmaniella crassifolia) on Women with the History of Gynecological Cancer

Understanding Patient Preference in Female Pelvic Imaging: Transvaginal Ultrasound and MRI

Women with pelvic pain or abnormal uterine bleeding may undergo diagnostic imaging. This study evaluates patient experience in transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and explores correlations between preference and symptom severity. Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant prospective study. Fifty premenopausal women with pelvic symptoms evaluated by recent TVUS and MRI and without history of gynecologic cancer or hysterectomy were included. A phone questionnaire used validated survey instruments including Uterine Fibroid Symptoms Quality of Life index, Testing Morbidities Index, and Wait Trade Off for TVUS and MRI examinations. Using Wait Trade Off, patients preferred TVUS over MRI (3.58 vs 2.80 weeks, 95% confidence interval [CI] -1.63, 0.12; P = .08). Summary test utility of Testing Morbidities Index for MRI was worse than for TVUS (81.64 vs 87.42, 95%CI 0.41, 11.15; P = .03). Patients reported greater embarrassment during TVUS than during MRI (P <.0001), but greater fear and anxiety both before (P <.0001) and during (P <.001) MRI, and greater mental (P = .02) and physical (P = .02) problems after MRI versus TVUS. Subscale correlations showed physically inactive women rated TVUS more negatively (R = -0.32, P = .03), whereas women with more severe symptoms of loss of control of health (R = -0.28, P = .04) and sexual dysfunction (R = -0.30, P = .03) rated MRI more negatively. Women with pelvic symptoms had a slight but significant preference for TVUS over MRI. Identifying specific distressing aspects of each test and patient factors contributing to negative perceptions can direct improvement in both test environment and patient preparation. Improved patient experience may increase imaging value.

Utility of multi-gene panel testing with next generation sequencing in women with endometrial cancer.

5588 Background: Lynch syndrome (LS) accounts for 2-6% of all endometrial cancers (EC), and women with a germline mutation in the mismatch repair (MMR) genes ( MLH1, MSH2, MSH6, and PMS2) have an average lifetime risk of EC of 40%. As with breast and ovarian cancer syndromes, there are likely other genes implicated in the development of EC outside of the MMR genes. Multi-gene panel testing (MGPT) with next generation sequencing (NGS) allows for simultaneous analysis of numerous genes.We sought to evaluate the characteristics and incidence of gene mutations in women with newly diagnosed EC. Methods: We conducted a review of EC patients diagnosed from 6/2013 to 12/2016 who had MGPT at our institution. Demographics, family history, genetic testing results, and tumor characteristics were collected and analyzed using χ2 tests. Results: Of the 129 patients who had MGPT, 13 (10%) had a mutation and only 5 (38%) were in patients &lt; 50 years old. The median age of EC diagnosis is 55 (31-100) years and median BMI = 27.5 (21-59). Majority were stage 1, 76 (59%) and grade 1, 50 (39%). Patients with additional primary cancers, breast or colon were not more likely to have a mutation. However, patients with a family history of gynecologic cancer were more likely to have a mutation identified, 10 (77%) mutation vs no mutation 34 (29%), p = 0.003. Among all patients tested, 8 (6%) had a mutation in LS genes, and 6 (5%) had mutations in other genes ( BRCA1, BRCA2, RAD51C, MUTYH, CHEK2); 1 (0.8%) had both MSH2 and CHEK2 mutation. Three patients had prior testing for breast cancer; 2 were found to have a BRCA1/ 2 mutation and the other was on Tamoxifen and BRCA negative. IHC was performed on 7 of 13 patients, and 5 (71%) had a loss of MMR protein expression. Variants of uncertain significance were noted in 35/129 (27%) of patients tested. Conclusions: Majority of EC patients with a mutation detected with NGS were &gt; age 50. We identified additional new mutations in non-LS genes including, CHEK2, RAD51C, and MUYTH with MGPT. These accounted for 29% of the mutations and would have not been not detected using classic LS gene testing. These genes are implicated in breast, ovary or colon cancer. MGPT testing is feasible and useful in identifying additional actionable gene mutations.

