title: Fecal incontinence affecting quality of life and social functioning among long-term gynecological cancer survivors.
abstract: BACKGROUND
  Fecal incontinence is a symptom reported by cancer survivors after pelvic radiotherapy and is recognized to be one of the most troubling symptom-induced sources of distress to patients.
  
  
  OBJECTIVE
  To investigate how fecal incontinence, patient-reported as emptying of all stools into clothing without forewarning, impact self-assessed quality of life from a social, psychological, sexual, and functional aspect among gynecological cancer survivors treated with pelvic radiotherapy.
  
  
  METHODS
  We identified a cohort of 789 eligible women in the Stockholm and Gothenburg areas treated with pelvic radiotherapy alone or as combined treatment of gynecological cancer. From the Swedish Population Registry, we identified 478 control women. Data were collected using a study-specific, validated, postal questionnaire including questions covering symptoms from the pelvic region, demographics, social functioning, psychological, and quality-of-life issues.
  
  
  RESULTS
  Participation was 78% for cancer survivors and 72% for control women. The fecal incontinence symptom emptying of all stools into clothing without forewarning was reported by 70 cancer survivors (12%), with lowered quality of life in 74% of the 70 cancer survivors. This symptom kept the survivors from going to parties (relative risk [RR], 11.8; 95% confidence interval [CI], 6.6-21.1), kept the survivors from traveling (RR, 9.3; 95% CI, 5.3-16.5), affected their work ability (RR, 7.9; 95% CI, 3.8-16.4), hindered their sexual life (RR, 9.2; 95% CI, 4.8-17.6), and changed them as persons (RR, 4.9; 95% CI, 2.9-8.1). The prevalence of the symptom emptying of all stools into clothing without forewarning among control women was 3 (1%) of 344.
  
  
  CONCLUSIONS
  Among gynecological cancer survivors having undergone pelvic radiotherapy alone or as part of a combined treatment, fecal incontinence is associated with social, psychological, sexual, and functional consequences.
authors.affiliation: Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden. gail.dunberger@ki.se
authors.forename: Gail
authors.initials: G
authors.lastname: Dunberger
authors.forename: Helena
authors.initials: H
authors.lastname: Lind
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Waldenström
authors.forename: Tommy
authors.initials: T
authors.lastname: Nyberg
authors.forename: Massoud
authors.initials: M
authors.lastname: al-Abany
authors.forename: Ullakarin
authors.initials: U
authors.lastname: Nyberg
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Avall-Lundqvist
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005242:Fecal Incontinence / Q000523:psychology* / Q000628:therapy; D005260:Female; D005833:Genital Neoplasms, Female / Q000523:psychology* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000523:psychology* / Q000532:radiotherapy / Q000601:surgery; D011379:Prognosis; D011788:Quality of Life; D012917:Social Adjustment; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors