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

• Pelvic floor myofascial disorders are common among cervical cancer patients treated with radiation. • Most cervical cancer patients with pelvic floor myofascial disorders improve across time and with treatment. • Scores on the non-invasive EORTC QLQ-CX24 are well correlated with invasive digital scoring in assessing severity of pelvic floor disorders and may serve as a useful research instrument. To define the prevalence and time course of pelvic floor dysfunction (PFD) among cervical cancer patients receiving chemoradiotherapy (CRT). 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. 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. 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.