Sleep, quality of life, and depression in endometrial cancer survivors with obesity seeking weight loss

Causal relationship between affect disorders and endometrial cancer: a Mendelian randomisation study

BACKGROUND

The aim was to assess the causal relationship between depression and anxiety disorders and endometrial cancer.

METHOD

We performed two-sample Mendelian randomisation analysis using summary statistics from genome-wide association studies to assess associations of major depressive disorder, anxiety and stress-related disorders with endometrial cancer. The genome-wide association studies(GWASs) data were derived from participants of predominantly European ancestry included in the Genome-wide Association Research Collaboration. Inverse variance-weighted, MR-Egger and weighted median MR analyses were performed, together with a range of sensitivity analyses.

RESULTS

Mendelian randomisation analysis showed no statistically significant genetic responsibility effect of anxiety and stress-related disorders on any pathological type of endometrial cancer. Only the effect of major depressive disorder under the inverse variance weighting method increasing the risk of endometrial endometrial cancer (effect 0.004 p = 0.047) and the effect of major depressive disorder under the MR-Egger method decreasing endometrial cancer of all pathology types (effect -0.691 p = 0.015) were statistically significant. Other Mendelian randomisation analyses did not show a statistically significant effect.

CONCLUSION

Major depressive disorder(MDD), anxiety and stress-related disorders(ASRD) are not genetically responsible for endometrial cancer. We consider that emotional disorders may affect endometrial cancer indirectly by affecting body mass index. This study provides us with new insights to better understand the aetiology of endometrial cancer and inform prevention strategies.

DEAR model in overweight endometrial cancer patients undergoing fertility-sparing treatment: A randomized controlled trial

OBJECTIVE

To evaluate the effects of DEAR weight management in overweight patients undergoing fertility-sparing treatment for endometrial cancer or atypical hyperplasia.

METHODS

Women with endometrial cancer or atypical hyperplasia who received fertility-sparing treatment and had a body mass index of >25 kg/m2 were randomly allocated to the DEAR (DEAR weight management) and control (self weight management) groups. Body morphology and composition, glycolipid metabolism, and tumor outcomes were assessed in both groups before and at 3 and 6 months after intervention.

RESULTS

Overall, 72 subjects were included (36 in each group). Following intervention, the DEAR group showed significantly lower median body weight (69.45 vs. 78.05), body mass index (26.19 vs. 29.15), lipid accumulation index (29.21 vs. 57.86), body fat mass (24.00 vs. 29.30), visceral fat area (112.5 vs. 133.3), and glycolipid metabolic indices (except high density lipoprotein) than the control group (P < 0.05) and showed a decreasing trend. The test group achieved significantly higher complete remission (88.46% vs. 57.14%; P < 0.05); the time to complete remission did not differ significantly (P > 0.05).

CONCLUSIONS

DEAR weight management can improve the studied parameters and complete remission rates in this population.

REGISTRATION

NCT06169449.

Impact of weight loss after treatment on survival outcomes of overweight and obese patients with early‑stage endometrial cancer