Intended care seeking for ovarian cancer symptoms among U.S. women.

To investigate U.S. women's intended care seeking for symptoms associated with ovarian cancer, data from the 2012 HealthStyles Fall survey of U.S. adults were examined. Analyses were limited to women with no history of gynecologic cancer (N = 1726). Logistic regression models for intended care seeking within 2 weeks of symptom onset were developed. A minority of women recognized that unexplained pelvic or abdominal pain (29.9%), unexplained bloating (18.1%), and feeling full after eating a small amount of food (10.1%) can indicate ovarian cancer, and 31.1% mistakenly believed that the Papanicolaou (Pap) test screens for the disease. In the multivariate regression models, the most consistent, significant predictors (p < 0.01) of intended care seeking within 2 weeks of symptom onset were age (older women were more likely to seek care) and awareness that symptoms could signal ovarian cancer. Care seeking in response to ovarian cancer symptoms may be delayed among younger women and those who do not recognize the potential significance of symptoms. Raising awareness of ovarian cancer symptoms may promote early detection. However, educational efforts should emphasize that symptoms associated with ovarian cancer may also result from benign conditions.

Venous Thromboembolism in Women Undergoing Pelvic Reconstructive Surgery With Mechanical Prophylaxis Alone

Venous thromboembolism (VTE) is a major postoperative complication associated with significant patient morbidity and mortality. Surgical patients can be stratified into different risk categories for a VTE event based on age, duration of surgery, and other clinical characteristics. Women undergoing pelvic reconstructive surgery are considered to be a high-risk group because they are generally older, and their procedures are associated with prolonged operative times. Although reported rates of VTE are low in women undergoing this type of surgical procedure, the substantial clinical impact and cost associated with a VTE event highlight the need to identify patients at high risk. Recommendations for perioperative VTE prophylaxis include postoperative ambulation in patients at low risk and the use of intermittent pneumatic compression (IPC) devices with or without pharmacological thromboprophylaxis in those at higher risk. The primary aim of this multicenter case-cohort retrospective study was to determine the frequency of symptomatic perioperative VTE and identify risk factors associated with its development among women undergoing elective pelvic reconstructive surgery who received IPC alone as VTE prophylaxis The study was conducted at 6 sites in the United States over a 66-month period (January 2006 to June 2011). At all sites, patients undergoing urogynecologic surgery were given standard IPC devices alone as VTE prophylaxis. Cases were defined as surgical patients who experienced symptomatic VTE during the same hospitalization and up to 6 weeks postoperatively. Cases were identified by the International Classification of Diseases, Ninth Revision hospital diagnosis codes. Each case was temporally matched to 4 control subjects. Data collected included demographics, medical history, surgical route, operative time, and intraoperative characteristics. Potential risk factors for VTE were assessed using univariate and multivariate backward stepwise logistic regression analysis. Twenty-seven patients (0.25%) among a cohort 10,627 who underwent elective urogynecologic surgery had a diagnosis of symptomatic perioperative VTE. Univariate analysis identified patient age, surgical approach (laparotomy vs other routes), type of surgery (major vs minor), history of gynecologic cancer, and duration of surgery as risk factors for VTE (all P < 0.05). In multivariate analysis, risk factors associated with increased frequency of VTE were laparotomy (P = 0.03), age 70 years or older (P = 0.036), and operative time 5 hours or longer (P = 0.025). These data show that the frequency of symptomatic perioperative VTE is very low in patients having urogynecologic surgery. Risk factors for VTE identified in multivariate analysis include laparotomy, patient age 70 years or older, and duration of surgery 5 hours or longer.

