Objective. Most women with type I endometrial cancer (EC) are obese, increasing the risk of morbidity and mortality in this population. The study objective was to evaluate the impact of obesity on quality of life (QOL) and general health status in EC survivors with early-stage disease. Methods. A prospective ancillary analysis of stage I/II EC survivors. The association of BMI with QOL questionnaire variables measured with the functional assessment of cancer therapy (subscales: physical (PWB), functional (FWB), social, and emotional well-being) and the physical (PCS) and mental component summary subscales of the short-form medical outcomes survey was determined. Results. 152 women completed both questionnaires; 81% were obese. After multiple linear regression, BMI was inversely associated with PWB ( ), FWB ( ), and PCS ( ). Conclusions. Despite the good prognosis associated with early-stage EC, QOL, and physical health are not optimized in obese survivors. This paper highlights the importance of incorporating health-related QOL assessments and obesity interventions during the survivorship period. 1. Introduction Outcomes research in the last decade has evolved beyond investigating conventional clinical endpoints to incorporating quality of life (QOL) endpoints, or direct assessments of how patients feel [1]. To that end, both the NCI and FDA have mandated that the goals of cancer therapies should be to improve both survival and QOL [1, 2]. As a result of earlier detection and improvement in therapies, many women with a cancer diagnosis are living longer, and therefore, there has been considerable interest in studying health-related QOL outcomes in cancer survivors after treatment. Women with endometrial cancer comprise a large segment of female cancer survivors. Endometrial cancer, the most common gynecologic malignancy in the USA, was diagnosed in over 42.000 women in 2010 [3]. One of the most significant risk factors for this cancer is obesity. Most women with endometrial cancer are overweight or obese and possess significant obesity-driven comorbidities that threaten their long-term health and QOL [4, 5]. It is well established that obese women without cancer have poorer health outcomes and QOL than their nonobese counterparts [6]. However, little is known about the effects of obesity on QOL and physical health of endometrial cancer survivors beyond the completion of therapy. Several epidemiologic studies have linked obesity with an increased rate of death from all causes, including cancer [4, 7–12]. A recent prospective cohort study examining the
References
[1]
M. Asadi-Lari, M. Tamburini, and D. Gray, “Patients' needs, satisfaction, and health related quality of life: towards a comprehensive model,” Health and Quality of Life Outcomes, vol. 2, no. 1, article 32, pp. 1–15, 2004.
[2]
R. L. Schilsky, K. M. Templeton-Somers, et al., “Food and drug administration center for drug evaluation and research,” in Proceedings of the 64th Meeting of the Oncologic Drug Advisory Committee, December 1999.
[3]
A. Jemal, R. Siegel, J. Xu, and E. Ward, “Cancer statistics, 2010,” CA Cancer Journal for Clinicians, vol. 60, no. 5, pp. 277–300, 2010.
[4]
V. E. von Gruenigen, C. Tian, H. Frasure, S. Waggoner, H. Keys, and R. R. Barakat, “Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma: a Gynecologic Oncology Group Study,” Cancer, vol. 107, no. 12, pp. 2786–2791, 2006.
[5]
V. E. von Gruenigen, K. S. Courneya, H. E. Gibbons, M. B. Kavanagh, S. E. Waggoner, and E. Lerner, “Feasibility and effectiveness of a lifestyle intervention program in obese endometrial cancer patients: a randomized trial,” Gynecologic Oncology, vol. 109, no. 1, pp. 19–26, 2008.
[6]
K. S. Courneya, K. H. Karvinen, K. L. Campbell et al., “Associations among exercise, body weight, and quality of life in a population-based sample of endometrial cancer survivors,” Gynecologic Oncology, vol. 97, no. 2, pp. 422–430, 2005.
[7]
W. M. Hopman, C. Berger, L. Joseph et al., “The association between body mass index and health-related quality of life: data from CaMos, a stratified population study,” Quality of Life Research, vol. 16, no. 10, pp. 1595–1603, 2007.
[8]
G. K. Reeves, K. Pirie, V. Beral, J. Green, E. Spencer, and D. Bull, “Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study,” British Medical Journal, vol. 335, no. 7630, pp. 1134–1139, 2007.
