Von Gruenigen VE, Tian C, Frasure H, Waggoner S, Keys H, Barakat RRTreatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma: a Gynecologic Oncology Group study. Cancer 107: 2786-2791

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospitals of Cleveland, MacDonald Women's Hospital, and the Ireland Cancer Center, Cleveland, Ohio 44106, USA.
Cancer (Impact Factor: 4.89). 12/2006; 107(12):2786-91. DOI: 10.1002/cncr.22351
Source: PubMed


The objective was to examine whether rates of disease recurrence, treatment-related adverse effects, and survival differed between obese or morbidly obese and nonobese patients.
Data from patients who participated in a randomized trial of surgery with or without adjuvant radiation therapy were retrospectively reviewed. RESULTS.: Body mass index (BMI) data were available for 380 patients, of whom 24% were overweight (BMI, 25-29.9), 41% were obese (BMI, 30-39.9), and 12% were morbidly obese (BMI, > or =40). BMI did not significantly differ based on age, performance status, histology, tumor grade, myometrial invasion, or lymphovascular-space involvement. BMI > 30 was more common in African Americans (73%) than non-African Americans (50%). Patients with a BMI > or = 40 compared with BMI < 30 (hazards ratio [HR], 0.42; 95% confidence interval [CI], 0.09-1.84; P = .246) did not have lower recurrence rates. Compared with BMI < 30, there was no significant difference in survival in patients with BMI 30-39.9 (HR, 1.48; 95% CI, 0.82-2.70; P = .196); however, there was evidence for decreased survival in patients with BMI > or = 40 (HR, 2.77; 95% CI, 1.21-6.36; P = .016). Unadjusted and adjusted BMI hazards ratios for African Americans versus non-African Americans in the current study differed, thus suggesting a confounding effect of BMI on race. Eight (67%) of 12 deaths among 45 morbidly obese patients were from noncancerous causes. For patients who received adjuvant radiation therapy, increased BMI was significantly associated with less gastrointestinal (R, -0.22; P = .003) and more cutaneous (R, 0.17; P = .019) toxicities.
In the current study, obesity was associated with higher mortality from causes other than endometrial cancer but not disease recurrence. Increased BMI was also associated with more cutaneous and less gastrointestinal toxicity in patients who received adjuvant radiation therapy. Future recommendations include lifestyle intervention trials to improve survival in obese endometrial cancer patients.