Venous thromboembolism in women undergoing pelvic reconstructive surgery with mechanical prophylaxis alone

The objective of this study was determine the frequency of symptomatic perioperative venous thromboembolism (VTE) and risk factor(s) associated with VTE occurrence in women undergoing elective pelvic reconstructive surgery using only intermittent pneumatic compression (IPC) for VTE prophylaxis. A multi-center case-cohort retrospective review was conducted at six clinical sites over a 66-month period. All sites utilize IPC as standard VTE prophylaxis for urogynecological surgery. VTE cases occurring during the same hospitalization and up to 6weeks postoperatively were identified by ICD9 code query. Four controls were temporally matched to each case. Information collected included demographics, medical history, route of surgery, operative time, and intraoperative characteristics. Univariate and multivariate backward stepwise logistic regression analyses were performed to identify potential risk factors for VTE. Symptomatic perioperative VTE was diagnosed in 27 subjects from a cohort of 10,627 women who underwent elective urogynecological surgery (0.25%). Univariate analysis identified surgical route (laparotomy vs others), type of surgery ("major" vs "minor"), history of gynecological cancer, surgery time, and patient age as risk factors for VTE (P < 0.05). Multivariate analysis identified increased frequency of VTE with laparotomy, age ≥ 70, and surgery duration ≥ 5h. In our study cohort, the frequency of symptomatic perioperative VTE was low. Laparotomy, age ≥ 70years, and surgery duration ≥ 5h were associated with VTE occurrence.

From “Sex Toy” to Intrusive Imposition: A Qualitative Examination of Women's Experiences with Vaginal Dilator Use Following Treatment for Gynecological Cancer

Regular use of vaginal dilators has been recommended as a prophylactic measure following radiation treatment for gynecological cancers in order to minimize vaginal stenosis and promote optimal healing of the vagina. Despite the well-established reluctance of women to adopt this practice, little is known about the difficulties and concerns associated with vaginal dilator use. To investigate women's experiences with the vaginal dilator and to understand the psychosocial factors that influence women's adoption of rehabilitative dilator use. This is an exploratory qualitative study using semi-structured interviews with a sample of 10 women with a history of gynecological cancer and who were prescribed a vaginal dilator. Interviews were analyzed using the grounded theory method and examined for recurrent themes. The main outcome measure was a semi-structured interview comprised of open-ended questions designed to elicit information concerning topic areas relevant to gynecological cancer, vaginal dilator use, and sexuality. The analysis resulted in five main categories underlying the core category of "From 'sex toy' to intrusive imposition." These were: (i) embarrassing sex toy; (ii) reliving the invasion of treatment; (iii) aversive "hands-on" experience; (iv) not at the forefront of my recovery; and (v) minimizing the resistance. Rehabilitative vaginal dilator use is a complex, multifaceted, and personal phenomenon that carries deep psychological and emotional implications that make it intrusive. These findings may enhance the way in which vaginal dilators are introduced and help healthcare providers address better women's difficulties and concerns with the dilators. Ultimately, it may also lead to improved health maintenance and quality of life for women recovering from gynecological cancer.

Confirmatory factor analysis of the sexual adjustment and body image scale in women with a diagnosis of gynecologic cancer.

