Supportive Care in Cancer

, Volume 26, Issue 7, pp 2239–2246 | Cite as

Health-related quality of life and pelvic floor dysfunction in advanced-stage ovarian cancer survivors: associations with objective activity behaviors and physiological characteristics

  • Christelle Schofield
  • Robert U. Newton
  • Paul A. Cohen
  • Daniel A. Galvão
  • Joanne A. McVeigh
  • Ganendra R. Mohan
  • Jason Tan
  • Stuart G. Salfinger
  • Leon M. Straker
  • Carolyn J. Peddle-McIntyre
Original Article



Little is known about the relationship between health-related quality of life (HRQoL), pelvic floor dysfunction (PFD), and modifiable lifestyle and physiological factors for ovarian cancer survivors (OCS). The primary aim of the study was to compare post-treatment advanced-stage OCS with age-matched controls on measures of HRQoL and PFD. The secondary aim was to examine associations between HRQoL, PFD, objective activity behaviors, physical function, and body composition in OCS.


Twenty advanced-stage OCS and 20 controls completed questionnaires assessing HRQoL (SF-36) and PFD (Australian Pelvic Floor Questionnaire), and underwent objective assessments of activity behavior (7-day accelerometry), physical function (400-m walk, repeated chair rise, 6-m usual-pace walk, one-repetition maximum chest press, and single-leg extension), and body composition (dual-energy x-ray absorptiometry).


Compared to controls, OCS had worse physical HRQoL (− 4.3 median difference, p = 0.013), but equivalent self-reported PFD, indicated by combined bladder, bowel, and pelvic organ prolapse symptoms (0.89 mean difference, p = 0.277). In OCS, physical HRQoL was significantly negatively associated with PFD (r = 0.468, p = 0.043). Decreased physical HRQoL and increased PFD were significantly associated with less moderate-to-vigorous physical activity in ≥ 10-min bouts (ρ = 0.627, p = 0.003; ρ = − 0.457, p = 0.049), more sedentary time (r = − 0.449, p = 0.047; r = 0.479, p = 0.038), and slower 400-m walk time (ρ = − 0.565, p = 0.022; ρ = 0.504, p = 0.028).


Post-treatment advanced-stage OCS have decreased physical HRQoL, which is associated with modifiable factors such as worse PFD, less moderate-to-vigorous physical activity, more sedentary time, and decreased objective physical function. This highlights the need for ongoing supportive care and multidisciplinary interventions after first-line ovarian cancer treatment.


Ovarian cancer Health-related quality of life Pelvic floor dysfunction Moderate-to-vigorous physical activity (MVPA) Sedentary time 


Funding information

Dr. Paul A. Cohen receives salary support from the Jakovich Family and the St John of God Foundation.

Prof Daniel A. Galvão is supported by a Cancer Council of Western Australia Research Fellowship.

