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Cancer of the uterus and treatment of stress incontinence: a pilot study

  • Katina Robison
    Affiliations
    Department of Obstetrics and Gynecology, Program in Women’s Oncology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, Rhode Island
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  • Elizabeth Lokich
    Affiliations
    Department of Obstetrics and Gynecology, Program in Women’s Oncology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, Rhode Island
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  • Sonali Raman
    Affiliations
    Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, Rhode Island
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  • Christine Luis
    Affiliations
    Department of Obstetrics and Gynecology, Program in Women’s Oncology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, Rhode Island
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  • Christina Raker
    Affiliations
    Department of Obstetrics and Gynecology, Division of Research, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, Rhode Island
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  • Melissa A. Clark
    Affiliations
    Department of Quantitative Health Sciences and Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, MA
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  • Kyle Wohlrab
    Affiliations
    Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, Rhode Island
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Published:February 13, 2016DOI:https://doi.org/10.1016/j.ajog.2016.02.025

      Objective

      Endometrial cancer is the most common gynecologic malignancy in the United States and typically is diagnosed at an early stage (I or II), resulting in a 95% 5-year survival rate.
      US Cancer Statistics Working Group
      United States Cancer Statistics: 1999–2012 Incidence and Mortality Web-based Report.
      The majority of women are cured with surgery alone. Women with endometrial cancer have high rates of stress urinary incontinence (SUI) that often go undiagnosed.
      • Thomas S.G.
      • Sato H.R.
      • Glantz J.C.
      • Doyle P.J.
      • Buchsbaum G.M.
      Prevalence of symptomatic pelvic floor disorders among gynecologic oncology patients.
      • Erekson E.A.
      • Sung V.W.
      • DiSilvestro P.A.
      • Myers D.L.
      Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer.
      • Dahl L.
      • Wittrup I.
      • Væggemose U.
      • Petersen L.K.
      • Blaakaer J.
      Life after gynecologic cancer—a review of patients quality of life, needs, and preferences in regard to follow-up.
      The purpose of this pilot study was to determine whether women with early-stage endometrial cancer could be screened for SUI at their initial gynecologic oncology visit and referred to a urogynecologist for concurrent treatment of their endometrial cancer and SUI.

      Study Design

      This was a prospective pilot study approved by an intuitional review board and performed at a large academic center in the Northeast. Women with a new diagnosis of clinical stage I or II endometrial cancer who screened positive for SUI and planned surgical treatment for their endometrial cancer were eligible. Women were screened for SUI with a single question: “Do you ever leak urine when you cough, sneeze, jump, or laugh?” All participants were offered referral to a urogynecologist for evaluation of their SUI, and evaluation of SUI was based on the discretion of the urogynecologist. Nonsurgical and surgical treatments for SUI were offered to eligible participants.

      Results

      Fifty-nine women were screened for SUI at their first visit with a gynecologic oncologist. Twenty-three (39%) patients screened positive for SUI and 20 enrolled. The average age was 62.1 years (range, 37−85) and average body mass index was 38.1 (range, 25.2−55.8). Sixteen (80%) patients opted for a urogynecology referral, and 15 women were diagnosed with SUI; 1 woman had urge incontinence only and so was not eligible for concurrent surgery. Cancer stages of the 20 patients were IA (12), IB (4), IIIA (1), and IIIC (2), and 1 patient had complex atypical hyperplasia without cancer. Eleven patients had grade 1 histology, 4 had grade 2, 4 had grade 3 endometrioid, 4 had papillary serous tumors, and 1 had complex atypical hyperplasia. Of the 15 women with SUI, 8 had anti-incontinence concurrent surgery, 2 had nonsurgical treatment, and 5 opted for observation. Two women in the concurrent surgery group subsequently received chemotherapy and one radiation therapy.
      The average time from the first gynecologic oncology visit to surgery for the concurrent surgery group was 32.0 days (range, 14−60 days) compared with 22.0 days (range, 2−39 days) for the no concurrent surgery group.

      Discussion

      This study supports the feasibility of screening women with endometrial cancer for SUI at the initial gynecologic oncology visit with a single question. Most women who screened positive for SUI desired a referral to an urogynecologist before cancer surgery. In addition, we were able to schedule referrals and concurrent surgery for women with endometrial cancer and SUI without a clinically significant delay in endometrial cancer treatment, although our study was not powered to detect a statistically significant difference.
      • Elit L.M.
      • O'Leary E.M.
      • Pond G.R.
      • Seow H.Y.
      Impact of wait times on survival for women with uterine cancer.
      A large multicenter study is underway to assess the impact on quality of life and clinical outcomes among women with endometrial cancer and SUI that choose concurrent surgery compared with women who choose either nonsurgical SUI treatment or no treatment of their SUI.

      References

        • US Cancer Statistics Working Group
        United States Cancer Statistics: 1999–2012 Incidence and Mortality Web-based Report.
        Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute, Atlanta, GA2015
        • Thomas S.G.
        • Sato H.R.
        • Glantz J.C.
        • Doyle P.J.
        • Buchsbaum G.M.
        Prevalence of symptomatic pelvic floor disorders among gynecologic oncology patients.
        Obstet Gynecol. 2013; 122: 976-980
        • Erekson E.A.
        • Sung V.W.
        • DiSilvestro P.A.
        • Myers D.L.
        Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer.
        Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 159-163
        • Dahl L.
        • Wittrup I.
        • Væggemose U.
        • Petersen L.K.
        • Blaakaer J.
        Life after gynecologic cancer—a review of patients quality of life, needs, and preferences in regard to follow-up.
        Int J Gynecol Cancer. 2013; 23: 227-234
        • Elit L.M.
        • O'Leary E.M.
        • Pond G.R.
        • Seow H.Y.
        Impact of wait times on survival for women with uterine cancer.
        J Clin Oncol. 2014; 32: 27-33