Differences Between Pelvic Cancer Survivors with Varying Activity Levels

By Kaitlyn D’Onofrio - Last Updated: October 30, 2019

A recent study observed different needs among survivors of pelvic cancer (i.e., gynecological, rectal, and anal cancer) depending on their levels of physical activity. Specifically, the researchers sought “to investigate if survivors who practiced physical activity less than once a week differed from survivors practicing physical activity at least once a week with respect to urinary and fecal leakage, clinical and sociodemographic characteristics, quality of life (QoL), and depressed and anxious mood.”

Exercise Benefits Cancer Survivors, But Radiotherapy Patients Face Barriers

Despite the proven benefits of physical activity in this patient population, radiotherapy patients face unique challenges. Patients who undergo radiotherapy may experience reduced elasticity and activation of the muscles of the pelvic floor, as well as damage to the nerves and reduced blood flood within the muscular tissues, sometimes leading to atrophy. These effects could last as long as three months, at which time they are called “late side effects”; these frequently result in urinary and fecal leakage, described by the researchers as “one of the most serious late consequences of pelvic radiotherapy that complicates life and aging.”

A previous study found that leakage was a barrier for engaging in physical activity among female pelvic cancer survivors—particularly if there was not an available restroom close by; the lack of exercise lowered their psychological energy and physical fitness.

“Based on observations from non-cancer female populations, it is plausible that leakage may be a barrier for pelvic cancer survivors keeping them from practicing physical activity. However, according to our database searches, no previous quantitative studies have explored the frequency of physical activity in relation to urinary or fecal leakage among female pelvic cancer survivors,” wrote the study authors, who searched PubMed with the search terms “(physical activity) AND cancer AND (incontinence OR leakage)” in 2018.

Patient Population and Survey

The study was conducted in the outpatient setting in southwest Sweden. Female survivors of pelvic cancer filled out a survey between six and 48 months after concluding radiotherapy, which they underwent between 2007 and 2016. The researchers implemented a multivariable regression model to evaluate factors covarying with physical activity levels. QoL and depressed and anxious mood was compared between women who exercised at least versus less than once a week. Patients were excluded from the study if they had ongoing cancer or any physical, psychological, or linguistic issues and could not consent to participating in the study. Some of the surey questions included:

  • Do you practice physical activity? (Seven response options, ranging from “No” to “Yes, at least once a day”)
  • Have you been wetting yourself because you could not reach the toilet in time within the past six months? (Seven response options, ranging from “No” to “Yes, at least once a day”)
  • How large volume do you leak? (Four response options, ranging from “Not applicable” to “All bladder volume”; this question was also asked regarding leaked stools)
  • Have you leaked stools because you could not reach the toilet in time, within the past six months? (Six response options, ranging from “No” to “Yes, at least daily”)
  • How has your quality of life been the last six months? (“No quality of life at all” to “Best possible quality of life”)
  • Have you felt low or depressed within the past six months?/Have you felt anxious within the past six months? (“Never” to “All the time”)

A total of 568 patients filled out the questionnaire, of whom a third (n = 186, 33%) practiced physical activity less than once a week, while 382 (67%) practiced at least once a week. The following patient factors were associated with physical activity practice less than once per week: leaked a large or all volume of stools (50%, P=0.01), had just elementary school level of education (45%, P<0.001), smokers (45%, P=0.049), or had lymphedema without receiving lymphedema treatment (37%, P=0.030). Women who engaged in physical activity at least one a week had a better QoL (P<0.001) and lower occurrence of depressed mood (P=0.044) compared to the other patients.

The researchers concluded, “We are uncertain to what extent the leakage leads to reduced physical activity and to what extent (in the other way) physical activity can be correlated with muscular exercise of the pelvic floor, which in turn leads to a reduced incidence of fecal leakage or urine leakage. Our results, however, indicate that there is a logical foundation (rationale) to try pelvic floor training in various ways to reduce the occurrence of leakage and thereby increase the possibilities of living a good life.”

Post Tags:Survivorship