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Impact of treatment modality on pelvic floor dysfunction among uterine cancer survivors
  1. David S Lakomy1,2,
  2. Alison K Yoder1,
  3. Juliana Wu1,3,
  4. Mike Hernandez4,
  5. Martins Ayoola-Adeola5,
  6. Anuja Jhingran1,
  7. Ann Klopp1,
  8. Pamela Soliman6,
  9. Susan K Peterson7 and
  10. Lilie L Lin1
  1. 1 Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
  3. 3 University of Texas School of Public Health, Houston, Texas, USA
  4. 4 Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  5. 5 Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
  6. 6 Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  7. 7 Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Lilie L Lin, Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; LLLin{at}


Objective Pelvic floor dysfunction is a common adverse effect of uterine cancer treatment. In this study we compared patient-reported outcomes regarding pelvic floor dysfunction among uterine cancer survivors after hysterectomy and bilateral salpingo-oophorectomy, surgery and brachytherapy, or surgery and external beam radiotherapy with or without brachytherapy versus women who had a hysterectomy for benign indications.

Methods We used the validated 20-item Pelvic Floor Distress Inventory to assess lower urinary distress, colorectal distress, and pelvic organ prolapse dysfunction in each treatment group. Pelvic floor dysfunction-related quality of life in these domains was compared across treatment modalities using the Pelvic Floor Impact Questionnaire-7. Treatment type, body mass index, comorbidities, and number of vaginal births were obtained from medical records. A zero-inflated negative binomial regression model was used to assess the association of treatment regimens and covariates relative to the non-cancer cohort.

Results A total of 309 surveys were analyzed. The median age of the patients at surgery was 58 years (range 20–87) and the median age at survey completion was 66 years (range 34–92). Most participants reported experiencing at least one symptom of pelvic floor dysfunction (76% by Pelvic Floor Distress Inventory-2). The type of treatment had no effect on overall pelvic floor dysfunction on multivariate analysis (all p>0.05). Worse urinary-related symptoms were associated with higher body mass index at surgery (OR 1.41), higher age at time of survey (OR 1.07), and higher numbers of vaginal births (OR 1.43) (all p<0.05).

Conclusions Overall, pelvic floor dysfunction did not significantly vary by treatment modality. Our findings suggest complex interactions among age, body mass index, and parity as to how uterine cancer treatment affects pelvic floor quality of life, which should be considered in the choice of treatment strategy and patient counseling.

  • Radiotherapy
  • Hysterectomy
  • Cancer Pain
  • Uterine Cancer
  • Pelvic Floor

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @DLakomy,, @PamSolimanMD, @LilieLinMD

  • Contributors DSL: Methodology, investigation, data curation, writing-original draft preparation, visualization. AKY: Conceptualization, methodology, data curation, writing-original draft preparation, project administration. JW: Methodology, investigation, resources, data curation, writing-original draft preparation. MH: Formal analysis, investigation; MA-A: Writing-original draft preparation. AJ: Writing-review and editing. AK: Writing-review and editing. PS: Writing-review and editing, data curation. SKP: Writing-review and editing, formal analysis. LL: Conceptualization, methodology, writing-review and editing, supervision, project administration, guarantor.

  • Funding Supported in part by Cancer Center Support (Core) Grant P30 CA016672 from the National Cancer Institute, National Institutes of Health, to The University of Texas MD Anderson Cancer Center.

  • Competing interests LL reports funding from AstraZeneca and Pfizer for investigator-initiated clinical trials. The other authors report no proprietary or commercial conflicts of interest with respect to any product mentioned or concept discussed in the present work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.