Why don't women seek pelvic rehab following cancer treatment?

A qualitative study based in patient interview aimed to identify the reasons that survivors of gynecologic cancer do not seek help for pelvic floor dysfunction (PFD). Interviews of 15 patients by a medical provider asked both open-ended questions and provided a list of reasons why a patient may not seek care for PFD. (These reasons were compiled by the researchers based on clinical experience and on literature reviews.) Reasons for not seeking care for PFD were separated into four categories: that the pelvic floor symptoms in comparison to cancer diagnosis seemed bearable, the specialists did not make any recommendations about the PFD, the patient did not want to go to the doctor or hospital, and the patient or provider was unaware of treatment options. Of the women included in this study, cancer diagnoses included cancer of the cervix, endometrium, and vulva, and types of pelvic floor dysfunction included urinary and/or fecal incontinence, overactive bladder, constipation, painful bladder, or obstructed voiding.

One of the primary reasons women did not seek care for PFD was lack of knowledge about potential treatments. Another frequent statement from the 15 women interviewed is that the pelvic floor symptoms, when compared to dealing with cancer, were "bearable." The authors in this research suggest that the medical community needs to consistently give attention to PFD following cancer treatment. In addition to screening for PFD, the medical community should provide "…timely referral to pelvic floor specialists."

In regards to the first category of reasons for not seeking referral, women made statements such as feeling "lucky" to only have PFD rather than the cancer, or that the PFD symptoms were not as severe as other symptoms related to cancer diagnosis and treatment. Other women reported that they had symptoms prior to cancer treatment and were "used to them." Reasons women reported for not wanting to visit the doctor or hospital included fear that the symptoms meant that the cancer had returned or that the symptoms were too embarrassing. When discussing the lack of awareness about treatment for PFD, some women assumed that the physician would have referred for treatment if therapy was warranted or needed, and others did not not know where to go for help. Some women even reported that the oncologist stated that there was no treatment available to help with symptoms of PFD.

This information begs a reaction from pelvic floor therapists everywhere. How can we best interface with both these patients and the physicians? How can we infiltrate the journals, community lectures, national conferences, and also educate our peers about available options? While women who have suffered from cancer and pelvic floor dysfunction are not unique in the lack of awareness about treatment for PFD, common treatments for cancer can create increased tissue dysfunction, fatigue, and comorbid issues such as lymph dysfunction which complicate recovery. If you would like to work more with patients who have dealt with cancer diagnoses, but have a lot of questions about how to appropriately direct treatment, the Institute has new coursework developed by Michelle Lyons, who brings her expertise to this patient population. The next opportunity to take Oncology and the Pelvic Floor A: Female Reproductive and Gynecologic Cancers is this June in Orlando.