Comparing surgeries for women who have both cancer of the uterus and bladder problems
BACKGROUND: Women with endometrial cancer have higher rates of stress urinary incontinence (SUI). Concomitant treatment of endometrial cancer and SUI may improve quality of life (QOL). At the time of endometrial cancer diagnosis, women are evaluated by a gynecologist and/or a gynecologic oncologist...
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| Format: | eBook |
| Language: | English |
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Washington, DC
Patient-Centered Outcomes Research Institute
[2020], 2020
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | BACKGROUND: Women with endometrial cancer have higher rates of stress urinary incontinence (SUI). Concomitant treatment of endometrial cancer and SUI may improve quality of life (QOL). At the time of endometrial cancer diagnosis, women are evaluated by a gynecologist and/or a gynecologic oncologist and undergo surgery within weeks of their diagnosis. Thus, urinary incontinence could easily be identified at this time, a referral made, and concomitant surgery performed if necessary. OBJECTIVE: Compare the QOL among women with endometrial intraepithelial neoplasia (EIN) or clinical stage I/II endometrial cancer and SUI who chose to have concomitant surgery (cancer plus SUI surgery) with women who chose cancer surgery alone. METHODS: A multicenter prospective cohort study was conducted across 8 US sites. Women with EIN or clinical stage I/II endometrial cancer were screened for SUI symptoms. These results were uncertain for the concomitant SUI surgery compared with the nonsurgical SUI treatment, but the point estimate is in the direction of favoring concomitant surgery. However, women in the concomitant surgery group were 20% more likely to have adjusted cancer-related QOL scores above the overall study population median score after surgery, compared with women who had cancer surgery alone (RR, 1.20; 95% CI, 1.01-1.41). CONCLUSIONS: Women with endometrial cancer have high rates of SUI. Women who received treatment of SUI at the time of cancer surgery had a higher cancer-specific QOL compared with women who had no SUI treatment. The impact on cancer-specific QOL was uncertain for the concomitant SUI surgery group compared with the nonsurgical SUI treatment group. Gynecologists and gynecologic oncologists should screen patients for SUI at the time of endometrial cancer diagnosis and discuss the possible benefits of concomitant surgery. Those who screened positive were offered a preoperative referral to a urogynecologist and offered all treatment options, including concomitant surgery. All women in the study underwent cancer surgery. However, women were distributed into 1 of 3 groups regarding incontinence treatment: concomitant cancer/SUI surgery, nonsurgical SUI treatment, or no SUI treatment. QOL for all women was assessed at baseline, 6 weeks, 6 months, and 12 months postoperative using the Functional Assessment of Cancer Therapy-Endometrial (FACT-En). This general QOL instrument specifically designed for patients with endometrial cancer does not include any incontinence measures. Multivariable Poisson regression with generalized estimating equations was used to examine the relationship between SUI treatment group and high QOL (FACT-En score greater than overall median score). Adjusted relative risks (RRs) and 95% CIs were reported. RESULTS: Of the 1322 women screened, 702 (53.1%) screened positive for SUI. A total of 88 women declined participation; 58 were ineligible before signing consent due to language barriers or mental illness, or opting not to have surgery (ie, a hysterectomy). Overall, 556 women were enrolled, 7 were ineligible, 10 withdrew, and 44 were missing baseline data, leaving 495 evaluable participants. Of these 495, 106 (21.4%) women chose concomitant cancer and SUI surgery, 91 (18.4%) chose nonsurgical SUI treatment with cancer surgery, and 298 (60.2%) chose cancer surgery alone. For all groups, median FACT-En scores increased from baseline through 12 months (78 points vs 84 points). Adjusting for demographics, clinical measures, and baseline SUI severity and QOL, concomitant urogynecologic surgery was associated with having QOL (as measured by the Fact-EN) above the overall study population median score compared with nonsurgical SUI treatment (RR, 1.19; 95% CI, 0.97-1.45; P = .093) and with no SUI treatment (RR, 1.20; 95% CI, 1.01-1.43; P = .038). LIMITATIONS: This was a prospective cohort study that intrinsically had confounding and selection bias associated with it. Additionally, more women than expected chose not to have concomitant surgery, so our study was slightly underpowered |
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| Physical Description: | 1 PDF file (91 pages) illustrations |