Urinary incontinence and health-related quality of life among older Americans with and without cancer: a cross-sectional study

A scoping review of risk factors for urinary incontinence in older men

BACKGROUND

Most epidemiological studies have not systematically identified or categorized risk factors for urinary incontinence (UI) in older men, despite a higher prevalence than in younger men. Considering the burden of UI, an understanding of risk factors can inform cost-effective prevention/treatment programs. This scoping review aimed to identify and categorise risk factors for UI in older men, identify gaps in the evidence, and opportunities for future research.

METHODS

The Joanna Briggs Institute (JBI) method for scoping reviews guided the conduct and reporting of this review alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI's Population, Concept, and Context approach framed the inclusion criteria (all evidence sources on UI risk factors that included older men [65 +]). We employed JBI's three-step search strategy, which included a limited initial search in Ovid MEDLINE, a detailed comprehensive database search, and a search of reference lists of included studies, Google Scholar and grey literature. There were no restrictions on language, study type, or publication date. Two independent reviewers screened, selected, and extracted eligible studies. Data were analyzed using descriptive statistics and qualitative content analysis.

RESULTS

Forty-seven articles that met the inclusion criteria identified 98 risk factors across six categories. Behavioural risk factors, reported by only two studies, were the least investigated of all the categories, whereas medical factors/diseases were the most investigated. No genetic factors were documented. The top five risk factors were increasing age/advanced age (n = 12), Benign Prostatic Hyperplasia (n = 11), Diabetes Mellitus (n = 11), Detrusor overactivity (n = 10), limitation in physical function/ADL disability (n = 10), increased Body Mass Index (BMI)/overweight/obesity (n = 8), Dementia (n = 8), and Parkinson's disease (n = 7).

CONCLUSION

There is a dearth of evidence to describe the role behavioural risk factors have in UI in older men. These factors may play a role in health promotion and disease prevention in this area.

REGISTRATION

A protocol detailing the methods was developed and published, and is registered in the Open Science Framework [Feb 07 2023; https://osf.io/xsrge/ ].

Prevalence of pelvic floor disorders, associations of endocrine therapy, and surgical intervention among breast cancer survivors

INTRODUCTION AND HYPOTHESIS

To evaluate prevalence of pelvic floor disorders, association of endocrine therapy with pelvic floor disorders, and rates of pelvic floor surgery among breast cancer survivors compared to matched controls without history of cancer.

METHODS

This is a retrospective, cohort study using electronic medical record data from a ten-hospital regional healthcare system. A total of 19,483 women diagnosed with breast cancer between January 2008 and April 2020 were propensity score matched to 19,483 women without a history of cancer. Medical charts were abstracted for ICD-9 and ICD-10 codes for pelvic floor disorders, use of endocrine therapy, and CPT codes for pelvic floor surgeries and procedures.

RESULTS

Overall, the prevalence of pelvic floor disorders was lower among breast cancer survivors (8.8% vs. 22.6%, p < 0.001), and mean time to development of pelvic floor disorders among breast cancer survivors was 3 years. Selective estrogen receptor modulators and aromatase inhibitors were associated with pelvic organ prolapse and stress urinary incontinence, while estrogen antagonists were associated with urge urinary incontinence and lower urinary tract symptoms. Women with breast cancer had similar or higher rates of pelvic floor surgery compared to matched controls.

CONCLUSIONS

Rates of pelvic floor disorders were lower among breast cancer survivors compared to controls but rates of surgical intervention did not differ and were higher for some conditions among breast cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Screening for these disorders should be considered as part of routine survivorship care.

Assessment of Dysfunction in the Urinary System as Well as Comfort in the Life of Women during and after Combination Therapy Due to Ovarian and Endometrial Cancer Based on the SWL, II-Q7 and UDI-6 Scales

This work aimed to assess the influence of oncological combination therapy that was done on endometrial or ovarian cancer and how the urinary system is influenced as well as the quality of life in comparison to a group of female patients after the removal of the uterus with appendages due to endometrial cancer, which did not require the supplementation of therapy after operative treatment. The study included 87 patients with endometrial cancer, where, after the removal of the uterus, there was no need for conducting adjuvant therapy (C), as well as 92 female patients with endometrial cancer or 38 patients with ovarian cancer in whom combination therapy was conducted (group A, B). The assessment of the quality of life was conducted using the questionnaires: Satisfaction Life Scale (SWLS), Incontinence Impact Questionnaire, Short Form (IIQ-7), and Urogenital Distress Inventory (UDI-6) for three, six, nine, and 12 months after the conclusion of oncological treatment. It was observed that there was a statistically significant decrease in the quality of life in female patients who underwent combination therapy in comparison to a group in whose treatment only included surgery (p < 0.05). The risk of developing urinary incontinence increases alongside an increase in the scope of the operation and in the case of supplementing treatment with brachytherapy in comparison to chemotherapy.