Despite the fact that obesity is the main risk factor for endometrial cancer, there is limited evidence regarding the effects of body weight change on overweight and obese women treated for early-stage endometrial can its impact on cancer outcomes. A retrospective cohort study was performed including all overweight and obese patients with early-stage type-I endometrial cancer that were treated at the Insular University Hospital of Las Palmas (Las Palmas de Gran Canaria, Spain) between January 2007 and December 2019. Body weight change at 12 months of treatment was evaluated, as well as its impact on cancer outcomes. Weight loss ≥5% was independently evaluated regarding its impact on survival. A total of 526 women were studied, of which 152 (28.90%) were overweight (BMI ≥25 and <30) and 374 (71.10%) were obese (BMI ≥30). The median follow-up was 76.17 months, during which time 77 (14.64%) women died. In the survivor group, body weight at initial diagnosis was 86.4±17.9 kg compared with 84.6±16.4 kg 1 year after treatment, which corresponded to a significant mean weight loss of 1.47 kg (P<0.001). However, in the group of non-survivors, body weight at initial diagnosis was 84.7±15.7 kg compared with 84.7±14.6 kg 1 year after treatment, which demonstrated a non-significant mean weight loss of 0.63 kg (P=0.180). When comparing between the patients who maintained or gained ≥5% weight and those who lost ≥5% weight, there were no significant differences taking into account the whole cohort and follow-up time; however, when adjusting for the period between 32 and 98 months, survival was significantly higher in those patients that lost ≥5% of their initial body weight (P=0.025; log-rank test). Based on the final univariate and cer and multivariate analyses, body weight change at 12 months was not indicated to be a factor significantly affecting overall survival; adjusted hazard ratio was 1.01 (95% CI 0.97-1.05, P=0.723). In conclusion, even if greater weight loss is observed in patients with endometrial cancer that survive the disease, no significant impact on survival outcomes is observed based on multivariate analysis.

Improvement of sleep quality in isolated metastatic patients with spinal cord compression after surgery

BACKGROUND

This study aimed to assess changes in quality of sleep (QoS) in isolated metastatic patients with spinal cord compression following two different surgical treatments and identify potential contributing factors associated with QoS improvement.

METHODS

We reviewed 49 patients with isolated spinal metastasis at our spinal tumor center between December 2017 and May 2021. Total en bloc spondylectomy (TES) and palliative surgery with postoperative stereotactic radiosurgery (PSRS) were performed on 26 and 23 patients, respectively. We employed univariate and multivariate analyses to identify the potential prognostic factors affecting QoS.

RESULTS

The total Pittsburgh Sleep Quality Index (PSQI) score improved significantly 6 months after surgery. Univariate analysis indicated that age, pain worsening at night, decrease in visual analog scale (VAS), increase in Eastern Cooperative Oncology Group performance score (ECOG-PS), artificial implant in focus, and decrease in epidural spinal cord compression (ESCC) scale values were potential contributing factors for QoS. Multivariate analysis indicated that the ESCC scale score decreased as an independent prognostic factor.

CONCLUSIONS

Patients with spinal cord compression caused by the metastatic disease had significantly improved QoS after TES and PSRS treatment. Moreover, a decrease in ESCC scale value of > 1 was identified as a favorable contributing factor associated with PSQI improvement. In addition, TES and PSRS can prevent recurrence by achieving efficient local tumor control to improve indirect sleep. Accordingly, timely and effective surgical decompression and recurrence control are critical for improving sleep quality.

Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention

OBJECTIVE

Sleep disturbances are under-identified and under-treated in oncology settings, especially for underserved populations and those with psychiatric comorbidities. This study examined the prevalence and correlates of poor subjective sleep quality as well as clinical sleep recommendations among a socioeconomically and ethnically diverse population of patients with cancer referred for depression management.

METHODS

Participants were 140 adults with cancer who screened positive for depression through routine, practice-based assessment with the Patient Health Questionnaire (PHQ-9 ≥ 8) and were referred to a study of collaborative care for depression. Demographics, clinical characteristics, subjective sleep quality, and sleep recommendations received were self-reported by patients prior to intervention. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), general health status was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10, and depressive symptoms were measured using the PHQ-9.

RESULTS

Of 138 patients with complete data, 123 (89.1%) reported poor sleep quality, and 87 (63%) met the threshold for possible insomnia. The strongest correlates of poor subjective sleep were female gender (β = 0.19, p = .02), greater depressive symptom severity (β = 0.28, p = .001), and worse physical health (β = -0.19, p = .04). Of 118 patients reporting problems with sleep since their cancer diagnosis, 95 discussed the issue with a medical provider; medications were recommended most often (37; 38.9%); only 9 (9.5%) received recommendations for cognitive-behavioral therapy for insomnia (CBT-I) or other CBT.

