Urinary Incontinence in Breast Cancer Survivors: A Controlled Comparsion

摘要：随着乳腺癌早期检测和治疗的不断进步，人们的兴趣越来越多地转移到疾病的长期和晚期影响的预防和治疗上。与此一致的是，大量研究记录了乳腺癌幸存者（BC+幸存者）更年期症状的患病率和严重程度及其对生活质量的影响。尿失禁（UI），或不自觉的尿漏，是一种泌尿生殖系统症状，通常与更年期过渡有关。先前对BC+幸存者的研究表明，28%至55%的BC+幸存者报告了某种UI症状。研究还表明，尿失忆症与生存期较差的健康相关生活质量之间存在关系。然而，以往的研究在概念和方法上都受到限制，可能低估了尿失联的患病率、严重程度和对BC+幸存者生活质量的影响。考虑到UI可能会严重影响幸存者的生活质量，如果不进行治疗，可能会随着时间的推移而恶化，未能评估和治疗这些症状可能会对BC+幸存者的健康和福祉产生长期影响。同样，缺乏关于UI结果的可用信息，这些结果对BC+幸存者日常生活的影响，以及幸存者管理症状的努力意味着在幸存者中解决UI的干预措施可能是不完整和无效的。为了解决先前研究的局限性，并提高我们对BC+幸存者中UI的理解，我们提出了一项具有乳腺癌病史的女性和年龄、种族和种族匹配的无癌症病史女性（CA-参与者）的比较样本的创新研究。参与者将完成一系列标准化的、生态有效的工具，旨在评估尿失禁、尿失禁结果和尿失禁相关的生活质量结果。参与者还将完成自我管理和寻求帮助行为的评估。这些数据将用于解决以下具体目标：1)与年龄、种族和民族匹配的无癌症病史的女性相比，估计有乳腺癌病史的女性的尿失联患病率；2)探讨BC+幸存者和匹配CA-参与者的UI严重程度和其他UI结局与生活质量的关系；3)识别BC+幸存者管理UI的自我管理和求助行为。这项拟议的研究预计将产生具有理论和临床意义的结果。在理论意义上，该研究有望更全面地了解BC+幸存者的UI，其对幸存者生活质量的影响，以及幸存者对UI症状的管理。它也有望为开展BC+幸存者尿失尿发生率的前瞻性纵向研究提供支持。就临床意义而言，该研究将提供必要的经验证据，以指导开发治疗BC+幸存者尿失尿的干预措施。总体而言，该研究有望通过设计干预的随机对照试验，对生存期的临床护理产生重大影响。

DESCRIPTION (provided by applicant): ABSTRACT As a result of ongoing advances in early detection and treatment for breast cancer, interest has shifted increasingly to include the prevention and treatment of long-term and late effects of the disease. Consistent with this, a large body of research has documented the prevalence and severity of menopausal symptoms and their impact on quality of life in breast cancer survivors (BC+ survivors). Urinary incontinence (UI), or the involuntary leakage of urine, is a genitourinary symptom commonly associated with the menopausal transition. Previous studies of BC+ survivors indicate that between 28% and 55% of BC+ survivors report some symptom of UI. Studies have also demonstrated a relationship between UI and poorer health-related quality of life in survivorship. However, previous studies have been limited conceptually and methodologically and likely are an underestimate of the prevalence, severity and impact of UI on quality of life in BC+ survivors. Given that UI may significantly impact survivors' quality of life and may worsen over time if not treated, failure to assess and treat these symptoms may have long-term implications for the health and well-being of BC+ survivors. As well, the dearth of information available on UI outcomes, the impact of these outcomes on BC+ survivors' daily lives, and survivors' efforts to manage symptoms means that interventions to address UI in survivorship are likely to be incomplete and ineffective. To address the limitations of prior research and to advance our understanding of UI in BC+ survivors, we propose an innovative study of women with a history of breast cancer and an age-, race-, and ethnicity-matched comparison sample of women with no history of cancer (CA- participants). Participants will complete a battery of standardized, ecologically valid instruments designed to assess UI, UI outcomes and incontinence-related quality of life outcomes. Participants will also complete an assessment of self-management and help-seeking behaviors. These data will be used to address the following specific aims: 1) To estimate the prevalence of UI in women with a history of breast cancer compared to women with no history of cancer matched for age, race, and ethnicity; 2) To explore the relationship between UI severity and other UI outcomes to quality of life in BC+ survivors and matched CA- participants; and 3) To identify the self- management and help-seeking behaviors used by BC+ survivors to manage UI. The proposed study is expected to yield results which are both theoretically and clinically significant. In terms of theoretical significance, the study is expected to yield a more complete understanding of UI in BC+ survivors, its impact on survivors' quality of life, and survivors' efforts to manage UI symptoms. It is also expected to provide support for the conduct of a prospective, longitudinal study of UI incidence in BC+ survivors. In terms of clinical significance, the study will yield the empirical evidence necessary to guide the development of an intervention to treat UI in BC+ survivors. Taken as a whole, the proposed study is expected to have significant implications for clinical care in survivorship by leading to the design of a randomized controlled trial of the intervention. PUBLIC HEALTH RELEVANCE: Urinary incontinence is increasingly recognized as a socially disabling condition that can have a profound impact on quality of life. Although there is preliminary evidence of the prevalence of urinary incontinence in breast cancer survivors, there is a dearth of information available on types of urinary incontinence in breast cancer survivors, the severity of urinary incontinence in survivors, its impact on survivors' quality of life, and survivors' efforts to manage symptoms. The proposed research plan is expected to have implications for public health by yielding a complete understanding of urinary incontinence in breast cancer survivors and its impact on survivors' quality of life so that interventions to address the condition are relevant and effective.