The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors recently awarded more than $2.7 million in contracted funding to Katina Robison, MD, a gynecologic oncologist with the Program in Women's Oncology at Women & Infants Hospital of Rhode Island, a Care New England hospital, for the study "Cancer of the Uterus and Treatment of Stress Incontinence (CUTI)."
The study, which will also include a recruitment site at the University of Alabama, is focused on improving the quality of life for women who undergo surgery for endometrial cancer by screening for and offering treatment of existing stress urinary incontinence (SUI) at the same time as their cancer surgery. This step should also decrease costs for patients and the health care system by combining two surgeries into one.
"We believe that concurrent treatment of endometrial cancer and stress urinary incontinence may improve quality of life, as well as emotional and physical health for women," Robison explains, who adds that the research team also includes Drs. Kyle Wohlrab, Vivian Sung and Paul DiSilvestro from Women & Infants, and Drs. Melissa Clark and Chanelle Howe from Brown University.
SUI often exists among women with endometrial cancer, which is the fourth most common cancer among American women. While SUI is very common, about 40 percent of women with it have not discussed their symptoms with a health care provider, and only 25 percent have sought care. This, Robinson says, is unfortunate because SUI can severely decrease a woman's quality of life, sexual function and is often a considerable financial burden.
"It's something of a domino effect. A woman with stress urinary incontinence experiences leakage when she laughs, coughs or sneezes. Because of her embarrassment over this, it can easily affect her sexual activity, which then can increase any chance of depression and reduce her overall quality of life," she notes.
In addition to impacting a woman's sexual activity, research has shown that endometrial cancer survivors with increased levels of physical activity report feeling better physically and emotionally. However, if the survivor experiences SUI, a fear of leakage can limit how much she exercises, Robison says.
She and the research team believe that asking basic questions about incontinence before any cancer surgery and then offering treatment of SUI at the time of cancer surgery can help.
"We want to see if treating SUI at the same time as we remove the endometrial cancer will improve a woman's quality of life in survivorship," Robison says. "We know that quality of life improves for women after treatment for pelvic floor symptoms causing SUI. We now want to promote screening of SUI among women with endometrial cancer and see if that improves their quality of life after surgery."
The study will measure the quality of life reported by women who have both surgeries at the same time, versus those who do not.
Robison was one of 13.18 percent of applicants chosen for the prestigious research funding. Her proposal was one of 46 that PCORI approved for funding to advance the field of comparative clinical effectiveness research and provide patients, health care providers, and other clinical decision makers with information that will help them make better informed choices. The award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract to Women & Infants.
"The project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill and important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options," says PCORI Executive Director Joe Selby, MD, MPH. "We look forward to following the study's progress and working with Women & Infants to share the results."