CONCLUSIONS

Patients with cancer seeking treatment for depression report very high rates of poor subjective sleep quality and insomnia, underscoring the importance of providing and referring to guideline-concordant sleep interventions in oncology supportive care contexts.

The association between sleep problems and general quality of life in cancer patients and in the general population

Objective

It is well-known that patients with cancer frequently experience sleep problems, and that sleep quality is associated with general quality of life (QoL). The aims of this study were to analyze the relationship between sleep problems and other components of QoL in more detail and to investigate sex and age differences in sleep quality in cancer patients in comparison with the general population.

Method

This study comprised one general population sample (n = 4,476) and eight samples with cancer patients (n between 323 and 4,020). Sleep Quality was measured using the QoL questionnaire EORTC QLQ-C30.

Results

All of the cancer patient groups reported more sleep problems than the general population. Sleep problems were associated with all facets of QoL both in cancer patients and in the general population. The highest associations were found in cancer patients for fatigue (r = 0.52) and emotional functioning (r = -0.47). The association between sleep quality and general QoL was lower in the cancer samples (r = -0.37) than in the general population (r = -0.46). Female cancer patients reported markedly more sleep problems than male patients did (d = 0.45), while this sex difference was lower in the general population (d = 0.15). In contrast to the general population, younger cancer patients had greater trouble sleeping than older patients did (d = -0.17).

Conclusion

The results underline the significance of the role mental factors play in sleep problems. Health care providers should pay special attention to female patients and younger patients concerning this issue.

Determinants of sleep quality in 5835 individuals living with and beyond breast, prostate, and colorectal cancer: a cross-sectional survey

PURPOSE

The present study aimed to quantify the level of sleep problems in 5835 breast, prostate, and colorectal cancer survivors, and explore a number of potential determinants of poor sleep quality in the present sample. BMI, diet, and physical activity were of particular interest as potential determinants.

METHODS

Participants who completed the 'Health and Lifestyle after Cancer' survey were adults who had been diagnosed with breast, prostate, or colorectal cancer (mean time since cancer diagnosis was 35.5 months, SD=13.56). Sleep quality was assessed using the Pittsburgh Sleep Quality Index. BMI was calculated from self-reported height and weight. Participants were categorised as meeting/not meeting the World Cancer Research Fund (WCRF) recommendations for fibre, fruit and vegetables, added sugar, red meat, processed meat, fat, alcohol, and physical activity. Analyses accounted for demographic and clinical factors.

RESULTS

Fifty-seven percent of those with sleep data were classified as poor sleepers (response rate 79%). Being female, having a higher number of cancer treatments, more comorbid conditions, and being more anxious/depressed increased the odds of being a poor sleeper. After adjustment for these factors, there were no associations between diet/alcohol/physical activity and sleep. However, BMI was associated with sleep. Individuals in the overweight and obese categories had 22% and 79% higher odds of being poor sleepers than individuals in the underweight/healthy weight category, respectively.

CONCLUSIONS

The findings suggest that there may be a need to develop sleep quality interventions for cancer survivors with obesity. Even after adjustment for multiple clinical and demographic factors, BMI (particularly obesity) was associated with poor sleep. Thus, researchers and health professionals should find ways to support individuals with overweight and obesity to improve their sleep quality.

IMPLICATIONS FOR CANCER SURVIVORS

The present findings highlight that poor sleep is a common issue in cancer survivors. Interventions seeking to improve outcomes for cancer survivors over the longer term should consider sleep quality.

Sleep and gynecological cancer outcomes: opportunities to improve quality of life and survival

Sleep is important for immune function, metabolic function and physical repair. Sleep is more commonly disrupted in women compared with men and is disrupted by surgery, chemotherapy, and cancer itself, making gynecological oncology patients at higher risk of insomnia and sleep disruption. Insomnia and sleep disruption are linked to increased pain, poorer quality of life, depression, and anxiety which can all negatively affect patient outcomes. A number of environmental, behavioral, and pharmacological interventions have been investigated to improve patient sleep and aid in the recovery process. It is vital to understand and address patient sleep quality in order to give patients the highest quality care and improve outcomes.

