Development of Overactive Bladder Symptoms in Patients Undergoing Chemotherapy

Objectives: The incidence of pelvic floor dysfunction in women receiving chemotherapy is unknown. Our aim was to assess the incidence of new onset or worsening overactive bladder (OAB) symptoms after initiation of chemotherapy for non-pelvic cancers.

Methods: This is a prospective longitudinal cohort study of cancer patients undergoing chemotherapy at a single institution from 2016-2023. Patients diagnosed with breast cancer, lung cancer, or lymphoma presenting for chemotherapy were included. After consent was obtained, all participants were asked to complete five validated questionnaires regarding bladder symptoms at baseline. The questionnaires were distributed by oncology nursing staff and included the Urogenital Distress Inventory Short Form (UDI-6), the Incontinence Impact Questionnaire-Short Form (IIQ-7), the Overactive Bladder Questionnaire Short Form (OAB-q SF), and the Patient Global Impression of Severity (PGI-S). Patients were asked to complete these questionnaires again at 3 months and 12 months after initiating chemotherapy. Descriptive statistics are reported. PGI-S results were compared with a Chi-square.

Results: Seventy patients were eligible for inclusion in the study of which 65 agreed to participate. Of those enrolled, 3 patients dropped out of the study due to side effects of chemotherapy. Complete data for the UDI-6, IIQ-7, OAB-q SF and PGI-S questionnaires were available for analysis. The median age of the patients was 57. The majority of patients had breast cancer (89%), while 7% had lymphoma, and 5% had lung cancer. Thirteen different chemotherapeutic agents were used, with cyclophosphamide being the most common (68%, Table 1). There were no significant differences in UDI-6, IIQ-7, and OAB-q SF from baseline to 3 or 12 months. Bother as reported on the OAB-q SF was not different at any time point. While not statistically significant, at 12 months more patients reported nocturia was a bother within the OAB-q SF, however, less patients reported nocturia bothered them “a great deal” or “a very great deal” at 12 months. There were trends in increased bladder symptoms in the IIQ-7 and PGI-S. At baseline, 80% of patients reported normal bladder function, at 3 months, this decreased to 63% in respondents, and at 12 months to 68%, although this change was not statistically significant (p=0.4). No patients reported experiencing severe bladder symptoms at 3 or 12 months after initiating chemotherapy. A complete summary of the findings for this study is reported in Table 2.

Conclusions: In this cohort of women, urinary symptoms remained largely unchanged throughout 12 months of chemotherapy treatment. Bladder symptoms did not appear to worsen or cause increased bother in women undergoing chemotherapy. A non-significant mild increase in nocturia could be related to increased fluids with therapy. More larger scale studies are needed to determine if there may be longer term effects.