5044 Background: There is evidence that treatment of gynecologic cancer (GC) negatively affects body image and sexuality. The Sexual Adjustment and Body Image Scale in women with GC (SABIS-G) was developed to assess disturbances after GC. Exploratory factor analysis resulted in a two factor structure with the underlying constructs of body image and sexual adjustment. Our objective was to confirm the factor structure using a confirmatory factor analysis (CFA). Methods: Women with a history of GC without active disease completed the SABIS-G, a 9-item self-report measure. CFA was performed in which the hypothesized two-factor model was tested against a one-factor model. Cronbach’s coefficient alpha was calculated to measure internal consistency reliability for subscales. Test-retest reliability between baseline and follow-up scores was assessed using the intra-class correlation coefficient (ICC). Correlation coefficients between SABIS-G and other instruments were calculated as measures of validity. Results: 357 patients were approached to participate, 254 (71%) consented to the study and 154 (61%) completed the SABIS-G. The median age was 54 (30-77) and the primary site of disease was: 64 (42%) uterine, 54 (35%) ovary and 32 (21%) cervix. Two variables were eliminated based on analysis of CFA residuals and modification indices. The median SABIS-G score was 46(3-100) with lower scores indicating greater disturbance. The CFA fit indices indicated excellent fit for the two-factor measurement model (standardized root mean square residual 0.05, non-normed fit index 0.96, comparative fit index 0.98). The two-factor solution provided significantly better fit over the one-factor solution (χ12 = 174.6, p < 0.001). Internal consistency reliability was very high for both the Body Image (α=0.88) and Sexual Adjustment (α=0.86) subscales, as was test-retest reliability (ICC = 0.88). Correlation coefficients support the concurrent, convergent and discriminant validity of SABIS-G. Conclusions: These results confirm the two factor structure of the SABIS-G and provides evidence that this is a valid and reliable instrument to measure changes in body image and sexuality in women after a diagnosis of GC.

Van Mother-Child Health and Family Planning Center Pap Smear Clinics of Information, Evaluation of Applicants

Objective: In this study of women admitted to our center with information on pap smear test, to evaluate the attitudes and behavior. Materials and Methods: This descriptive study of Van Mother-Child Health and Family Planning Center on a voluntary basis, women aged 15-49 were admitted to the control. The education level of participants, age at first marriage, before the presence of vaginal infection, the story, and motivations pap smear level of information availability, and a family history of cancer, administered a questionnaire asking the state to have a regular income. Results: The study included 362 women with age and hear the pap smear test was significantly increased (p = 0.01). Working women and pap smear level of knowledge (p = 0.04) and pap smears than women not working for International rates significantly higher (p = 0.02). Treatment of vaginal infection at least once before to get there was a significant relationship between the pap smear motivations (p>0.05). Family history of gynecologic cancer or non-gynecologic cancer smears have significantly increased the level of motivations (p = 0.0001). Pap smear information, regular the economic income of those levels, significantly higher than those without regular income (p = 0.0001). Conclusion: We serve the region, with low socio-economic characteristics that are considered, gynecological examination by health workers or women from the home visits, pap smear test for what purpose and how often you get the work done and the importance of explaining and giving more space to this issue suggest that the written and visual media. Keywords: Pap smears, health care, education

Urinary incontinence and quality of life in long‐term gynecological cancer survivors: A population‐based cross‐sectional study

To investigate quality of life (QoL) among women reporting urinary incontinence (UI). Population-based cross-sectional study. Survival status for all women who had primary treatment between 1987 and 1996 at the University Hospital, Trondheim, Norway, was assessed in 2003. Eligible for study participation were recurrence-free survivors of gynecological cancer and age-matched women selected from the general population. Women who had no history of gynecological cancer were selected as age-matched controls in a 4:1 ratio to survivors in the population census. In 2004, all eligible participants were sent an extensive questionnaire. After one reminder the response rate was 55% (176/319) and 41% (521/1276) for survivors and controls, respectively. UI (total, stress, urge and mixed) was in agreement with definitions of the International Continence Society. QoL was measured by Ferrans and Powers' Quality of Life Index (QLI). The chi-squared test for categorical variables, unpaired T-test for continuous variables and logistic regression were applied. A history of recurrence-free gynecologic cancer was not associated with reduced QLI. The prevalence of UI was 34.5%. Women with UI had lower scores on total QLI and all domains (health/functioning, psychological/spiritual, socio-economic, and family domain) compared with continent women. A decreasing score of QLI and its domains were found for increasing severity of UI. After adjustment for other co-morbidities UI remained an independent significant predictor of QLI below the 25. percentile, but not for QLI below the 10. percentile. UI has a negative impact on QoL. The more severe UI, the more reduced were total and all QLI domains.