[9]
S. Abu-Abid, A. Szold, and J. Klausner, “Obesity and cancer,” Journal of Medicine, vol. 33, no. 1–4, pp. 73–86, 2002.
[10]
P. Hossain, B. Kawar, and M. El Nahas, “Obesity and diabetes in the developing world—a growing challenge,” New England Journal of Medicine, vol. 356, no. 3, pp. 213–215, 2007.
[11]
E. E. Calle, C. Rodriguez, K. Walker-Thurmond, and M. J. Thun, “Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. Adults,” New England Journal of Medicine, vol. 348, no. 17, pp. 1625–1638, 2003.
[12]
V. E. von Gruenigen, S. E. Waggoner, H. E. Frasure et al., “Lifestyle challenges in endometrial cancer survivorship,” Obstetrics and Gynecology, vol. 117, no. 1, pp. 93–100, 2011.
[13]
V. E. von Gruenigen, K. M. Gil, H. E. Frasure, E. L. Jenison, and M. P. Hopkins, “The impact of obesity and age on quality of life in gynecologic surgery,” American Journal of Obstetrics and Gynecology, vol. 193, no. 4, pp. 1369–1375, 2005.
[14]
J. E. Ware, M. Kosinski, and S. D. Keller, SF-36 Physical and Mental Health Summary Scales: A User's Manual, Health Assessment Lab, Boston, Mass, USA, 1994.
[15]
P. Nieboer, C. Buijs, S. Rodenhuis et al., “Fatigue and relating factors in high-risk breast cancer patients treated with adjuvant standard or high-dose chemotherapy: a longitudinal study,” Journal of Clinical Oncology, vol. 23, no. 33, pp. 8296–8304, 2005.
[16]
D. F. Cella, D. S. Tulsky, G. Gray et al., “The functional assessment of cancer therapy scale: development and validation of the general measure,” Journal of Clinical Oncology, vol. 11, no. 3, pp. 570–579, 1993.
[17]
K. Webster, D. Cella, and K. Yost, “The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: properties, applications, and interpretation,” Health and Quality of Life Outcomes, vol. 1, article 79, 2003.
[18]
USDHHS, Physical Activity and Health: A Report of the Surgeon General, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Ga, USA, 1996.
[19]
E. J. Groessl, R. M. Kaplan, E. Barrett-Connor, and T. G. Ganiats, “Body mass index and quality of well-being in a community of older adults,” American Journal of Preventive Medicine, vol. 26, no. 2, pp. 126–129, 2004.
[20]
M. Klee and D. Machin, “Health-related quality of life of patients with endometrial cancer who are disease-free following external irradiation,” Acta Oncologica, vol. 40, no. 7, pp. 816–824, 2001.
[21]
C. Li, G. Samsioe, and C. Iosif, “Quality of life in endometrial cancer survivors,” Maturitas, vol. 31, no. 3, pp. 227–236, 1999.
[22]
L. V. van de Poll-Franse, F. Mols, M. -L. Essink-Bot et al., “Impact of external beam adjuvant radiotherapy on health-related quality of life for long-term survivors of endometrial adenocarcinoma: a population-based study,” International Journal of Radiation Oncology Biology Physics, vol. 69, no. 1, pp. 125–132, 2007.
[23]
D. Lauver, K. Connolly-Nelson, and P. Vang, “Health-related goals in female cancer survivors after treatment,” Cancer Nursing, vol. 30, no. 1, pp. 9–15, 2007.
[24]
K. Basen-Engquist, S. Scruggs, A. Jhingran et al., “Physical activity and obesity in endometrial cancer survivors: associations with pain, fatigue, and physical functioning,” American Journal of Obstetrics and Gynecology, vol. 200, no. 3, pp. 288e1–288e8, 2009.
[25]
A. L. Schwartz, “Understanding and treating cancer-related fatigue,” Oncology, vol. 21, no. 11, pp. 30–35, 2007.
[26]
D. L. Barton, G. S. Soori, B. A. Bauer et al., “Pilot study of Panax quinquefolius (American ginseng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evaluation: NCCTG trial N03CA,” Supportive Care in Cancer, vol. 18, no. 2, pp. 179–187, 2010.
