The objective of this study was to examine the evidence regarding the effectiveness of PFM and education-based therapies, on bladder, bowel, vaginal, sexual, psychological function, quality of life, and PFM function in breast cancer populations.
A systematic review was conducted, guided by PRISMA reporting guidelines. Six databases were searched to identify interventional studies on the effect of PFM therapies, education-based therapies or combined (multimodal) therapies on our outcomes of interest in female breast cancer populations, regardless of the comparator group and timeframe. Active PFM therapies involve voluntary PFM contractions. Passive PFM therapies involve no voluntary PFM contractions and may include manual therapy, dilator therapy, desensitization techniques, direct application of vaginal lubricant, or moisturizer. Education-based therapies involve the provision of information related to cognitive aspects related to the pelvic floor. Screening, data extraction and risk of bias assessment (Cochrane risk-of-bias tool, Newcastle–Ottawa Scale, Joanna Briggs Institute Checklist) were performed by two reviewers independently; disagreements between reviewers were solved through discussion.
The search resulted in 603 records, with 12 studies included for analysis. Of these, six (50%) were randomized controlled trials (RCTs), one (8%) was a non-RCT with two groups, and five (42%) were single-group trials. Active PFM therapies and education, particularly in the form of cognitive-behavioural therapy, may improve bladder function. No data regarding bowel function was found. Two RCTs provided inconclusive evidence on vaginal function. Sexual function was the most commonly reported outcome, with active PFM therapies (more than passive PFM therapies) showing potential benefits, and education more likely than not to improve sexual function. Both active and passive PFM therapies appeared beneficial, but education was less likely to improve psychological outcomes. PFM therapies (active or passive) were beneficial, while education had a lower likelihood of improving quality-of-life outcomes, although cognitive-behavioural therapy combined with physical exercise might offer additional benefits. PFM function could improve with active (and passive) PFM therapies. Regarding risk of bias, all RCTs had ‘some concerns’, non-RCT with two groups were of ‘poor quality’ and single-group non-RCTs had satisfied criteria on the JBI checklist ranging from 43% and 86%.
PFM and education-based therapies may be helpful for breast cancer populations, however given the limited number of studies and their methodological limitations, caution is recommended when interpreting these study results. More research is needed.
Although some results are encouraging for specific therapies and specific outcomes, clinicians should consider the highest level of available evidence to guide their practice.
Oncology
Pelvic floor