Dr. Carolyn J. Peddle-McIntyre is supported by a Cancer Council of Western Australia Postdoctoral Research Fellowship.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Ferlay J, Soerjomataram I, Ervik M et al GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from:, accessed on 20/9/2016
  2. 2.
    Sato S, Itamochi H (2014) Neoadjuvant chemotherapy in advanced ovarian cancer: latest results and place in therapy. Ther Adv Med Oncol 6(6):293–304. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Herzog TJ (2004) Recurrent ovarian cancer: how important is it to treat to disease progression? Clin Cancer Res 10(22):7439–7449. CrossRefPubMedGoogle Scholar
  4. 4.
    Ahmed-Lecheheb D, Joly F (2016) Ovarian cancer survivors’ quality of life: a systematic review. J Cancer Surviv 10(5):789–801. CrossRefPubMedGoogle Scholar
  5. 5.
    Zhou Y, Irwin ML, Ferrucci LM, McCorkle R, Ercolano EA, Li F, Stein K, Cartmel B (2016) Health-related quality of life in ovarian cancer survivors: results from the American Cancer Society’s Study of Cancer Survivors—I. Gynecol Oncol 141(3):543–549. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Rutledge TL, Heckman SR, Qualls C, Muller CY, Rogers RG (2010) Pelvic floor disorders and sexual function in gynecologic cancer survivors: a cohort study. Am J Obstet Gynecol 203(5):514.e1–514.e7. CrossRefGoogle Scholar
  7. 7.
    Skjeldestad FE, Hagen B (2008) Long-term consequences of gynecological cancer treatment on urinary incontinence: a population-based cross-sectional study. Acta Obstet Gynecol Scand 87(4):469–475. CrossRefPubMedGoogle Scholar
  8. 8.
    Smits A, Smits E, Lopes A, Das N, Hughes G, Talaat A, Pollard A, Bouwman F, Massuger L, Bekkers R, Galaal K (2015) Body mass index, physical activity and quality of life of ovarian cancer survivors: time to get moving? Gynecol Oncol 139(1):148–154. CrossRefPubMedGoogle Scholar
  9. 9.
    Stevinson C, Faught W, Steed H et al (2007) Associations between physical activity and quality of life in ovarian cancer survivors. Gynecol Oncol 106(1):244–250CrossRefPubMedGoogle Scholar
  10. 10.
    Kenton K, Mueller ER (2006) The global burden of female pelvic floor disorders. BJU Int 98(Suppl 1):1–5. CrossRefPubMedGoogle Scholar
  11. 11.
    Lowenstein L, Pierce K, Pauls R (2009) Urogynecology and sexual function research. How are we doing? J Sex Med 6(1):199–204CrossRefPubMedGoogle Scholar
  12. 12.
    Bretschneider CE, Doll KM, Bensen JT, Gehrig PA, Wu JM, Geller EJ (2016) Prevalence of pelvic floor disorders in women with suspected gynecological malignancy: a survey-based study. Int Urogynecol J 27(9):1409–1414. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Davis K, Kumar D (2003) Pelvic floor dysfunction: a conceptual framework for collaborative patient-centred care. J Adv Nurs 43(6):555–568. CrossRefPubMedGoogle Scholar
  14. 14.
    Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, Bortolini M, Dumoulin C, Gomes M, McClurg D, Meijlink J, Shelly E, Trabuco E, Walker C, Wells A (2017) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J 28(2):191–213. CrossRefPubMedGoogle Scholar
  15. 15.
    Hopkins TG, Stavraka C, Gabra H et al (2015) Sexual activity and functioning in ovarian cancer survivors: an internet-based evaluation. Climacteric 18(1):94–98CrossRefPubMedGoogle Scholar
  16. 16.
    Ferrell B, Smith S, Cullinane C, Melancon C (2003) Symptom concerns of women with ovarian cancer. J Pain Symptom Manag 25(6):528–538. CrossRefGoogle Scholar
  17. 17.
    Schofield C, Newton RU, Galvão DA, Cohen PA, Peddle-McIntyre CJ (2017) A physiological profile of ovarian cancer survivors to inform tailored exercise interventions and the development of exercise oncology guidelines. Int J Gynecol Cancer 27(7):1560–1567. CrossRefPubMedGoogle Scholar
  18. 18.
