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Is a behavioral treatment for urinary incontinence beneficial to prostate cancer survivors as a follow-up care?

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Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

The American Cancer Society (ACS) recommends a follow-up care plan for urinary incontinence of prostate cancer survivors that includes pelvic floor muscle exercise (PFME). We examined potential impacts and access barriers of this recommendation with consideration of patients who normally do not seek such care.

Methods

We compared 267 participants of a clinical trial that tested a PFME-based treatment of urinary incontinence and 69 nonparticipants who declined the trial. All subjects were assessed at baseline, 3, and 6 months on leakage frequency, disease-specific quality of life (QOL), and physical well-being. The nonparticipants were interviewed to examine reasons for intervention refusal.

Results

The participating and nonparticipating groups did not differ in most baseline demographics and clinical variables except that the nonparticipants had lower baseline prostate-specific antigen (P ≤ 0.01), lower education levels, and higher likelihood of receiving surgery alone (both P ≤ 0.05). Nonparticipants exhibited significantly more frequent daily leakage, poorer urinary function and bother, and severer urinary problems at 3 and 6 months, as well as worse physical well-being at 6 months, relative to baseline, than the participants. The primary reason for refusal was economical, such as lacking transportation and time for participation.

Conclusions

Urinary function and QOL can worsen without appropriate follow-up care. It is important to make a PFME-based follow-up care program available to all incontinent prostate cancer survivors as recommended by ACS guidelines.

Implications for cancer survivors

Seeking PFME-based treatment is crucial for long-term urinary health outcomes even if present leakage is minor or financial challenge is a concern.

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Acknowledgments

The study was supported by the National Institutes of Health/National Cancer Institute (R01CA127493; PI: Zhang). Cleveland Clinic, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, and the MetroHealth System, which are all affiliated with Case Western Reserve University, provided support for patient access.

Author information

Authors and Affiliations

  1. Case Western Reserve University School of Nursing, 10900 Euclid Avenue, Cleveland, OH, 44106-4904, USA

    Amy Y. Zhang & Shirley Moore

  2. Cancer Prevention and Control Program, Georgetown University Medical Center, 3300 Whitehaven Street NW, Suite 4100 - Milton Harris Bldg., Washington, DC, 20007, USA

    Alex Z. Fu

  3. Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Urology Clinic, Case Western Reserve University School of Medicine, 10701 East Blvd., Cleveland, OH, 44106, USA

    Hui Zhu

  4. Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd., Cleveland, OH, 44106, USA

    Gerald Strauss, Denise Kresevic & Donald R. Bodner

  5. Cleveland Clinic Lerner College of Medicine, Glickman Urological and Kidney Institute, Desk Q10-1, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Eric Klein

  6. Department of Urology, Case Western Reserve University School of Medicine; University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Lee Ponsky & Donald R. Bodner

Authors
  1. Amy Y. Zhang
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  2. Alex Z. Fu
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  3. Shirley Moore
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  4. Hui Zhu
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  5. Gerald Strauss
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  6. Denise Kresevic
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  7. Eric Klein
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  8. Lee Ponsky
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  9. Donald R. Bodner
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Corresponding author

Correspondence to Amy Y. Zhang.

Ethics declarations

There are no financial disclosures from the authors. 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. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflicts of interest.

Appendix: American Cancer Society guidelines for assessment and management of physical and psychosocial long-term and late effects—urinary dysfunction

Appendix: American Cancer Society guidelines for assessment and management of physical and psychosocial long-term and late effects—urinary dysfunction

  1. 1.

    Discuss urinary function (e.g., urinary stream, difficulty emptying the bladder) and incontinence with all survivors.

  2. 2.

    Consider timed voiding, prescribing anticholinergic medications (e.g., oxybutynin) to address issues such as nocturia, frequency, or urgency. Consider alpha blockers (e.g., tamsulosin) for slow stream.

  3. 3.

    Refer survivors with postprostatectomy incontinence to a physical therapist for pelvic floor rehabilitation; at a minimum, instruct survivors about Kegel exercises.

  4. 4.

    Refer men with persistent leakage or other urinary symptoms to a urologist for further evaluation (e.g., urodynamic testing, cystoscopy) and discussion of treatment options including surgical placement of a male urethral sling or artificial urinary sphincter for incontinence.

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Zhang, A.Y., Fu, A.Z., Moore, S. et al. Is a behavioral treatment for urinary incontinence beneficial to prostate cancer survivors as a follow-up care?. J Cancer Surviv 11, 24–31 (2017). https://doi.org/10.1007/s11764-016-0557-0

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  • DOI: https://doi.org/10.1007/s11764-016-0557-0

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