Palabras clave
Suelo pélvico
Incontinencia urinaria
Disfunciones sexuales fisiológicas
Calidad de vida
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Resumen
Objetivo: Sintetizar la evidencia disponible sobre la ocurrencia, los correlatos y el impacto en la calidad de vida de las disfunciones del suelo pélvico (DSP) en mujeres con cáncer de mama. Método: Revisión sistemática realizada según las directrices PRISMA 2020, registrada en PROSPERO (CRD42023495350). Se realizaron búsquedas en PubMed y Medline utilizando los términos "breast cancer" y "pelvic floor dysfunctions", restringida a estudios en humanos publicados entre febrero de 2014 y septiembre de 2024. Se incluyeron estudios originales que evaluaran incontinencia urinaria, incontinencia fecal o disfunción sexual en mujeres con cáncer de mama. De los 342 registros identificados, 25 fueron sometidos a evaluación de texto completo y 9 cumplieron los criterios de elegibilidad. Resultados: Ocho de los nueve estudios incluidos (88,9%) informaron una asociación positiva entre el cáncer de mama o sus tratamientos y las DSP. Las mujeres en terapia endocrina reportaron una mayor reducción del deseo sexual, dispareunia y síntomas vaginales. Más del 90% de las pacientes nunca habían recibido fisioterapia del suelo pélvico. Consideraciones finales: Las DSP son prevalentes y están sub-reconocidas en mujeres con cáncer de mama, especialmente en aquellas que reciben terapia endocrina. La identificación temprana, la educación de la paciente y el manejo multidisciplinar, incluyendo la rehabilitación del suelo pélvico, son esenciales para mejorar la calidad de vida en esta población.
Referencias
AWAN A, ESFAHANI K. Terapia endócrina para câncer de mama na atenção primária. Curr. Oncol., 2018; 25(4): 285-291.
BARACHO E. Fisioterapia aplicada à saúde da mulher. Rio de Janeiro: Guanabara Koogan, 2014; 31-32.
ASKLUND I, et al. Mobile app for treatment of stress urinary incontinence: a randomized controlled trial. Neurourology and Urodynamics, 2017; 36(5): 1369-1376.
BONASSA EMA, et al. Conceitos gerais em quimioterapia antineoplásica. In: BONASSA EMA, et al. Terapêutica oncológica para enfermeiros e farmacêuticos. Rio de Janeiro: Atheneu, 2022; 1-21.
BRAY F, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 2018; 68(6): 394-424.
CAAGBAY DM, et al. Can a leaflet with brief verbal instruction teach Nepali women how to correctly contract their pelvic floor muscles? Journal of Nepal Health Research Council, 2017; 15(2): 105-109.
CHENG C-L, et al. Associação positiva entre sintomas de bexiga hiperativa feminina e privação de estrogênio: um estudo de coorte populacional em âmbito nacional em Taiwan. Medicine, 2016; 95: e4107.
COLOMBAGE UN, et al. Experiences of pelvic floor dysfunction and treatment in women with breast cancer: a qualitative study. Supportive Care in Cancer, 2022; 30(10): 8139-8149.
COLOMBAGE UN, et al. Occurrence and impact of pelvic floor dysfunction in women with and without breast cancer. Brazilian Journal of Physical Therapy, 2022; 30(10): 8139-8149.
COLOMBAGE UN, et al. Prevalência e impacto de distúrbios da bexiga e do intestino em mulheres com câncer de mama: uma revisão sistemática com meta-análise. Neurourol. Urodyn., 2021; 40: 15-27.
CUCCINIELLO L, et al. Efeitos da privação de estrogênio da terapia endócrina em pacientes com câncer de mama: incidência, manejo e resultado. Tratamento do Câncer, 2023; 120: 102624.
CREAN-TATE KK, et al. Management of genitourinary syndrome of menopause in female cancer patients. American Journal of Obstetrics and Gynecology, 2020; 222(2): 103-113.
FAM EM, ZIMMERMAN PE. Desafios do manejo dos sintomas do trato urinário inferior em mulheres que utilizam tamoxifeno. Women's Health Rep., 2022; 3: 430-436.
FALLOWFIELD L, et al. Qualidade de vida de mulheres pós-menopáusicas no estudo adjuvante de câncer de mama com arimidex, tamoxifeno, isolado ou em combinação (ATAC). J. Clin. Oncol., 2004; 22: 4261-4271.