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    • "High body mass index (BMI), a strong risk factor for endometrial carcinoma development, has inconsistently been associated with prognosis following an endometrial carcinoma diagnosis [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14]. A systematic review [15] found that eight studies reported no association [2–5,7–10] while four studies demonstrated increased all-cause mortality associated with high BMI [16] [17] [18] [19]. Seven studies that were not included in this review found equally mixed results: no association for three [11] [12] [13] and increased risk of death with higher BMI in four [14,20–22]. "
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    ABSTRACT: Few studies have analyzed relationships between risk factors for endometrial cancer, especially with regard to aggressive (non-endometrioid) histologic subtypes, and prognosis. We examined these relationships in the prospective NRG Oncology/Gynecologic Oncology Group 210 trial. Prior to surgery, participants completed a questionnaire assessing risk factors for gynecologic cancers. Pathology data were derived from clinical reports and central review. We used the Fine and Gray subdistribution hazards model to estimate subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations between etiologic factors and cause-specific subhazards in the presence of competing risks. These models were stratified by tumor subtype and adjusted for stage and socioeconomic status indicators. Median follow-up was 60 months after enrollment (range: 1 day - 118 months). Among 4,609 participants, a total of 854 deaths occurred, of which, 582 deaths were attributed to endometrial carcinoma. Among low-grade endometrioid cases, endometrial carcinoma-specific subhazards were significantly associated with age at diagnosis (HR=1.04, 95% CI=1.01-1.06 per year, P-trend) and BMI (class II obesity vs. normal BMI: HR=2.29, 95% CI=1.06-4.98, P-trend=0.01). Among high-grade endometrioid cases, endometrial carcinoma-specific subhazards were associated with age at diagnosis (HR=1.05, 95% CI=1.02-1.07 per year, P-trend<0.001). Among non-endometrioid cases, endometrial carcinoma-specific subhazards were associated with parity relative to nulliparity among serous (HR=0.55, 95% CI=0.36-0.82) and carcinosarcoma cases (HR=2.01, 95% CI=1.00-4.05). Several endometrial carcinoma risk factors are associated with prognosis, which occurs in a tumor-subtype specific context. If confirmed, these results would suggest that factors beyond histopathologic features and stage are related to prognosis. ClinicalTrials.govIdentifier: NCT00340808. Copyright © 2015. Published by Elsevier Inc.
    Gynecologic Oncology 09/2015; 139(1). DOI:10.1016/j.ygyno.2015.08.022 · 3.77 Impact Factor
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    • "Data from the Cancer Prevention Study II, suggested that women with a BMI ≥ 40 kg/m 2 were six times more likely to die from endometrial cancer than those of a normal weight [7]. von Gruenigen et al. found that while obesity was not associated with increased recurrence risk, higher BMI was associated with higher all-cause mortality [9]. This is consistent with an analysis of SEER data suggesting that women with local, lowgrade endometrial cancer who survived N 5 years were more likely to die from cardiovascular disease than their cancer [8]. "
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    ABSTRACT: Burnout is specific to the work domain and in physicians is indicative of emotional exhaustion, depersonalization in relationships with co-workers and detachment from patients, and a sense of inadequacy or low personal accomplishment. The purpose of this study was to determine the burnout rate among gynecologic oncologists and evaluate other personal, professional and psychosocial factors associated with this condition. This study used a cross-sectional design. Current members of the Society of Gynecologic Oncology were sent an anonymous email survey including 76 items measuring burnout, psychosocial distress, career satisfaction, and quality of life. 1086 members were invited, 436 (40.1%) responded, and 369 (84.6%) completed the survey. Thirty percent of physicians scored high for emotional exhaustion, 10% high for depersonalization and 11% low for personal accomplishment. Overall, 32% of physicians scored above clinical cut-offs indicating burnout. 33% screened positive for depression 13% endorsed a history of suicidal ideation, 15% screened positive for alcohol abuse, and 34% reported impaired quality of life . Nonetheless, 70% reported high levels of personal accomplishment, and results suggested most were satisfied with their careers, as 89% would enter medicine again and 61% would encourage their child enter medicine. Respondents with high burnout scores were less likely to report they would become a physician again (p .002), to encourage a child to enter medicine (p<.001), and more likely to screen positive for depression (p<.001), alcohol abuse (p .02), history of suicidal ideation (p <.001), and impaired quality of life (p<.001). Burnout is a significant problem associated with psychosocial distress and lower levels of career satisfaction in gynecologic oncologists. Burnout in obstetrics-gynecology and gynecologic oncology is of particular concern as young age and female gender are often identified as risk factors for this significant problem. Interventions targeted at improving quality of life, treatment of depression, or alcohol abuse may have an impact on burnout. However, significant barriers may exist as 44.5% of respondents in this study reported that they would be reluctant to seek medical care for depression, substance use, or other mental health issues due to concerns about their medical license. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 07/2015; DOI:10.1016/j.ajog.2015.07.036 · 4.70 Impact Factor
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    • "Obese EC survivors have poorer overall survival than normal weight EC survivors [9] and have the highest risk of death among all obesity-associated cancers [10] [11]. Many EC patient deaths have been attributed to non-cancer causes suggesting that patients are dying from comorbidities associated with their obesity [11] [12] [13]. Unlike other cancer survivors [14], EC survivors do not make spontaneous lifestyle changes during the " teachable moment " of a cancer diagnosis [15], and their poor fitness levels [16] and surgical treatments may make weight loss particularly challenging [17] [18]. "
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    ABSTRACT: Background Obesity is a leading risk factor for endometrial cancer (EC), particularly Type I forms, which are increasing in the U.S. Although death rates from most cancers have been decreasing, overall mortality in EC is increasing in the U.S. EC survivors’ poor fitness combined with their surgical treatments may make weight loss particularly challenging. High intensity exercise increases neurotrophins and neurological reward via altered striatal dopamine in animals; and, in humans, chronic high intensity exercise enhances meal-induced satiety and may reduce hedonic eating. 'Assisted' exercise, a mode of exercise whereby a patient’s voluntary exercise rate is augmented mechanically, may modulate brain dopamine levels in Parkinson's Disease patients but has not been previously evaluated as a treatment for obesity. Methods We describe the rationale and design of the REWARD trial, which has the overarching goal of randomizing 120 obese EC survivors to 'assisted' or voluntary rate cycling to evaluate the efficacy of ‘assisted’ exercise in enhancing and sustaining weight loss. Patients in both arms will receive 3 days/week of supervised exercise and 1 day/week of a group behavioral dietary intervention for 16 weeks and, then, will be followed for 6 months. Outcomes The primary outcome is weight loss. Secondary outcomes include measures for body composition, fitness, eating behavior, exercise motivation, quality of life as well as cognition and food reward and motivation as assessed by functional magnetic resonance imaging (fMRI) tasks. Conclusions If successful, the REWARD program could be extended to help sustain weight loss in obese cancer and non-cancer patients.
    Contemporary Clinical Trials 08/2014; 39(2). DOI:10.1016/j.cct.2014.08.008 · 1.94 Impact Factor
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