Similar QOL benefit for dual endometrial cancer, urinary incontinence surgery vs. cancer surgery alone

Key takeaways:

• Concurrent surgeries for stress urinary incontinence and endometrial cancer fail to improve quality of life.
• Cancer-related quality of life scores improved with concomitant surgery and cancer surgery alone.

Among women with stress urinary incontinence and endometrial intraepithelial neoplasia or early-stage cancer, concomitant surgeries for both conditions did not improve quality of life compared with cancer surgery alone, researchers reported.

“Up to 83% of women with endometrial cancer report symptoms of urinary incontinence after treatment, and 50% of women with endometrial cancer have stress urinary incontinence before treatment of their cancer. Stress urinary incontinence may be surgically treated with minimally invasive approaches,” Katina Robison, MD, associate professor of obstetrics and gynecology at the Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, and colleagues wrote.

In a multicenter, prospective cohort study, Robinson and colleagues compared endometrial cancer–specific quality of life, urinary and clinical outcomes and surgical complications for concomitant surgeries for endometrial cancer and stress urinary incontinence and cancer surgery alone.

Researchers identified 1,322 women (mean age, 62.2 years) who were screened for stress urinary incontinence symptoms across eight U.S. sites. Of the 702 women who were positive for stress urinary incontinence, 532 were offered referral to urogynecology and incontinence treatment including concomitant surgery. Participants were categorized according to concomitant surgery (n = 110) or cancer surgery alone (n = 422).

Researchers used the Functional Assessment of Cancer Therapy-Endometrial (FACT-En) score and questionnaires to assess urinary symptom-specific severity and effects prior to surgery and 6 weeks, 6 months and 12 months after surgery.

The primary outcome was cancer-related quality of life (QOL) measured by the FACT-En score, with higher scores indicating better QOL.

Women who received concomitant stress urinary incontinence surgery and those who received cancer surgery only had increases in the FACT-En score from the pre- to postoperative period. In the postoperative period, the median change in the FACT-En score was 1.2 points higher among women who received concomitant surgery compared with women who received cancer surgery alone.

Women who received concomitant surgery also experienced longer median time until surgery (22 vs. 16 days; P < .001), more estimated blood loss (150 mL vs. 72.5 mL; P < .001) and longer operative time (185.5 vs. 152 minutes; P < .001) compared with women who received cancer surgery alone.

“Although there were improvements in incontinence symptoms, the clinical effect on incontinence-specific QOL remains unclear because the Urinary Impact Questionnaire-Short Form-7 scores did not reach the minimal clinically important difference,” the researchers wrote.