Pelvic Floor Disorders in Women with Breast Cancer and Gynaecological Cancer: Real-World Data from a Prospective...

Background/Objectives: Women with breast cancer (BC) and gynaecological cancer (GC) often undergo extensive oncological treatment, which can lead to pelvic floor disorders (PFD). However, there is still limited evidence regarding their real-world treatment practices, patient counselling, and prevalence. This study aims to systematically evaluate the prevalence of PFD and current treatment approaches, identify unmet needs, and improve future care. Methods: This observational multicentre survey was conducted at four university hospitals and one gynaecological oncology outpatient clinic in Germany. Women with BC and GC, who had undergone at least one oncological treatment, completed anonymously a study-specific questionnaire and the validated German Pelvic Floor Questionnaire. Recruitment was undertaken over a period of nine months, reflecting real-world daily care. Results: A total of 246 patients were included (median age 57 years, range 30-88); 74% were postmenopausal, and 52% had at least one vaginal delivery. BC was the most common diagnosis (63.8%). The most common symptoms were urinary incontinence (22.3% in BC, 38.1% in GC) and urgency (32.5% in BC, 35.7% in GC). Pelvic radiotherapy was significantly associated with increased urgency symptoms (p = 0.017), pelvic surgery with urgency symptoms (p = 0.048) and dyspareunia (p = 0.045), and antihormonal therapy with vaginal dryness (p = 0.028). The combination of chemotherapy and antihormonal therapy was associated with significantly higher rates of vaginal dryness in women with GC, whereas no such association was observed in women with BC (p = 0.036). Among the 108 patients classified as having new-onset symptoms, 51 (47.2%) reported symptom onset within one year of the cancer diagnosis. Overall, 34.1% of patients reported impairment in more than one patient-reported domain, including daily life, social life, sexual well-being, and psychological well-being. The median study-specific impact rating for the most bothersome pelvic floor symptom was 5/10. Only 28.0% of patients received prior counselling on PFD, and 19.9% were actively asked about symptoms. In total, 26.0% received urogynaecological treatment, whereas 15.4% reported unmet treatment needs. Conclusions: PFD is highly prevalent in women with BC and GC. Symptoms are clinically relevant but underestimated in routine care. Despite the availability of effective treatment options, significant gaps exist in patient counselling, early detection, and access to specialised care.