Age at Diagnosis and Sex Are Associated With Long-term Deficits in Disease-Specific Health-Related Quality of Life of Survivors of Colon and Rectal Cancer: A Population-Based Study

BACKGROUND

Despite the increasing number of younger individuals diagnosed with colon and rectal cancer, research on the long-term disease-specific health-related quality of life of younger (<50 years) survivors of colon and rectal cancer is scarce.

OBJECTIVE

Our study aimed to compare disease-specific functional deficits and symptoms of survivors of colon and rectal cancer 5 to 16 years postdiagnosis, stratified by age at diagnosis and by sex.

DESIGN

This is a cross-sectional study.

SETTING

We used data from the population-based CAncEr Survivorship-A multi-Regional study in collaboration with 5 population-based German cancer registries.

PATIENTS

Survivors of colon and rectal cancer were included in the study.

MAIN OUTCOME MEASURES

Respondents completed the disease-specific European Organization for Research and Treatment of Cancer Quality of Life colorectal cancer module. Age at diagnosis categories were <50, 50 to 59, 60 to 69, and ≥70 years. Least square mean health-related quality of life scores, derived from linear regression, were adjusted for sex, education, time since diagnosis, cancer site, cancer stage, and treatment, where appropriate.

RESULTS

The sample comprised 697 survivors of colon cancer and 479 survivors of rectal cancer. In general, survivors of colon and rectal cancer diagnosed at <50 years of age reported lower functioning and higher symptom burden in comparison with survivors diagnosed at an older age. When stratified by sex, female survivors of colon cancer tended to report more concerns with hair loss but fewer sexual problems when compared with male survivors of colon cancer of the same age. Female survivors of rectal cancer in all age groups tended to report lower levels of sexual interest than male survivors of rectal cancer of the same age.

LIMITATIONS

This was a cross-sectional study with findings that could be biased toward healthier long-term survivors. The generalizability of results is limited to survivors diagnosed before 2005.

CONCLUSIONS

Our results suggest that supportive care for survivors of colon and rectal cancer to improve their self-management of symptoms should be adapted according to cancer type, age at diagnosis, and sex. See Video Abstract at http://links.lww.com/DCR/B29. LA EDAD AL DIAGNÓSTICO Y EL GÉNERO ESTÁN ASOCIADOS CON DÉFICITS A LARGO PLAZO EN LA CALIDAD DE VIDA RELACIONADA CON LA SALUD ESPECíFICA DE LA ENFERMEDAD DE LOS SOBREVIVIENTES DE CÁNCER DE COLON Y RECTO: UN ESTUDIO BASADO EN LA POBLACIÓN:: A pesar del creciente número de individuos jóvenes diagnosticados con cáncer de colon y recto, la investigación sobre la calidad de vida relacionada con la salud específica de la enfermedad a largo plazo de los sobrevivientes de cáncer de colon y recto jóvenes (<50 años) es escasa.Nuestro estudio tuvo como objetivo comparar los déficits funcionales específicos de la enfermedad y los síntomas de los sobrevivientes de cáncer de colon y recto 5-16 años después del diagnóstico, estratificados por edad al momento del diagnóstico y por género.Transversal.Utilizamos datos del estudio Supervivencia de CAncEr basada en la población: Un estudio multirregional en colaboración con cinco bases de datos alemanas de cáncer basados en la población.Sobrevivientes de cáncer de colon y recto.Los encuestados respondieron el módulo de calidad de vida específica para la enfermedad en cáncer colorrectal de la Organización Europea para la Investigación y Tratamiento del Cáncer. Las categorías de edad al diagnóstico fueron <50, 50-59, 60-69 y ≥70 años. Los puntajes de CVRS (calidad de vida relacionada a la salud) medios mínimos cuadrados, derivados de la regresión lineal, se ajustaron por género, educación, tiempo desde el diagnóstico, sitio del cáncer, etapa del cáncer y tratamiento, cuando apropiado.La muestra comprendió 697 y 479 sobrevivientes de cáncer de colon y de recto, respectivamente. En general, los sobrevivientes de cáncer de colon y recto diagnosticados con <50 años de edad reportaron una menor funcionalidad y una mayor carga de síntomas en comparación con los sobrevivientes diagnosticados a una edad más avanzada. Cuando se estratificaron por género, las mujeres sobrevivientes de cáncer de colon tendieron a informar más preocupaciones sobre la pérdida de cabello pero menos problemas sexuales en comparación con los hombres sobrevivientes de colon de la misma edad. Las mujeres sobrevivientes de cáncer rectal en todos los grupos de edad tendieron a informar niveles más bajos de interés sexual que los hombres sobrevivientes de cáncer rectal de la misma edad.Estudio transversal con hallazgos que podrían estar sesgados hacia sobrevivientes a largo plazo más saludables. La generalización de los resultados se limitó a los sobrevivientes diagnosticados antes de 2005.Nuestros resultados sugieren que los cuidados de soporte para los sobrevivientes de cáncer de colon y recto para mejorar su automanejo de síntomas deben adaptarse según el tipo de cáncer, la edad en el momento del diagnóstico y el género. Vea el resumen en video en http://links.lww.com/DCR/B29.

