Effectiveness of Pelvic Floor Muscle and Education-based Therapies on Bladder, Bowel, Vaginal, Sexual, Psychological Function, Quality of Life, and Pelvic Floor Muscle Function in Females Treated for Breast Cancer: A Systematic Review.

Purpose of review: Breast malignancy is the most common cancer in females. Symptoms of pelvic floor disorders and sexual dysfunction secondary to systemic cancer treatment may occur. Non-surgical, non-pharmaceutical conservative therapies, namely pelvic floor muscle (PFM) and education-based therapies, could be beneficial to reduce these symptoms in this population. This systematic review aimed to examine the evidence regarding their effectiveness on bladder, bowel, vaginal, sexual, psychological function, quality of life, and PFM function in breast cancer populations.

Recent findings: Six databases were searched to identify interventional studies on the effect of PFM therapies, education-based therapies, or combined (multimodal) therapies on any outcome of interest. The search yielded 603 results, from which 12 studies were included. Of these, six (50%) were RCTs, one (8%) was a non-RCT with two groups, and five (42%) were non-RCTs with a single group. Findings suggest that PFM therapies (active) may be beneficial, and education in the format of CBT may improve bladder function. No data were found for bowel function and results from two RCTs were inconclusive to draw conclusions for vaginal function. Sexual function was the most frequently reported outcome. PFM therapies (active > passive) may be beneficial, and education is more likely than not to improve sexual function. For psychological function, PFM therapies (active + passive) may be beneficial, and education is more unlikely than likely to improve psychological function. For quality of life, PFM therapies (active + passive) may be beneficial, and education is more unlikely than likely to improve quality of life, although CBT combined with physical exercise may provide further improvement. PFM therapies (active ± passive) may improve PFM function. Given the limited number of studies and their methodological limitations, caution should be exercised when interpreting these study results. More research is needed to confirm findings and to investigate the clinical value of PFM therapies and combined, multimodal therapies for breast cancer populations. Non-surgical, non-pharmaceutical conservative therapies may be helpful for breast cancer populations. Clinicians should consider the highest level of available evidence to guide their practice and use their clinical judgement to select the treatment components and appropriate dosages.