    Schofield C, Newton RU, Galvão DA et al (2017) Activity behaviors and physiological characteristics of women with advanced-stage ovarian cancer: a preliminary cross-sectional investigation. Int J Gynecol Cancer (Accepted for publication)Google Scholar
  19. 19.
    Stewart AL, Greenfield S, Hays RD et al (1989) Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA 262(7):907–913CrossRefPubMedGoogle Scholar
  20. 20.
    Lazovich D, Robien K, Cutler G et al (2009) Quality of life in a prospective cohort of elderly women with and without cancer. Cancer 115(S18):4283–4297. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ware JE (2007) User’s Manual For The Sf-36v2 Health Survey, Second edn. Quality Metric Inc., Lincoln, pp 81–84Google Scholar
  22. 22.
    Schlenk EA, Erlen JA, Dunbar-Jacob J, McDowell J, Engberg S, Sereika SM, Rohay JM, Bernier MJ (1998) Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36. Qual Life Res 7(1):57–65CrossRefPubMedGoogle Scholar
  23. 23.
    Baessler K, O'Neill SM, Maher CF et al (2009) Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research. Int Urogynecol J Pelvic Floor Dysfunct 20(2):149–158. CrossRefPubMedGoogle Scholar
  24. 24.
    Baessler K, O'Neill SM, Maher CF et al (2010) A validated self-administered female pelvic floor questionnaire. Int Urogynecol J 21(2):163–172. CrossRefPubMedGoogle Scholar
  25. 25.
    Freedson PS, Melanson E, Sirard J (1998) Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc 30(5):777–781. CrossRefPubMedGoogle Scholar
  26. 26.
    Matthews CE, Chen KY, Freedson PS et al (2008) Amount of time spent in sedentary behaviors in the United States, 2003-2004. Am J Epidemiol 167(7):875–881CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Simonsick EM, Fan E, Fleg JL (2006) Estimating cardiorespiratory fitness in well-functioning older adults: treadmill validation of the long distance corridor walk. J Am Geriatr Soc 54(1):127–132CrossRefPubMedGoogle Scholar
  28. 28.
    Cesari M, Kritchevsky SB, Newman AB, Simonsick EM, Harris TB, Penninx BW, Brach JS, Tylavsky FA, Satterfield S, Bauer DC, Rubin SM, Visser M, Pahor M, for the Health, Aging and Body Composition Study (2009) Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging And Body Composition Study. J Am Geriatr Soc 57(2):251–259. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Peiffer JJ, Galvão DA, Gibbs Z, Smith K, Turner D, Foster J, Martins R, Newton RU (2010) Strength and functional characteristics of men and women 65 years and older. Rejuvenation Res 13(1):75–82. CrossRefPubMedGoogle Scholar
  30. 30.
    Galvão DA, Taaffe DR (2005) Resistance exercise dosage in older adults: single- versus multiset effects on physical performance and body composition. J Am Geriatr Soc 53(12):2090–2097. CrossRefPubMedGoogle Scholar
  31. 31.
    Greimel ER, Bottomley A (2001) Quality of life issues in gynecological cancer. Expert Rev Pharmacoecon Outcome Res 1(1):93–98. CrossRefGoogle Scholar
  32. 32.
    Liavaag AH, Dørum A, Fosså SD et al (2007) Controlled study of fatigue, quality of life, and somatic and mental morbidity in epithelial ovarian cancer survivors: how lucky are the lucky ones? J Clin Oncol 25(15):2049–2056CrossRefPubMedGoogle Scholar
  33. 33.
    Galvão DA, Newton RU (2005) Review of exercise intervention studies in cancer patients. J Clin Oncol 23(4):899–909. CrossRefPubMedGoogle Scholar
  34. 34.
    Newton RU, Galvão DA (2008) Exercise in prevention and management of cancer. Curr Treat Options in Oncol 9(2–3):135–146. CrossRefGoogle Scholar
  35. 35.
    Hayes SC, Spence RR, Galvão DA, Newton RU (2009) Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport 12(4):428–434. CrossRefPubMedGoogle Scholar
  36. 36.
