Introduction
Methods
Setting and inclusion
The study-specific questionnaire
Sociodemographic and clinical characteristics
Frequency of physical activity
Urinary and fecal leakage
Quality of life and depressed and anxious mood
Statistical analysis
Results
The participating women
Variable | Total study group of female pelvic cancer survivors, n = 578 |
---|---|
Cancer type, n (%) | |
Gynecological cancer | 367 (63) |
Rectal cancer | 131 (23) |
Anal cancer | 77 (13) |
Other | 3 (1) |
Age in years, mean ± SD | n = 577 64 ± 12.9 |
Years since radiotherapy, mean ± SD | n = 576 2.7 ± 3.4 |
Cancer treatment, n (%) | n = 577 |
External radiotherapy, only | 131 (23) |
Brachytherapy, only | 1 (0.2) |
External radiotherapy and brachytherapy | 20 (3) |
External radiotherapy, brachytherapy and surgery | 178 (31) |
External radiotherapy and surgery | 243 (42) |
Brachytherapy and surgery | 4 (0.6) |
Marital status, n (%) | |
Married or living with a partner | 386 (67) |
Widow | 66 (11) |
Has a partner but lives alone | 28 (5) |
Single | 98 (17) |
Education level, n (%) | n = 569 |
Elementary school | 171 (30) |
Secondary school | 211 (36) |
Collage/university | 187 (32) |
Employment status, n (%) | n = 573 |
Student | 4 (0.6) |
Unemployed job seeker | 11 (2) |
Employed, n (%) | 161 (28) |
Home maker | 4 (0.6) |
On sick leave | 48 (8) |
Disability pension | 31 (5) |
Retired | 314 (54) |
Resident, n (%) | n = 577 |
On the countryside | 108 (19) |
Small or medium-sized city | 297 (51) |
In a big city | 172 (30) |
Smoking, n (%) | n = 555 |
Yes | 66 (11) |
No | 489 (85) |
Frequency of physical activity
Physical activity in women with or without urinary leakage
Variable | Practicing physical activity at least once a week, n = 382 | Practicing physical activity less than once a week, n = 186 | Relative risk, 95% CI, p value, n = 568 |
---|---|---|---|
Frequency of leakage in case of urgency, n (%) | n = 374 | n = 182 | |
No | 220/310 (71) | 90/310 (29) | Ref. |
Occasionally | 105/162 (65) | 57/162 (35) | 1.21, 0.14–0.92, 0.166 |
At least once a month | 10/20 (50) | 10/20 (50) | 1.72, 1.07–2.76, 0.024* |
At least once a week | 17/24 (70) | 7/24 (29) | 1.0, 0.53–1.92, 0.989 |
At least three times a week | 9/13 (69) | 4/13 (31) | 1.06, 0.46–2.44, 0.891 |
At least once a day | 13/27 (48) | 14/27 (52) | 1.79, 1.19–2.67, 0.005* |
Volume of leakage, n (%) | n = 371 | n = 177 | |
No leakage | 193/262 (74) | 69/262 (26) | Ref. |
Small volume of urine | 132/207 (63) | 75/207 (36) | 1.38, 1.05–1.80, 0.021* |
Large volume of urine | 37/63 (59) | 26/63 (41) | 1.57, 1.10–2.24, 0.014* |
All volume of urine | 5/11 (45) | 6/11 (55) | 2.10, 1.16–3.69, 0.014* |
Capacity to hold urine before leakage in case of urgency, n (%) | n = 366 | n = 178 | |
At least 30 min | 56/76 (74) | 20/76 (26) | Ref. |
10–30 min | 89/124 (72) | 35/124 (28) | 1.07, 0.67–1.72, 0.77 |