Sleep deprivation and quality of life among uterine cancer survivors: systematic review

INTRODUCTION

While cancer survival might be a relief from a near-death health condition, the after-recovery period also predisposes the survivors to deteriorated quality of life as well as sleep deprivation. Patients with cancer may experience post-traumatic stress disorder (PTSD) throughout the diagnostic process and even after diagnosis is completed, especially when facing the possibility of tumor recurrence. Survivors, in particular, are frequently in a condition of uncertainty due to the 15 to 20% chance of recurrence within 3 years of the main treatment. Despite the high rate of cancer survival, which is believed to be around 83%, assessing quality of life after a cancer diagnosis can help to improve such results.

PURPOSE

This article aimed to describe the sleep patterns among uterine cancer survivors and verify psychological and physical factors affecting their general qualities of life. According to the qualitative study, uterine cancer survivors who receive treatment, whether pharmaceutical or therapeutic, have a higher quality of life than those who do not.

METHOD

PRISMA reporting was used for this systematic review. Electronic databases that were searched include PubMed, Cochrane Trial Register, and ScienceDirect for studies evaluating the sleep deprivation and quality of life among uterine cancer survivors. Ten publications were chosen based on inclusion criteria that included uterine cancer survivors who had finished their treatments and addressed sleep quality or overall quality of life.

RESULTS

The main finding of the systematic review is that 61% of uterine cancer survivors had poor sleep quality, and 81% have a decreased quality of life.

CONCLUSION

According to the most recent research, uterine cancer survivors suffer from sleep deprivation, which leads to a lower quality of life. However, the same study reveals that uterine cancer survivors suffering with sleep loss use a variety of cognitive behavioral therapy to improve their quality of life. Maintaining a healthy diet, incorporating physical activity into daily routines, receiving cognitive behavior therapy, participating in relevant training programs, and obtaining frequent depression and sexual health screenings are just a few of the CBT mechanisms mentioned.

Is sleep associated with BMI, waist circumference, and diet among long-term colorectal cancer survivors? Results from the population-based PROFILES registry

PURPOSE

In the general population, poor sleep quality and short sleep duration are associated with a higher body mass index (BMI) and waist circumference (WC), and an unhealthy diet. The aim of this study was to assess if the association between sleep quality and duration and BMI, WC, and diet quality also exists among colorectal cancer (CRC) survivors, as many CRC survivors have an unhealthy weight and diet.

METHODS

Cross-sectional data from a longitudinal CRC cohort were used. In this study, survivors were 4-13 years post diagnosis. The Pittsburgh Sleep Quality Index (PSQI) was used to assess both sleep quality and sleep duration. Diet quality was assessed by scoring adherence (low, moderate, high) to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations of five food groups and nutrients: fruit and vegetables, dietary fiber, red and processed meat, alcoholic beverages, and sugary drinks, using a brief diet screener. BMI and WC were self-measured. Associations were analyzed by multivariable linear and multinomial logistic regression analyses.

RESULTS

Among 1002 CRC survivors, 23% reported poor sleep quality (PSQI score ≥ 8) and 24% reported short sleep duration (≤ 6 h). No associations between sleep and BMI, WC, and diet quality were found.

CONCLUSION

Sleep problems are common in long-term CRC survivors; however, sleep quality and duration was not associated with BMI, WC, and diet quality in this population. It is unknown why the results differ from findings in the general population.

Weight and weight control behaviors during long-term endometrial cancer survivorship: Results of the Laparoscopic Approach to Cancer of the Endometrium long-term follow-up study

BACKGROUND

Overweight or obesity is common in endometrial cancer (EC). This study aimed to examine sociodemographic, clinical, and psychosocial characteristics associated with being discontent with current weight and use of weight control methods among long-term EC survivors.