Long-term Cardiovascular Outcomes Among Endometrial Cancer Survivors in a Large, Population-Based Cohort Study

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.

Factors associated with self-reported falls, balance or walking difficulty in older survivors of breast, colorectal, lung, or prostate cancer: Results from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage

Background

Cancer and its treatment affect body systems that are important in preventing falls and controlling balance/walking. This study examined factors associated with self-reported falls and balance/walking difficulty in the past 12 months in older survivors of four major cancers.

Methods

This was a cross-sectional study analyzing population-based data from Surveillance, Epidemiology, and End Results–Medicare Health Outcomes Survey (SEER-MHOS). Data from cohorts 9 to 14 (January 2006 to December 2013) were extracted. Inclusion criteria were: age ≥65 years at cancer diagnosis, first MHOS completed during years 1–5 post-cancer diagnosis, first primary breast (n = 2725), colorectal (n = 1646), lung (n = 752), and prostate (n = 4245) cancer, and availability of cancer staging information. Primary outcomes were self-reported falls and balance/walking difficulty in the past 12 months. Multivariable logistic regression was constructed for each cancer type to examine independent factors associated with falls and balance/walking difficulty.

Results

In all cancer types, advancing age at cancer diagnosis and dependence in activities of daily living were significant independent factors associated with increased odds of reporting falls and balance/walking difficulty in the past 12 months. Additionally, depression was independently associated with falls and sensory impairment in feet was independently linked to balance/walking difficulty in all cancer types. Other independent factors of falls and balance/walking difficulty varied across cancer types. In breast cancer only, localized or regional cancer stage was significantly associated with increased odds of reporting falls and balance/walking difficulty, whereas treatment with radiation decreased the odds of falling. No association between falls and balance/walking difficulty with time since cancer diagnosis, cancer stage, or cancer treatment was found in colorectal, lung, and prostate cancer.

Conclusion

There exists some heterogeneity in factors associated with self-reported falls and balance/walking difficulty between different cancer types. Future research is necessary to ascertain factors predictive of falls and balance/walking difficulty in older cancer survivors, particularly factors related to cancer diagnosis and treatment.

Pelvic and hypogastric nerves are injured in a rat prostatectomy model, contributing to development of stress urinary incontinence