HALE MJ, et al. Tamoxifen related side effects and their impact on breast cancer incidence: a retrospective analysis of the randomised IBIS-I trial. Breast, 2020; 54: 216-221.
INSTITUTO NACIONAL DE CÂNCER JOSÉ ALENCAR GOMES DA SILVA. Estimativa 2023: incidência de câncer no Brasil. Rio de Janeiro: INCA, 2022.
LANDI SN, et al. Endocrine therapy and urogenital outcomes among breast cancer survivors. Cancer Causes & Control, 2016; 27(11): 1325-1332.
MESSELINK B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the Pelvic Floor Clinical Assessment Group of the International Continence Society. Neurourology and Urodynamics, 2005; 24(4): 374-380.
MCGLADRIGAN E, et al. Explorando intervenções de pré-habilitação para pacientes com câncer ginecológico submetidas à radioterapia: uma revisão de escopo. PLoS One, 2025; 20: e0319518.
MIGOWSKI A, et al. Guidelines for early detection of breast cancer in Brazil. Cadernos de Saúde Pública, 2018; 34(6): e00074817.
OOI PS, et al. Sexual dysfunction among women with breast cancer: a systematic review. Sexual Medicine, 2021; 9(3): 100351.
PENNYCUFF JF, et al. Prevalence of pelvic floor disorders among breast cancer survivors. International Urogynecology Journal, 2022; 33(9): 2421-2426.
PIZZATTI, et al. Toxicoproteomics disclose pesticides as downregulators of TNF-α, IL-1β and estrogen receptor pathways in breast cancer women chronically exposed. Frontiers in Oncology, 2020; 10: 1-11.
RAMASESHAN AS, et al. Pelvic floor disorders in women with gynecologic malignancies: a systematic review. International Urogynecology Journal, 2018; 29(4): 459-476.
RIBI K, et al. Treatment-induced symptoms, depression, and age as predictors of sexual problems in breast cancer survivors. Breast Cancer Research and Treatment, 2020; 181(2): 347-359.
SEARS CS, et al. A comprehensive review of sexual health concerns after cancer treatment and the biopsychosocial treatment options available to female patients. Eur J Cancer Care (Engl), 2018; 27(2): e12738.
SEAV S, et al. Management of sexual dysfunction in breast cancer survivors: a systematic review. Women's Midlife Health, 2015; 1: 9.
SOUSA M, et al. Genitourinary symptoms in women with early breast cancer: a systematic review. European Journal of Cancer Care, 2018; 27(2): e12820.
STABILE C, et al. Sexual health needs and educational intervention preferences for women with cancer. Breast Cancer Research and Treatment, 2017; 165(1): 77-84.
SUSSMAN TA, et al. Managing genitourinary syndrome of menopause in breast cancer survivors receiving endocrine therapy. Journal of Oncology Practice, 2019; 15(7): 363-370.
TEKIN YB, et al. Evaluation of the pelvic floor of women with breast cancer using tamoxifen. The Journal of Obstetrics and Gynecology of India, 2022; 72(6): 509-514.
THOMAZ RP, et al. Influence of pelvic floor muscle fatigue on stress urinary incontinence: a systematic review. International Urogynecology Journal, 2018; 29(2): 197-204.
TOMADON A, et al. Genitourinary symptoms and quality of life of women with breast cancer undergoing chemotherapy. Fisioterapia e Pesquisa, 2023; 30(2): e23001823.
TORRES-BALANZÁ S, et al. Sexual perception in Spanish female breast cancer survivors. Clinical Breast Cancer, 2023; 23(1): 15-22.
VERONESI U, et al. Tamoxifeno para a prevenção do câncer de mama: resultados tardios do Ensaio Clínico Randomizado Italiano de Prevenção com Tamoxifeno em mulheres submetidas à histerectomia. J. Natl. Cancer Inst., 2007.
WANG G, et al. Cânceres metastáticos promovem caquexia por meio da regulação positiva de Zip14 no músculo esquelético. Nature Medicine, 2018; 24: 770-781.
WEINER M, et al. Vaginal health in breast cancer survivors: a practical clinical approach. Ther Adv Med Oncol, 2025; 17: 17588359251344007.
ZHAO X, et al. A elaiofilina desencadeia a paraptose e mata preferencialmente células de câncer de ovário resistentes a medicamentos, induzindo a hiperativação da MAPK. Signal Transduction and Targeted Therapy, 2022; 7(1): 317.