    Brown JC, Winters-Stone K, Lee A, Schmitz KH (2012) Cancer, physical activity, and exercise. Compr Physiol 2(4):2775–2809. PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Vallance JK, Boyle T, Courneya KS et al (2014) Associations of objectively assessed physical activity and sedentary time with health-related quality of life among colon cancer survivors. Cancer 120(18):2919–2926CrossRefPubMedGoogle Scholar
  38. 38.
    Thomas SG, Sato HRN, Glantz JC, Doyle PJ, Buchsbaum GM (2013) Prevalence of symptomatic pelvic floor disorders among gynecologic oncology patients. Obstet Gynecol 122(5):976–980. CrossRefPubMedGoogle Scholar
  39. 39.
    Pecorelli S, Angioli R, Pasinetti B et al (2006) Systemic therapy for gynecological neoplasms: ovary, cervix and endometrium. Updat Cancer Ther 1(4):515–538CrossRefGoogle Scholar
  40. 40.
    Andreyev HJN, Wotherspoon A, Denham JW et al (2011) “Pelvic radiation disease”: new understanding and new solutions for a new disease in the era of cancer survivorship. Scand J Gastroenterol 46(4):389–397CrossRefPubMedGoogle Scholar
  41. 41.
    Nygaard IE, Shaw JM (2016) Physical activity and the pelvic floor. Am J Obstet Gynecol 214(2):164–171. CrossRefPubMedGoogle Scholar
  42. 42.
    Kafri R, Shames J, Golomb J et al (2012) Self-report function and disability: a comparison between women with and without urgency urinary incontinence. Disabil Rehabil 34(20):1699–1705CrossRefPubMedGoogle Scholar
  43. 43.
    Pomian A, Lisik W, Kosieradzki M, Barcz E (2016) Obesity and pelvic floor disorders: a review of the literature. Med Sci Monit 22:1880–1886. CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Laakkonen EK, Kulmala J, Aukee P et al (2017) Female reproductive factors are associated with objectively measured physical activity in middle-aged women. PLoS One 12:e0172054CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A, American College of Sports Medicine., American Heart Association (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116(9):1081–1093. CrossRefPubMedGoogle Scholar
  46. 46.
    Dumoulin C, Hay-Smith J, Habée-Séguin GM et al (2015) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn 34(4):300–308CrossRefPubMedGoogle Scholar
  47. 47.
    Mishra SI, Scherer RW, Snyder C et al (2012) Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 8:CD008465Google Scholar
  48. 48.
    Neto IJFC, Pinto RA, Jorge JMN, Santo MA, Bustamante-Lopez LA, Cecconello I, Nahas SC (2017) Are obese patients at an increased risk of pelvic floor dysfunction compared to non-obese patients? Obes Surg 27(7):1822–1827. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Christelle Schofield
    • 1
  • Robert U. Newton
    • 1
    • 2
  • Paul A. Cohen
    • 3
    • 4
    • 5
  • Daniel A. Galvão
    • 1
  • Joanne A. McVeigh
    • 6
    • 7
  • Ganendra R. Mohan
    • 3
    • 4
    • 8
    • 9
  • Jason Tan
    • 3
    • 4
    • 8
    • 10
  • Stuart G. Salfinger
    • 3
    • 4
    • 8
    • 11
  • Leon M. Straker
    • 12
  • Carolyn J. Peddle-McIntyre
    • 1
  1. 1.Exercise Medicine Research InstituteEdith Cowan UniversityJoondalupAustralia
  2. 2.UQ Centre for Clinical ResearchUniversity of QueenslandHerstonAustralia
  3. 3.St John of God Hospital Bendat Family Comprehensive Cancer CentreSubiacoAustralia
  4. 4.Division of Women’s and Infants’ Health, School of MedicineUniversity of Western AustraliaCrawleyAustralia
  5. 5.Institute for Health ResearchUniversity of Notre Dame AustraliaFremantleAustralia
  6. 6.School of Occupational Therapy and Social WorkCurtin UniversityBentleyAustralia
  7. 7.Exercise Laboratory, School of PhysiologyUniversity of WitwatersrandJohannesburgSouth Africa
  8. 8.School of MedicineUniversity of Notre Dame AustraliaFremantleAustralia
  9. 9.NedlandsAustralia
  10. 10.WOMEN CentreWest LeedervilleAustralia
  11. 11.St John of God HospitalSubiacoAustralia
  12. 12.School of Physiotherapy and Exercise ScienceCurtin UniversityBentleyAustralia

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