Urinary incontinence affects 40% of elderly men, is common in diabetic patients and in men treated for prostate cancer, with a prevalence of up to 44%. Seventy-two percent of prostatectomy patients develop stress urinary incontinence (SUI) in the first week after surgery and individuals who do not recover within 6 months generally do no regain function without intervention. Incontinence has a profound impact on patient quality of life and a critical unmet need exists to develop novel and less invasive SUI treatments. During prostatectomy, the cavernous nerve (CN), which provides innervation to the penis, undergoes crush, tension, and resection injury, resulting in downstream penile remodeling and erectile dysfunction in up to 85% of patients. There are other nerves that form part of the major pelvic ganglion (MPG), including the hypogastric (HYG, sympathetic) and pelvic (PN, parasympathetic) nerves, which provide innervation to the bladder and urethra. We examine if HYG and PNs are injured during prostatectomy contributing to SUI, and if Sonic hedgehog (SHH) regulatory mechanisms are active in the PN and HYG nerves. CN, PN, HYG and ancillary (ANC) of uninjured, sham and CN crush/MPG tension injured (prostatectomy model) adult Sprague Dawley rats (n = 37) were examined for apoptosis, sonic hedgehog (SHH) pathway, and intrinsic and extrinsic apoptotic mechanisms. Fluorogold tracing from the urethra/bladder was performed. PN and HYG response to SHH protein was examined in organ culture. TUNEL, immunohistochemical analysis for caspase-3 cleaved, -8, -9, SHH, Patched and Smoothened (SHH receptors), and neurite formation, were examined. Florogold positive neurons in the MPG were reduced with CN crush. Apoptosis increased in glial cells of the PN and HYG after CN crush. Caspase 9 was abundant in glial cells (intrinsic), while caspase-8 was not observed. SHH and its receptors were abundant in neurons and glia of the PN and HYG. SHH treatment increased neurite formation. PN and HYG injury occur concomitant with CN injury during prostatectomy, likely contributing to SUI. PN and HYG response to SHH treatment indicates an avenue for intervention to promote regeneration and prevent SUI.

Colorectal cancer survivors: an investigation of symptom burden and influencing factors

Background

Colorectal cancer is a significant issue internationally, with over 1.3 million people diagnosed annually. Survival rates are increasing as treatments improve, although physical symptoms can persist despite eradication of the tumour. In order to optimize survivorship care, further research is warranted in relation to symptom burden. Therefore, the objectives of this study are to (i) investigate frequency of physical symptoms in colorectal cancer survivors (ii) identify which symptoms occur together (iii) examine the associations between demographic and clinical variables, and symptoms.

Methods

Participants nine months to three years post diagnosis were identified from the population-based National Cancer Registry Ireland. Respondents completed the EORTC QLQ-C30 and EORTC QLQ-CR29. Reported physical symptom frequencies were transformed into continuous scale variables, which were then analysed using one way analysis of variance, general linear modelling and Spearman rank correlations.

Results

There were 496 participants. Fatigue, insomnia and flatulence were the most frequent symptoms, with ≥20% of respondents reporting these to be often present in the previous week. Eight other symptoms were experienced often by 10–20% of respondents. At least one of these eleven most common symptoms was experienced frequently by almost every respondent (99%). 66% of respondents experienced at least two of these symptoms together, and 16% experienced five or more together. Current stoma was the single most common variable associated with increased symptom scores, although statistically significant relationships (p ≤ 0.05) between symptom frequency scores and clinical/demographic variables were generally weak (R-sq value ≤0.08).

Conclusion

Findings may inform targeted interventions during the nine month to three year post diagnosis timeframe, which would enable supported self-management of symptoms.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4923-3) contains supplementary material, which is available to authorized users.

Factors Influencing Lower Urinary Tract Symptoms in Advanced Cancer Patients With Chemotherapy-Induced Peripheral Neuropathy

Purpose

This study aimed to investigate the severity of lower urinary tract symptoms (LUTS) and to identify factors that influenced LUTS in advanced cancer patients with chemotherapy-induced peripheral neuropathy (CIPN).

Methods

This cross-sectional study included a total of 158 advanced cancer patients with CIPN. A structured questionnaire including the International Prostate Symptom Score and the Functional Assessment of Cancer Therapy/Gynecology Oncology Group/Neurotoxicity scale was used. Data were analyzed using the Pearson correlation coefficient and multiple regression analysis.

Results

Nocturia was the most prevalent LUTS. A positive relationship was found between CIPN symptoms and LUTS. The duration of cancer diagnosis and the severity of CIPN were key factors that influenced LUTS.

Conclusions

The severity of CIPN symptoms was the most important predictor of LUTS. Nurses’ care for advanced cancer patients should incorporate a comprehensive health assessment, which includes a history of treatment and physical neuropathic symptoms, for any patient complaining of CIPN symptoms.

