PANTHERA "Pelvic Floor Disorders in Patients Under ANtineoplastic THERApy" Prospective Evaluation of Subjectively Perceived Pelvic Floor Function in Patients with Gynecologic and Breast Cancers Undergoing Systemic Antineoplastic Therapy Using a Validated Pelvic Floor Questionnaire.

INTRODUCTION AND HYPOTHESIS: With increasing cancer survival rates, long-term sequelae of oncological therapies on the pelvic floor-including bladder, bowel, sexual dysfunction, and pelvic organ prolapse-have gained clinical relevance. The PANTHERA study evaluates the impact of systemic antineoplastic therapy on pelvic floor function (PFF) in women with breast and gynecological malignancies.

METHODS

This prospective observational study enrolled 201 patients with histologically confirmed breast or gynecological cancers undergoing systemic therapy. PFF was assessed using the validated German Pelvic Floor Questionnaire (GPFQ) before therapy initiation, at treatment completion, and during follow-up. The primary endpoint was the occurrence of a clinically relevant deterioration in overall PFF. Additional data on treatment type and risk factors were collected.

RESULTS

Almost all patients (99%) received chemotherapy; 33% received endocrine therapy. Breast cancer affected 66% and gynecological cancers 34% of patients. Psychiatric comorbidity and the presence of gynecological malignancy were independently associated with higher baseline pelvic floor dysfunction scores. Mean follow-up time was 3 years (SD 1.8). Importantly, the total GPFQ score showed sustained deterioration across all follow-up intervals. Patients with gynecological cancers had greater baseline impairment but less pronounced therapy-related decline compared with breast cancer patients. Except for prolapse scores, which improved after an initial decline, bladder, bowel, and sexual function worsened persistently over time.

CONCLUSION

Pelvic floor disorder is a prevalent, impactful, yet underestimated issue in patients undergoing systemic therapy for breast and gynecological cancers. Incorporating structured PFF assessment into routine oncological care is essential to improve long-term quality of life.