5–10 min | 92/127 (72) | 35/127 (28) | 1.05, 0.65–1.68, 0.847 |
1–5 min | 96/143 (67) | 47/143 (33) | 1.25, 0.80–1.95, 0.326 |
Less than 1 min | 33/74 (45) | 41/74 (55) | 2.11, 1.37–3.23, < 0.001* |
Physical activity in women with or without fecal leakage
Variable | Practicing physical activity at least once a week, n = 382 | Practicing physical activity less than once a week, n = 186 | Relative risk, 95% CI, p value, n = 568 |
---|---|---|---|
Frequency of leakage in case of urgency, n (%) | n = 365 | n = 170 | |
No | 155/223 (68) | 68/223 (30) | Ref. |
Occasionally | 135/194 (70) | 59/194 (30) | 1.00, 0.75–1.33, 0.986 |
At least once a month | 26/40 (65) | 14/40 (35) | 1.15, 0.72–1.83, 0.563 |
At least once a week | 33/47 (70) | 14/47 (30) | 0.98, 0.60–1.58, 0.924 |
At least three times a week | 11/18 (61) | 7/18 (39) | 1.28, 0.69–2.35, 0.436 |
At least once a day | 5/13 (39) | 8/13 (62) | 2.02, 1.26–3.24, 0.004* |
Volume of leakage, n (%) | n = 360 | n = 172 | |
No leakage | 156/223 (70) | 67/223 (30) | Ref. |
Just soiling | 103/147 (70) | 44/147 (30) | 1.0, 0.72–1.37, 0.982 |
Small volume of stools | 74/110 (67) | 36/110 (33) | 1.1, 0.78–1.52, 0.616 |
Large volume of stools | 20/41 (49) | 21/41 (51) | 1.70, 1.19–2.44, 0.004* |
All stools | 7/11 (64) | 4/11 (36) | 1.21, 0.54–2.71, 0643 |
Leakage of all stools without forewarning, n (%) | n = 364 | n = 177 | |
No | 315/448 (70) | 133/448 (30) | Ref. |
Yes | 49/98 (50) | 49/98 (50) | 1.68, 1.32–2.15, < 0.001* |
Variable | Practicing physical activity at least once a week, n = 382 | Practicing physical activity less than once a week, n = 186 | Relative risk, 95% CI, p value univariable analyses (crude models), n = 568 | Relative risk, 95% CI, p value multivariable analysis (adjusted models), n = 492 |
---|---|---|---|---|
Urinary leakage, n (%) | n = 369 | n = 178 | n = 547 | |
No leakage | 195/266 (73) | 71/266 (27) | Ref. | Ref. |
Small leakage | 132/207 (64) | 75/207 (36) | 1.36, 1.04–1.78, 0.026* | 1.17, 0.89–1.54, 0.261 |
Moderate to large, i.e., moderate, large, or all volume | 42/74 (57) | 32/74 (43) | 1.62, 1.17–2.25, 0.04* | 1.33, 0.942–1.889, 0.105 |
Fecal leakage, n (%) | n = 369 | n = 183 | n = 552 | |
No leakage, i.e., no leakage or just soiling | 268/388 (69) | 120/388 (31) | Ref. | Ref. |
Small leakage | 74/110 (67) | 36/110 (33) | 1.06, 0.78–1.44, 0.72 | 1.02, 0.75–1.38, 0.91 |
Large volume, i.e., large or all volume | 27/54 (50) | 27/54 (50) | 1.62, 1.19–2.19, 0.002* | 1.54, 1.11–2.15, 0.01* |
Cancer type, n (%) | ||||
Gynecological cancer | 230/359 (64) | 129/359 (36) | 1.32, 1.02–1.71, 0.034* | 1.26, 0.96–1.65, 0.097 |
Not gynecological cancer | 152/209 (73) | 57/209 (27) | Ref. | Ref. |
Age in years, n (%) | n = 382 | n = 183 | ||
24–45 | 39/59 (66) | 20/59 (34) | 1.08, 0.71–1.62, 0.710 | Not applicable5 |