Predictors of falls in older survivors of breast and prostate cancer: A retrospective cohort study of surveillance, epidemiology and end results-Medicare health outcomes survey linkage

OBJECTIVES

To identify predictors of falls in older breast and prostate cancer survivors.

METHODS

This retrospective cohort study analyzed population-based Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linkage. Inclusion criteria were age >65 years at cancer diagnosis, first primary female breast or prostate cancer, cancer staging information available, completion of baseline MHOS during years 2-3 and follow-up MHOS during years 4-5 post-diagnosis, and falls information available. Data from 437 breast and 660 prostate cancer survivors were analyzed. Multivariable logistic regression was constructed to evaluate variables from baseline MHOS with relation to falls from follow-up MHOS. Model accuracy was assessed using area under receiver-operating-characteristic curve (AUC).

RESULTS

At follow-up MHOS, 26% of breast and 22% of prostate cancer survivors reported falls in the past 12 months. In breast cancer, a history of falls (odds ratio (OR) = 4.95, 95% confidence interval (CI) = 2.44-10.04) and sensory impairment in feet (OR = 3.33, 95%CI = 1.51-7.32) were significant predictors of falls. In prostate cancer, a history of falls (OR = 3.04, 95%CI = 1.79-5.15), unmarried (OR = 1.82, 95%CI = 1.12-2.95), lower physical summary score of quality-of-life(OR = 0.96, 95%CI = 0.94-0.98), urinary incontinence (OR = 1.69, 95%CI = 1.08-2.65), older age at diagnosis (OR = 1.05, 95%CI = 1.01-1.09), and shorter time post-diagnosis (OR = 0.96, 95%CI = 0.93-0.99) were significant predictors of falls. AUC was 0.67 and 0.77 for breast and prostate cancer, respectively, indicating moderate accuracy of models in detecting fallers.

CONCLUSIONS

Asking older breast and prostate cancer survivors about falls in the past 12 months is imperative in fall prevention. Further examination of deficits specific to each cancer is necessary to assess fall risks.

Urinary, bowel and sexual health in older men from Northern Ireland

Objectives

To provide data on the prevalence of urinary, bowel and sexual dysfunction in Northern Ireland (NI), to act as a baseline for studies of prostate cancer outcomes and to aid service provision within the general population.

Subjects and Methods

A cross‐sectional postal survey of 10 000 men aged ≥40 years in NI was conducted and age‐matched to the distribution of men living with prostate cancer. The EuroQoL five Dimensions five Levels (EQ‐5D‐5L) and 26‐item Expanded Prostate Cancer Composite (EPIC‐26) instruments were used to enable comparisons with prostate cancer outcome studies. Whilst representative of the prostate cancer survivor population, the age‐distribution of the sample differs from the general population, thus data were generalised to the NI population by excluding those aged 40–59 years and applying survey weights. Results are presented as proportions reporting problems along with mean composite scores, with differences by respondent characteristics assessed using chi‐squared tests, analysis of variance, and multivariable log‐linear regression.

Results

Amongst men aged ≥60 years, 32.8% reported sexual dysfunction, 9.3% urinary dysfunction, and 6.5% bowel dysfunction. In all, 38.1% reported at least one problem and 2.1% all three. Worse outcome was associated with increasing number of long‐term conditions, low physical activity, and higher body mass index (BMI). Urinary incontinence, urinary irritation/obstruction, and sexual dysfunction increased with age; whilst urinary incontinence, bowel, and sexual dysfunction were more common among the unemployed.

Conclusion

These data provide an insight into sensitive issues seldom reported by elderly men, which result in poor general health, but could be addressed given adequate service provision. The relationship between these problems, raised BMI and low physical activity offers the prospect of additional health gain by addressing public health issues such as obesity. The results provide essential contemporary population data against which outcomes for those living with prostate cancer can be compared. They will facilitate greater understanding of the true impact of specific treatments such as surgical interventions, pelvic radiation or androgen‐deprivation therapy.

Pelvic floor disorders in women with gynecologic malignancies: a systematic review

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.

Endocrine therapy and urogenital outcomes among women with a breast cancer diagnosis

PURPOSE

Endocrine therapy for breast cancer can exacerbate menopausal symptoms. The association between endocrine therapy and common pelvic floor disorders including urinary incontinence has rarely been evaluated. We examined urogenital and sexual side effects among women with a breast cancer diagnosis, comparing endocrine therapy users to nonusers.

