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Fecal Incontinence Affecting Quality of Life and Social Functioning Among Long-Term Gynecological Cancer Survivors
  1. Gail Dunberger, RN*,
  2. Helena Lind, MD*,
  3. Gunnar Steineck, MD, PhD*,,
  4. Ann-Charlotte WaldenstrÖM, MD,
  5. Tommy Nyberg, MSc*,
  6. Massoud Al-Abany, PhD*,§,
  7. Ullakarin Nyberg, MD, PhD and
  8. Elisabeth ÅVall-Lundqvist, MD, PhD
  1. *Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm;
  2. Clinical Cancer Epidemiology, Sahlgrenska Academy, Gothenburg;
  3. Department of Gynecological Oncology, Sahlgrenska University Hospital, Gothenburg;
  4. §Department of Medical Physics, Karolinska University Hospital, Stockholm;
  5. Department of Clinical Neuroscience, Section of Psychiatry, St Görans Hospital, Stockholm; and
  6. Department of Gynecological Oncology, Karolinska University Hospital, Stockholm, Sweden.
  1. Address correspondence and reprint requests to Gail Dunberger, RN, Clinical Cancer Epidemiology, Karolinska Institutet, Karolinska University Hospital, Z5U1, SE-171 76 Stockholm, Sweden. E-mail: gail.dunberger{at}ki.se.

Abstract

Introduction: Fecal incontinence is a symptom reported by cancer survivors after pelvic radiotherapy and is recognized to be one of the most troubling symptom-induced sources of distress to patients.

Objective: To investigate how fecal incontinence, patient-reported as emptying of all stools into clothing without forewarning, impact self-assessed quality of life from a social, psychological, sexual, and functional aspect among gynecological cancer survivors treated with pelvic radiotherapy.

Methods: We identified a cohort of 789 eligible women in the Stockholm and Gothenburg areas treated with pelvic radiotherapy alone or as combined treatment of gynecological cancer. From the Swedish Population Registry, we identified 478 control women. Data were collected using a study-specific, validated, postal questionnaire including questions covering symptoms from the pelvic region, demographics, social functioning, psychological, and quality-of-life issues.

Results: Participation was 78% for cancer survivors and 72% for control women. The fecal incontinence symptom emptying of all stools into clothing without forewarning was reported by 70 cancer survivors (12%), with lowered quality of life in 74% of the 70 cancer survivors. This symptom kept the survivors from going to parties (relative risk [RR], 11.8; 95% confidence interval [CI], 6.6-21.1), kept the survivors from traveling (RR, 9.3; 95% CI, 5.3-16.5), affected their work ability (RR, 7.9; 95% CI, 3.8-16.4), hindered their sexual life (RR, 9.2; 95% CI, 4.8-17.6), and changed them as persons (RR, 4.9; 95% CI, 2.9-8.1). The prevalence of the symptom emptying of all stools into clothing without forewarning among control women was 3 (1%) of 344.

Conclusions: Among gynecological cancer survivors having undergone pelvic radiotherapy alone or as part of a combined treatment, fecal incontinence is associated with social, psychological, sexual, and functional consequences.

  • Fecal incontinence
  • Quality of life
  • Cancer survivors
  • Radiotherapy

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Footnotes

  • This study was funded by grants from the Swedish Cancer Society, The Cancer Research Funds of Radiumhemmet, The King Gustav V Jubilee Clinic Cancer Foundation, Gothenburg, and The Swedish State under the ALF agreement, Gothenburg.

  • The authors declare no conflicts of interest.

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