METHODS

Women diagnosed with early-stage EC who participated in the Laparoscopic Approach to Cancer of the Endometrium (LACE) trial (n = 516) were invited to complete a long-term follow-up survey at least 4.5 years after treatment. Chi-square test and multivariate logistic regression models adjusted for time since surgery were used to determine factors associated with being discontent with current weight.

RESULTS

On average 9 years after surgery, 190/259 (73%) of participants were currently discontent with their weight, and 146 (56%) had used one or more weight loss methods during the past 12 months. Women who were discontent with their weight were more likely to be younger than 70 years (p < 0.000), and used one or more weight loss methods ever or during the past 12 months (p < 0.000). Among the weight loss methods used, exercise (40.1%), meal reductions (52.7%), or fat/sugar reductions (48.5%) were much more commonly reported than fasting (2.6%) or designated weight loss programs (2.3%).

CONCLUSIONS

Our study provides evidence that the majority of long-term EC survivors in this clinical trial population are discontent with their weight and over half continue to use multiple methods to lose weight each year. These data indicate that health professionals and lifestyle educators need to assess weight issues, and develop a tailored plan to address the specific needs of long-term survivors to assist them become content with their weight after treatment for EC.

Health-Related Quality of Life across Recent Pediatric Obesity Classification Recommendations

Extreme body mass index (BMI) values (i.e., above the 97th and below the 3rd percentiles) are inaccurately represented on the Centers for Disease Control and Prevention's growth curves, which may limit the utility of BMI percentile and BMI z-score for capturing changes in clinical outcomes for patients at extreme weights. Modeling child obesity severity based upon the percentage of BMI in excess of the 95th percentile (BMI95pct) has been proposed as an improved metric to better capture variability in weight at extreme ends of growth curves, which may improve our understanding of relationships between weight status and changes in clinical outcomes. However, few studies have evaluated whether the use of BMI95pct would refine our understanding of differences in clinical psychosocial constructs compared to previous methods for categorization. This cross-sectional study evaluated child obesity severity based on BMI95pct to examine potential group differences in a validated, obesity-specific measure of Health-Related Quality of Life (HRQoL). Four hundred and sixty-five children with obesity completed Sizing Me Up, a self-report measure of HRQoL. Children were classified into categories based on BMI95pct (i.e., class I: ≥100% and <120%; class II: ≥120% and <140%; class III: ≥140%). The results indicate that children with class III obesity reported lower HRQoL than children with class I and class II obesity; however, there were no differences between Class II and Class I. In much of the previous literature, children with class II and class III obesity are often combined under the category "Severe Obesity" based upon BMI above the 99th percentile. This study suggests that grouping children from various classes together would neglect to capture critical differences in HRQoL. Future research including children with severe obesity should consider obesity classes to best account for functioning and clinical outcomes.

Exploring the Causes of Obesity Among Adults in the Kurdish Regions of Iran: A Qualitative Study

BACKGROUND

Obesity is one of the most important public health problems in the world, which is occurred by various factors. The purpose of this study is to explore the causes of obesity in the Kurdish regions of Iran with a qualitative approach.

METHODS

A qualitative content analysis study was conducted in the Kurdish regions of Iran from June 2019 to November 2019. The data were collected by holding focus group discussions and semi-structured interviews with 111 obese and thin men and women, and experts from different fields, who were selected through purposive sampling. Additionally, the data were analyzed by the conventional content analysis approach following the steps proposed by Graneheim and Lundman. The researchers used ATLAS.ti (Version 2019) software for data analysis and management. Lincoln and Guba's criteria were used to assess the quality of the research.

RESULTS

The results of the data analysis were classified into 5 categories and 16 sub-categories. The main categories included the modern lifestyle, sociocultural norms, indigenous culture of nutrition, lack of institutionalization of exercise, and low health literacy.

CONCLUSION

Changing people's beliefs and values ​​about obesity and thinness, changing the dietary habits of individuals, expanding and institutionalizing exercise and physical activity, and enhancing health literacy can prevent and control obesity.