METHODS

Urogenital and sexual symptoms were self-reported during the enrollment interview within the University of North Carolina Cancer Survivorship Cohort. Tumor characteristics and endocrine therapy use were collected from medical and prescription records. We calculated multivariable prevalence ratios (PR) and 95 % confidence intervals (CI) for the association of endocrine therapy (versus no endocrine therapy) and urinary incontinence, overall and by therapy type (tamoxifen or aromatase inhibitors). PROMIS Sexual Function and Satisfaction domain scores were compared across endocrine therapy groups.

RESULTS

Among the 548 women with a breast cancer diagnosis, 49 % received endocrine therapy. Overall, 18 % of women reported urinary incontinence symptoms. We observed no association between urinary incontinence and endocrine therapy use overall (PR = 0.97; 95 % CI 0.67, 1.43), tamoxifen (PR = 1.20; 95 % CI 0.74, 1.96), or aromatase inhibitors (PR = 0.89; 95 % CI 0.55, 1.42), compared to no use. Approximately 55 % of women were sexually active. Sexual function scores did not vary according to endocrine therapy use, although urinary incontinence was associated with lower satisfaction scores (p = 0.05).

CONCLUSIONS

Our findings demonstrate a high prevalence of urinary incontinence after breast cancer diagnosis similar to the overall prevalence in older U.S. women, and this did not vary strongly according to use of endocrine therapy.

New Rates of Interventions to Manage Complications of Modern Prostate Cancer Treatment in Older Men

BACKGROUND

Interventions to treat complications from prostate cancer (PCa) treatment are common and affect the course of a patient's life.

OBJECTIVE

To examine rates of complications other than urinary incontinence and impotence for older patients treated for PCa.

DESIGN, SETTING, AND PARTICIPANTS

Population-based retrospective cohort study of patients aged 65-79 yr receiving radical prostatectomy or radiotherapy (RT) from 2001 to 2008 in the US Surveillance Epidemiology and End Results and Medicare linked databases.

OUTCOME MEASURES AND STATISTICAL ANALYSIS

Complications were organised in three categories: urologic procedures, rectal-anal procedures, and major surgeries. We analysed the role of primary treatment on the number of complications using negative binomial regression.

RESULTS AND LIMITATIONS

Among 60476 men, 14492 underwent primary surgery and 45984 underwent primary RT; 33418 (55%) experienced at least one complication (mean: 2.6 complications per patient). For both groups, complications peaked within 2 yr of treatment but continued at a steady rate for 10 yr. Patients treated with radiation had higher rates of urologic procedures (adjusted relative rate [aRR]: 1.25; 95% confidence interval [CI], 1.2-1.3; p<0.0001) and rectal-anal procedures (aRR: 1.4; 95% CI, 1.4-1.5; p<0.0001) but a lower rate of major surgeries (aRR: 0.9; 95% CI, 0.8-0.9; p<0.0001) compared with those having surgery. Because patients treated with RT were older and more comorbid, selection bias limits the strength of conclusions that can be drawn from this data.

CONCLUSIONS

Complications are common following PCa cancer treatment and occur many years after treatment. The primary treatment is an important predictor of complication rates that may inform treatment decisions and long-term survivorship plans.

PATIENT SUMMARY

We examined complications after prostate cancer treatment in a large American population. Patients treated with radiotherapy rather than surgery had higher rates of complications requiring urologic procedures and rectal-anal procedures but lower rates of open surgeries. However, we were only able to examine men aged >65 yr, and this, along with the observational study technique, means that these results may not apply to all patients and that factors beyond those that we could measure may have affected these results.

Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies

AIM

To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context.

METHODS

PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK.

RESULTS

Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment.

CONCLUSION

Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.

Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis

PURPOSE

This population-level study was conducted to define the health-related quality of life (HRQL) of individuals living with and beyond colorectal cancer (CRC) and to identify factors associated with poor health outcomes.

PATIENTS AND METHODS

All individuals diagnosed with CRC in England in 2010 and 2011 who were alive 12 to 36 months after diagnosis were sent a questionnaire. This included questions related to treatment, disease status, other long-term conditions (LTCs), generic HRQL (EuroQol-5D), and cancer-specific outcomes (Functional Assessment of Cancer Therapy and Social Difficulties Inventory items).