Urinary incontinence after gynecologic cancer treatment

Dear Sir, Recently, Skjeldestad and Hagen reported an interesting study where urinary incontinence among long-term survivors of gynecological cancer was detailed 1. They enrolled 160 recurrence-free survivors of gynecological cancer and 432 controls without a history of gynecological cancer. They reported that the prevalence of total, stress, urge and mixed urinary incontinence was 34.3, 24, 0.8 and 9%, respectively. In addition, they found that previous gynecological cancer treatment was not associated with any outcomes of urinary incontinence (p = 0.79). They concluded that recurrence-free long-term survivors of gynecological cancer are not at increased risk for urinary incontinence. In this respect, we would like to give our contribution to the argument as follows: It is well known that all forms of cancer therapy have the potential to cause complications that vary according to surgical treatment. On the other hand, the different type of radical procedure performed in endometrial, ovarian and cervical cancer patients may have a different impact on urinary function after surgery. According to the FIGO guidelines 2, type 3 radical hysterectomy is considered the standard treatment for patients affected by early stage (FIGO stage IA2–IB1) cervical carcinoma. Urinary incontinence after type 3 radical hysterectomy is the consequence of damage to nerve fibers from the pelvic plexus. During radical hysterectomy, pelvic nerves and fascial structures can be interrupted in the anterior, posterior and lateral parametrium, leading to various degrees of bladder dysfunction with an incidence of about 80% at 12 months urodynamic evaluation 3. On the other hand, the standard treatment of ovarian and endometrial cancer does not require radical parametrectomy with the possibility of preservation of pelvic nerve structures during surgery. Moreover, it is well known that intraoperative modulation of radicality (reducing extent of parametrectomy) is feasible and safe in selected cases of cervical cancer patients 4 and it can reduce the incidence of bladder dysfunction to 9% 2. Skjeldestad and Hagen have enrolled 66 (41.3%), 34 (21.3%) and 60 (37.5%) patients affected cervical, endometrial and ovarian cancer, respectively. Thus, probably each patient group had previously received a different type of surgery. However, the type of surgery and the stage of the gynecologic cancers were not reported. We think that the most important factor that influences urinary function after cancer treatment is the type of radical surgery performed in accordance with what is indicated for the type of gynecologic cancer. However, in order to avoid misinterpretation of the results, patients enrolled in such a study should be stratified according to the type of previous surgery received for the different type and stage of gynecologic cancers. Thus until these points are clarified the present conclusions should be interpreted with caution.

Long‐term consequences of gynecological cancer treatment on urinary incontinence: a population‐based cross‐sectional study

To study urinary incontinence among long-term survivors of gynecological cancer. In a population-based, cross-sectional design, we identified 319 recurrence-free survivors of gynecological cancer, and 1,276 controls without a history of gynecological cancer. All participants were addressed with a 16-pages questionnaire covering issues of quality of life, general health, daily living conditions, natural functions and co-morbidities. Following 1 reminder, the response rates were 55 and 41% for cases and controls, respectively. Urinary incontinence (total, stress, urge and mixed) was in agreement with definitions of the International Continence Society. Mean relapse-free follow-up time after treatment was 12 years (range: 8-17 years) for cases. The prevalence of total, stress, urge and mixed urinary incontinence were 34.3, 24, 0.8 and 9.5%, respectively. Previous gynecological cancer treatment was not associated with any outcomes of urinary incontinence. Obesity, previous and current use of HRT were associated with total, stress and mixed urinary incontinence, whereas increasing parity order was associated with total and stress urinary incontinence. In comparison with single factor analyses, the combination of obesity and parity 2+ had a multiplicative effect on total, stress and mixed incontinence. Recurrence-free long-term survivors of gynecological cancer are not at increased risk for urinary incontinence.