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

ABSTRACT 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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    • "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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    • "The confounding effect of BMI on the association between race and endometrial cancer survival is well-described [13]. In this study we examine the effect of race on comorbidities, post-surgical complications, length of stay, and endometrial cancer survival in a smaller but specific morbidly obese population. "
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    ABSTRACT: Objective Endometrial cancer mortality disproportionately affects black women and whether greater prevalence of obesity plays a role in this disparity is unknown. We examine the effect of race on post-surgical complications, length of stay, and mortality specifically in a morbidly obese population. Methods Black and white women with endometrial cancer diagnosed from 1996 to 2012 were identified from the University Pathology Group database in Detroit, Michigan, and records were retrospectively reviewed to obtain clinicopathological, demographic, and surgical information. Analysis was limited to those with a body mass index of 40 kg/m2 or greater. Differences in the distribution of variables by race were assessed by chi-squared tests and t-tests. Kaplan–Meier and Cox regression analyses were performed to examine factors associated with mortality. Results 97 white and 89 black morbidly obese women were included in this analysis. Black women were more likely to have type II tumors (33.7% versus 15.5% of white women, p-value = 0.003). Hypertension was more prevalent in black women (76.4% versus 58.8%, p-value = 0.009), and they had longer hospital stays after surgery despite similar rates of open vs minimally invasive procedures and lymph node dissection (mean days = 5.4) compared to whites (mean days = 3.5, p-value = 0.036). Wound infection was the most common complication (16.5% in whites and 14.4% in blacks, p-value = 0.888). Blacks were more likely to suffer other complications, but overall the proportions did not differ by race. In univariate analyses, black women had higher risk of endometrial cancer-related death (p-value = 0.090). No racial differences were noted in adjusted survival analyses. Conclusion A more complete investigation, incorporating socio-demographic factors, is warranted to understand the effects of morbid obesity and race on endometrial cancer.
    Gynecologic Oncology 04/2014; 133(1):38–42. DOI:10.1016/j.ygyno.2014.01.013 · 3.77 Impact Factor
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    • ". The effect of BMI on role functioning has not been assessed by other studies due to the fact that they used different questionnaires [6] [9] [11] [12]. Furthermore, morbidly obese women reported significantly more pain and diarrhoea (P = 0.025 and P = 0.009), these symptoms are known to be associated with obesity [27] [28]. "
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    ABSTRACT: Survivorship and quality of life issues are becoming increasingly relevant in endometrial cancer as a result of the marked increase in incidence of the disease combined with excellent and improving long term survival. The purpose of this study was to evaluate the effect of obesity on quality of life (QoL) in endometrial cancer survivors. Participants were endometrioid endometrial cancer survivors diagnosed between 2008 and 2013. Quality of life was measured through the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C30, version 3.0). Associations between BMI and quality of life were determined by means of multivariate analyses. 322 women diagnosed with endometrioid endometrial cancer were invited to participate. Excluded were 15 women with unknown BMI, 40 with non-endometrioid histology and 10 with concurrent cancer. The QLQ-C30 questionnaire was completed by 158 (61.5%) women, of which 63 women (40%) were obese (BMI ≥30-39.9), and 30 women (19%) were morbidly obese (BMI ≥40). Morbidly obese women reported worse physical, role and social functioning and more somatic complaints. Morbid obesity is associated with poorer quality of life in endometrial cancer survivors. Life style interventions such as exercise programs and diet interventions could be viable means to improve the quality of life of obese endometrial cancer survivors. Future research should focus on means to improve quality of life in obese endometrial cancer survivors.
    Gynecologic Oncology 11/2013; 132(1). DOI:10.1016/j.ygyno.2013.11.018 · 3.77 Impact Factor
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