Correlation of patient reported outcomes and physical exam screening for pelvic floor dysfunction: An opportunity for improved quality of life during chemoradiotherapy for cervical cancer.

Objective: To define the prevalence and time course of pelvic floor dysfunction (PFD) among cervical cancer patients receiving chemoradiotherapy (CRT). Methods: In a prospective study, women receiving curative-intent CRT were assessed for PFD at baseline, mid-treatment (3 weeks), completion (6 weeks), and follow-up (6 months) through pelvic exams and patient-reported outcome measures (PROMs). A standardized pelvic floor exam was performed at each time point by a trained oncologist, with pelvic floor pain defined as levator/obturator score > 3. Correlations between exam findings and PROM scores were analyzed using Spearman's coefficient, and changes over time were assessed with ANOVA. Results: Twenty patients were enrolled, most with FIGO stage III disease, and received concurrent cisplatin. At baseline, 50% had PFD, improving to 25% by follow-up. EORTC QLQ-CX24 scores showed consistent positive correlations with exam findings at baseline (ρ = 0.465, p < 0.001), mid-treatment (ρ = 0.444, p < 0.001), and follow-up (ρ = 0.398, p < 0.001). PFIQ-7 demonstrated significant negative correlations, while PFDI-20 showed no consistent correlations. PROM trends indicated substantial improvement in EORTC QLQ-CX24 scores from pre-treatment to follow-up, paralleling exam findings. Conclusions: Half of patients with advanced cervical cancer exhibit PFD prior to CRT. While the lack of validated PROM thresholds limits their use for initial diagnosis, the EORTC QLQ-CX24 correlated most consistently with exams, highlighting its potential superiority as a non-invasive monitoring tool for PFD. Additional studies are warranted to determine if early intervention would benefit patients with pre-existing PFD and identify strategies for management of persistent dysfunction.