title: Is a behavioral treatment for urinary incontinence beneficial to prostate cancer survivors as a follow-up care?
abstract: The American Cancer Society (ACS) recommends a follow-up care plan for urinary incontinence of prostate cancer survivors that includes pelvic floor muscle exercise (PFME). We examined potential impacts and access barriers of this recommendation with consideration of patients who normally do not seek such care.
  
  
  
  We compared 267 participants of a clinical trial that tested a PFME-based treatment of urinary incontinence and 69 nonparticipants who declined the trial. All subjects were assessed at baseline, 3, and 6 months on leakage frequency, disease-specific quality of life (QOL), and physical well-being. The nonparticipants were interviewed to examine reasons for intervention refusal.
  
  
  
  The participating and nonparticipating groups did not differ in most baseline demographics and clinical variables except that the nonparticipants had lower baseline prostate-specific antigen (P ≤ 0.01), lower education levels, and higher likelihood of receiving surgery alone (both P ≤ 0.05). Nonparticipants exhibited significantly more frequent daily leakage, poorer urinary function and bother, and severer urinary problems at 3 and 6 months, as well as worse physical well-being at 6 months, relative to baseline, than the participants. The primary reason for refusal was economical, such as lacking transportation and time for participation.
  
  
  
  Urinary function and QOL can worsen without appropriate follow-up care. It is important to make a PFME-based follow-up care program available to all incontinent prostate cancer survivors as recommended by ACS guidelines.
  
  
  
  Seeking PFME-based treatment is crucial for long-term urinary health outcomes even if present leakage is minor or financial challenge is a concern.
authors.affiliation: Case Western Reserve University School of Nursing, 10900 Euclid Avenue, Cleveland, OH, 44106-4904, USA. Amy.Zhang@case.edu.
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Zhang
authors.affiliation: Cancer Prevention and Control Program, Georgetown University Medical Center, 3300 Whitehaven Street NW, Suite 4100 - Milton Harris Bldg., Washington, DC, 20007, USA.
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Fu
authors.affiliation: Case Western Reserve University School of Nursing, 10900 Euclid Avenue, Cleveland, OH, 44106-4904, USA.
authors.forename: Shirley
authors.initials: S
authors.lastname: Moore
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Urology Clinic, Case Western Reserve University School of Medicine, 10701 East Blvd., Cleveland, OH, 44106, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd., Cleveland, OH, 44106, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Strauss
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd., Cleveland, OH, 44106, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Kresevic
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Glickman Urological and Kidney Institute, Desk Q10-1, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Klein
authors.affiliation: Department of Urology, Case Western Reserve University School of Medicine; University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Ponsky
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd., Cleveland, OH, 44106, USA.|Department of Urology, Case Western Reserve University School of Medicine; University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Bodner
mesh_terms: D000359:Aftercare; D001521:Behavior Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life; D017741:Survivors; D014549:Urinary Incontinence / Q000628:therapy*
keywords: Pelvic floor muscle exercise; Prostate cancer; Quality of life; Survivorship; Urinary incontinence