Physiotherapy - Theses
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ItemPelvic floor disorders in women with breast cancer( 2022)Problems related to bladder, bowel, sexual and pelvic floor (PF) muscle function are collectively termed PF disorders. Previous literature suggests that women with breast cancer may experience PF disorders at higher rates following cancer treatment than prior to cancer treatment. A causal pathway for this observation has not been clearly established. Pelvic floor muscle training (PFMT), the first-line management for treating PF disorders such as urinary incontinence (UI) and pelvic organ prolapse (POP), currently does not appear in breast cancer clinical care pathways. More data about PF disorders in women with breast cancer are required before PFMT can be included in clinical care pathways. Therefore, the aim of this thesis was to investigate PF disorders in women with breast cancer. While the abrupt precipitation of female sexual dysfunction (FSD) after breast cancer treatments is well documented, much less is known about bladder and bowel symptoms in this population. Study one, a systematic review and meta-analysis, assessed the prevalence and impact of bladder and bowel disorders in women with breast cancer. Results showed that 33% of women with breast cancer reported experiencing bladder disorders and 18% reported bowel disorders. The impact of bladder and bowel disorders in studies that used cancer-specific questionnaires was rated as low. Further studies using validated PF-specific questionnaires are required to assess the prevalence and impact of PF symptoms in this population. To address the research gap identified in the previous study, study two, a cross-sectional study, was conducted to compare the prevalence, distress and impact of PF disorders between women with and without breast cancer. Women in this study with breast cancer had a higher prevalence (although not significant) of UI, and significantly higher distress and impact of UI compared to women without breast cancer. These findings highlight that more studies are needed to understand which subgroups of women with breast cancer (e.g., women who have undergone a specific type of cancer treatment such as chemotherapy) may be most at risk of developing these symptoms. Study three, a secondary analysis of data collected as part of the previous cross-sectional study (study 2), was conducted to determine the prevalence of PF disorders according to breast cancer characteristics such as breast cancer stage and treatment type. Women in this study who underwent chemotherapy experienced the highest rates of UI (79%) and FI (24%) although this association was not statistically significant. The impact of PF disorders also appeared to increase with more time after breast cancer diagnosis. This demonstrates that the screening and treatment of PF disorders may be indicated as women enter the survivorship phase of their cancer recovery. Sexual dysfunction is another symptom that has been reported to have long-term negative impacts in women with breast cancer. Sexual function in women with breast cancer who experience UI has not been investigated. Study four, a matched control study using data collected as part of study two, compared the prevalence and severity of sexual dysfunction in matched women with and without breast cancer who experienced UI. Women who participated in this study with breast cancer and experience of UI reported significantly higher rates and severity of sexual dysfunction than women with UI of the same age, body mass index and parity without breast cancer. This finding adds to the existing body of literature that highlights the burden of FSD in women with breast cancer, and implies that clinicians may wish to consider the impact of UI when addressing FSD in this population. Study five, a cross-sectional study, compared the PF muscle function in women with and without breast cancer. The group of women in this study with breast cancer had reduced PF muscle strength and poorer relaxation ability compared to women without breast cancer. This suggests that PF therapies such as PF muscle training or relaxation techniques may be a therapeutic target to improve PF muscle function in women with breast cancer. Additionally, there is a need to better understand whether women with breast cancer who experience PF disorders are interested in seeking treatment for these symptoms during, or after breast cancer treatment. Study six, a qualitative study, explored the experiences of women with breast cancer who had PF disorders, and their perceived enablers and barriers to the uptake of treatment for PF disorders during their breast cancer recovery. Women in this study were divided as to whether they felt resigned to, or bothered by PF disorders. Their reactions to the experiences of PF disorders acted as a barrier or enabler to accessing treatment for PF disorders. For those who are interested in treatment for their symptoms, further research is required to investigate whether PF muscle therapies are a feasible treatment option for women with breast cancer. No trials to date have tested the feasibility of implementing a PFMT program in women with breast cancer. Study seven, a pilot clinical trial, assessed the feasibility of recruiting into a PFMT delivered via telehealth to treat UI in women with breast cancer. Women underwent a 12-week individualised PFMT program using a home-based intra-vaginal pressure biofeedback device (femfit). The consent rate was 100%. A significant decline in the prevalence, frequency and severity of UI was observed in this feasibility study following treatment. Pelvic floor muscle strength increased significantly from pre- to post-intervention, a mean difference of 4.8 mmHg (95%CI 3.9, 5.5). This indicated that PFMT delivered via telehealth may potentially be beneficial in treating UI, particularly stress UI in women with breast cancer. In conclusion, the findings of this thesis highlight that women with breast cancer may experience PF disorders, particularly UI, at a higher magnitude than women without breast cancer. Women with breast cancer who are bothered by their PF symptoms are interested in receiving information and treatment for PF disorders. This indicates that there may be a role of PF physiotherapy in addressing PF disorders in this population. While further research is required, these findings present an opportunity to place PF physiotherapy in breast cancer care pathways to ultimately improve the quality of life in women with breast cancer.