46–65 | 153/223 (69) | 70/223 (31) | Ref. | |
66–94 | 190/286 (66) | 96/286 (34) | 1.07, 0.83–1.38, 0.604 | Not applicable5 |
Year since radiotherapy, n (%) | n = 381 | n = 186 | ||
Less than 1 year ago | 151/227 (67) | 76/227 (33) | 1.13, 0.66–1.91, 0.66 | Not applicable5 |
1–5 years ago | 204/303 (67) | 99/303 (33) | 1.10, 0.65–1.85, 0.723 | Not applicable5 |
More than 5 years ago | 26/37 (70) | 11/37 (30) | Ref. | |
Cancer treatment, n (%) | n = 258 | n = 114 | ||
External radiotherapy, only | 79/130 (61) | 51/130 (39) | 1.24, 0.89–1.73, 0.20 | Not applicable5 |
External radiotherapy and surgery | 174/237 (73) | 63/237 (27) | Ref. | |
Brachytherapy and surgery | 5/5 (100) | 0/5 (0) | Not applicable1 | |
Marital status,n (%) | n = 382 | n = 186 | ||
Married, living together, or has a partner | 285/408 (70) | 123/408 (30) | Ref. | Ref. |
Widow or single | 97/160 (61) | 63/160 (39) | 1.31 1.02–1.66, 0.031* | 1.24, 0.97–1.60, 0.091 |
Education level, n (%) | n = 378 | n = 183 | ||
Elementary school | 90/164 (55) | 74/164 (45) | 1.64, 1.30–2.07, < 0.001* | 1.62, 1.27–2.01, < 0.001* |
Secondary school, college or university | 288/397 (73) | 109/397 (27) | Ref. | Ref. |
Employment status, n (%) | n = 379 | n = 184 | ||
Unemployed job seeker | 3/11 (27) | 8/11 (73) | 2.32, 1.52–3.56, < 0.001* | Not applicable1 |
Employed, housewife/man, or student | 116/169 (69) | 53/169 (31) | Ref. | |
On sick leave | 30/48 (63) | 18/48 (37) | 1.20, 0.78–1.83, 0.413 | Not applicable5 |
Retired due to age or disability | 230/335 (69) | 105/335 (31) | 1.0, 0.76–1.31, 0.999 | Not applicable5 |
Resident, n (%) | n = 381 | n = 186 | ||
On the countryside | 65/106 (61) | 41/106 (39) | 1.23, 0.93–1.62, 0.141 | Not applicable5 |
In a small or big city | 316/461 (69) | 145/461 (31) | Ref. | |
Smoking, n (%) | n = 370 | n = 177 | ||
Yes | 36/66 (55) | 30/66 (45) | 1.49, 1.10–2.00, 0.009* | 1.34, 1.00–1.79, 0.049* |
No | 334/481 (69) | 147/481 (31) | Ref. | Ref. |
Weight change3, n (%) | n = 337 | n = 151 | ||
No | 118/164 (72) | 46/164 (28) | Ref. | |
Yes, weight gain | 81/119 (68) | 38/119 (32) | 1.13, 0.82–1.56, 0.453 | Not applicable5 |
Yes, weight loss | 138/205 (67) | 67/205 (33) | 1.27, 0.93–1.74, 0.131 | Not applicable5 |
Pain in the abdomen2,n (%) | n = 370 | n = 184 | ||
Less than once a day | 345/509 (68) | 164/509 (32) | Ref. | Ref. |
At least once a day | 25/45 (56) | 20/45 (44) | 1.38, 0.97–1.96, 0.072 | 1.30, 0.89–1.904, 0.17 |
Lymphedema diagnose and treatment, n (%) | n = 386 | n = 174 | ||
No lymphedema diagnose | 269/402 (67) | 133/402 (33) | 2.22, 1.11–4.46, 0.025* | 2.02, 1.02–4.02, 0.045* |
Lymphedema diagnose but has not received any treatment | 59/93 (63) | 34/93 (37) | 2.45, 1.18–5.11, 0.017* | 2.25, 1.08–4.67, 0.030* |
Lymphedema diagnose and received treatment4 | 40/47 (85) | 7/47 (15) | Ref. | Ref. |