RESULTS

The response rate was 63.3% (21,802 of 34,467 patients). One or more generic health problems were reported by 65% of respondents, with 10% of patients reporting problems in all five domains. The reporting of problems was higher than in the general population and was most marked in those age less than 55 years. Certain subgroups reported a higher number of problems, notably those with one or more other LTCs, those with active or recurrent disease, those with a stoma, and those at the extremes of the age range (< 55 and > 85 years). Of respondents without a stoma, 16.3% reported no bowel control. Reversal of a stoma resulted in fewer severe bowel problems but more moderate problems than those who had never had a stoma. A quarter of rectal cancer respondents (25.1%) reported difficulties with sexual matters (compared with 11.2% of colon cancer respondents).

CONCLUSION

This study demonstrates the success of a national patient-reported outcomes survey. The results have the potential to support system-wide improvement in health outcomes through the identification of particular challenges faced by individuals after treatment for CRC.

Coexistence of urinary incontinence and major depressive disorder with health-related quality of life in older Americans with and without cancer

PURPOSE

This study evaluates the prevalence and factors associated with major depressive disorder (MDD) in a population of cancer survivors and the impact of co-occurring MDD and urinary incontinence (UI) on health-related quality of life (HRQOL).

METHODS

The prevalence of MDD risk among cancer survivors (breast, prostate, bladder, colorectal, lung, and endometrial/uterine cancers) and those without cancer was estimated using the Surveillance, Epidemiology and End Results Program-Medicare Health Outcomes Survey (SEER-MHOS) linked database (n = 9,282 with cancer/n = 289,744 without cancer). Risk for MDD was measured using three items from the Diagnostic Interview Schedule, and HRQOL was measured by the SF-36. UI was defined as self-reported leakage of urine causing a problem in previous 6 months. Factors associated with MDD were investigated using logistic regression, and the impact of co-occurring MDD and UI on HRQOL scores was determined using linear regression.

RESULTS

The prevalence of MDD risk ranged from 19.2 % for prostate to 34.1 % for lung. Lung cancer diagnosis was associated with risk of MDD. Being ≥5 years from diagnosis was associated with decreased risk of MDD (prevalence odds ratio (POR) = 0.82, 95 % confidence interval (95 % CI) 0.71, 0.95). The coexistence of both UI and MDD was associated with a decrease across HRQOL subscales; including 40 points on role-emotional (RE) score.

CONCLUSIONS

Cancer survivors reporting co-occurrence of UI and MDD experienced significant decrements in HRQOL.

IMPLICATIONS OF CANCER SURVIVORS

Understanding the combined effect of UI and MDD may help clinicians to better recognize and alleviate their effects on cancer survivors' HRQOL.

Impact of bladder cancer on health related quality of life in 1,476 older Americans: a cross-sectional study

PURPOSE

The impact of bladder cancer diagnosis on health related quality of life is poorly understood. We compared health related quality of life measures in patients before and after bladder cancer diagnosis.

MATERIALS AND METHODS

We performed a cross-sectional study in 1,476 patients 65 years old or older with bladder cancer in the SEER-MHOS linkage database between 1998 and 2007 to assess differences in physical and mental component summary scores in 620 and 856 who completed a survey before and after bladder cancer diagnosis, respectively. To determine differences in physical and mental scores in the prediagnosis and post-diagnosis cohorts, we used ANOVA adjusting for baseline covariates.

RESULTS

There were statistically significant differences in physical and mental component summary scores between the prediagnosis and post-diagnosis groups (-2.7, 95% CI -3.8, -1.7 vs -1.4, 95% CI -2.6, -0.3). In patients with nonmuscle invasive bladder cancer the physical and mental score differences were -1.9 (p <0.01) and -1.4 (p = 0.01), respectively. In those with muscle invasive bladder cancer there was a statistically and clinically significant difference in the physical but not the mental score (-5.3, p <0.01 vs -2.7, p = 0.07). This difference in the physical domain persisted up to 10 years after the diagnosis of muscle invasive bladder cancer. Patients with bladder cancer who had 4 or more comorbid medical conditions and 1 or more deficits in daily living activity were most at risk for low physical component summary scores.

CONCLUSIONS

Future research into interventions to improve health related quality of life and methods to incorporate health related quality of life into decision making models are critical to improve outcomes in older patients with bladder cancer.