title: Severe pelvic floor symptoms after cervical cancer treatment are predominantly associated with mental and physical well-being and body image: a cross-sectional study.
abstract: OBJECTIVE
  To identify associations between demographic, disease-related, and psychological variables and severe distress from pelvic floor symptoms (PFSs) after cervical cancer treatment.
  
  
  METHODS
  This study was cross-sectional and questionnaire based. We included patients with cervical cancer treated between 1997 and 2007 in the Academic Medical Center, Amsterdam. Pelvic floor symptoms were assessed with urogenital distress inventory and defecatory distress inventory. Scores were dichotomized into severe (>90th percentile) versus nonsevere distress. Disease-related variables were extracted from medical files. Psychological factors included mental and physical well-being, optimism, and body image, which were assessed with standardized questionnaires. Univariate and multivariate logistic regression analyses were performed.
  
  
  RESULTS
  A total of 282 patients were included: 148 were treated with radical hysterectomy and pelvic lymph node dissection, 61 patients were treated with surgery and adjuvant radiotherapy, and 73 patients were treated with primary radiotherapy. Demographic: Multivariate analyses showed no significant relation between demographic variables and symptoms. Disease-related: None of these variables were significantly associated in multivariate analyses. Psychosocial: In all treatment groups, multivariate associations were found. In general, better mental and physical well-being was associated with nonsevere PFSs. Increased body image disturbance was associated with severe defecation symptoms.
  
  
  CONCLUSIONS
  Few associations were found between demographic and disease-related variables and distress from PFS after cervical cancer treatment. However, better mental and physical well-being is associated with nonsevere distress from urogenital and defecation symptoms and more body image disturbance with severe PFSs. Improving these factors might reduce distress from PFSs and should be a focus of future research.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. m.h.hazewinkel@amc.uva.nl
authors.forename: Menke H
authors.initials: MH
authors.lastname: Hazewinkel
authors.forename: Mirjam A G
authors.initials: MA
authors.lastname: Sprangers
authors.forename: Jacobus van der
authors.initials: Jv
authors.lastname: Velden
authors.forename: Matthé P M
authors.initials: MP
authors.lastname: Burger
authors.forename: Jan-Paul W R
authors.initials: JP
authors.lastname: Roovers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001828:Body Image; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D059952:Pelvic Floor Disorders / Q000209:etiology* / Q000523:psychology; D011183:Postoperative Complications / Q000523:psychology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000532:radiotherapy / Q000601:surgery