1Urogynecology, Division of Gynecologic Oncology.
2Division of Biostatistics, Department of Computational and Quantitative Medicine, and.
J Natl Compr Canc Netw. 2020 Jun;18(6):712-716. doi: 10.6004/jnccn.2020.7535.
Among breast cancer survivors, urinary incontinence (UI) is often attributed to cancer therapy. We prospectively assessed urinary symptoms before and after (neo)adjuvant treatment of early-stage breast cancer.
With consent, women with stage I-III breast cancer completed the Urogenital Distress Inventory and the Incontinence Impact Questionnaire before and 3 months after initiating (neo)adjuvant therapy. Patients with UI were at least slightly bothered by urinary symptoms. If UI was present pretreatment, it was considered prevalent; if UI was new or worse at 3 months posttreatment, it was considered incident; if prevalent UI was no worse at 3 months posttreatment, it was considered stable. Ordinal logistic regression models identified characteristics associated with the level of prevalent UI and with the degree of UI impact on quality of life (QoL).
On pretreatment surveys, participants (N=203; age 54.5 ± 11.4 years) reported 79.8% prevalence of UI, including overactive bladder (29.1%), stress incontinence (10.8%), or both (39.9%). The level of prevalent UI increased with body mass index (BMI; P<.05). Of 163 participants assessed at both time points, incident UI developed in 12 of 32 patients without prevalent UI and 27 of 131 patients with prevalent UI. Regardless of whether UI was prevalent (n=162), incident (n=39), or stable (n=94) at QoL assessment, the impact of UI increased (P<.01) with the number and severity of UI symptoms, subjective urinary retention, and BMI. Adjusted for those characteristics, incident UI had less impact on QoL (P<.05) than did prevalent or stable UI.
We found that UI is highly prevalent at breast cancer diagnosis and that new or worsened UI is common after (neo)adjuvant therapy. Because UI often impairs QoL, appropriate treatment strategies are needed.
在乳腺癌幸存者中，尿失禁（UI）通常归因于癌症治疗。我们前瞻性地评估了早期乳腺癌新辅助治疗前后的尿症状。
征得同意后，I-III 期乳腺癌患者在开始（新）辅助治疗前和治疗后 3 个月完成尿生殖窘迫量表和尿失禁影响问卷。有 UI 的患者至少对尿症状感到困扰。如果预处理时存在 UI，则认为是普遍存在的；如果在治疗后 3 个月出现新的或更严重的 UI，则认为是新发病例；如果治疗后 3 个月时普遍存在的 UI 没有恶化，则认为是稳定的。有序逻辑回归模型确定了与普遍存在的 UI 水平以及 UI 对生活质量（QoL）影响程度相关的特征。
在预处理调查中，参与者（N=203；年龄 54.5±11.4 岁）报告了 79.8%的 UI 患病率，包括膀胱过度活动症（29.1%）、压力性尿失禁（10.8%）或两者（39.9%）。普遍存在的 UI 水平随体重指数（BMI）升高而升高（P<.05）。在两个时间点都进行评估的 163 名参与者中，32 名无普遍存在 UI 的患者中有 12 名出现新发病例，131 名有普遍存在 UI 的患者中有 27 名出现新发病例。无论 UI 是否普遍存在（n=162）、新发（n=39）或稳定（n=94）在 QoL 评估中，UI 症状的数量和严重程度、主观尿潴留和 BMI 都会增加（P<.01）。在调整了这些特征后，新发 UI 对 QoL 的影响（P<.05）小于普遍存在或稳定的 UI。
我们发现，UI 在乳腺癌诊断时非常普遍，新辅助治疗后新发病例或加重的 UI 很常见。由于 UI 常影响 QoL，因此需要适当的治疗策略。
