Urinary Incontinence in Breast Cancer Survivors: A Controlled Comparsion

描述(申请人提供)：摘要随着乳腺癌早期发现和治疗的不断进步，人们的兴趣越来越多地转向包括预防和治疗这种疾病的长期和晚期影响。与此相一致，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)，或不由自主的尿漏，是一种通常与绝经过渡有关的泌尿生殖系统症状。以前对BC+幸存者的研究表明，28%到55%的BC+幸存者报告了一些尿失禁症状。研究还表明，尿失禁与较差的健康相关生存生活质量之间存在关系。然而，以前的研究在概念和方法上都是有限的，可能低估了尿失禁的患病率、严重性和对BC+幸存者生活质量的影响。鉴于尿失禁可能会显著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。此外，缺乏关于尿失禁结局的信息，这些结局对BC+幸存者日常生活的影响，以及幸存者为控制症状所做的努力，意味着解决尿失禁生存问题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，并促进我们对BC+幸存者中UI的理解，我们提出了一项针对有乳腺癌病史的女性的创新研究，以及没有癌症病史的年龄、种族和民族匹配的对照样本(CA参与者)。参与者将完成一系列标准化的、生态上有效的工具，旨在评估尿失禁、尿失禁结果和失禁相关的生活质量结果。参与者还将完成对自我管理和求助行为的评估。这些数据将被用来解决以下具体目标：1)与年龄、种族和民族相匹配的没有癌症病史的妇女相比，有乳腺癌病史的妇女中尿失禁的患病率；2)探索尿失禁严重程度和其他尿失禁结果与BC+幸存者和匹配的CA参与者生活质量的关系；以及3)确定BC+幸存者用来管理尿失禁的自我管理和求助行为。这项拟议的研究有望产生具有理论和临床意义的结果。在理论意义上，这项研究有望对BC+幸存者的尿崩症及其对幸存者生活质量的影响，以及幸存者对尿崩症症状的管理做出更全面的了解。这也有望为对BC+存活者的尿崩症发病率进行前瞻性、纵向研究提供支持。在临床意义上，这项研究将提供必要的经验证据，以指导开发干预措施治疗BC+幸存者的尿失禁。作为一个整体，这项拟议的研究有望通过导致干预的随机对照试验的设计，对生存临床护理产生重大影响。 与公共卫生相关：尿失禁日益被认为是一种社会残疾状况，可能对生活质量产生深远影响。虽然有初步证据表明乳腺癌幸存者的尿失禁盛行，但关于乳腺癌幸存者的尿失禁类型、幸存者的尿失禁严重程度、其对幸存者生活质量的影响以及幸存者如何控制症状的信息很少。这项拟议的研究计划预计将对公众健康产生影响，因为它将全面了解乳腺癌幸存者的尿失禁及其对幸存者生活质量的影响，从而使针对这种情况的干预措施具有相关性和有效性。

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.