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Ducote M, Schauer T, Ross R, Boyer LM, Stagg MP, Domangue E, Graham B, Garcia J, Stillwell C, Drews KL, Schauer PR, Cook MW, Jernigan A, Albaugh VL. High prevalence of dysfunctional uterine bleeding in candidates for metabolic/bariatric surgery: increased endometrial cancer risk? Surg Obes Relat Dis 2024:S1550-7289(24)00688-9. [PMID: 39129110 DOI: 10.1016/j.soard.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/22/2024] [Accepted: 07/07/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Endometrial cancer (EC) is the strongest obesity-associated malignancy and the fastest-growing cancer in young women. Early identification of EC and other endometrial pathology (malignant and nonmalignant) in women with severe obesity may improve treatment options and uterine preservation. Screening for endometrial pathology using abnormal or postmenopausal uterine bleeding (APUB) as a surrogate in women pursuing metabolic/bariatric surgery may be clinically beneficial, but data supporting this effort are limited. OBJECTIVE To develop and institute a screening program for APUB as a surrogate for endometrial pathology in bariatric surgery candidates. SETTING Two, academic metabolic/bariatric surgery programs in Louisiana, United States. METHODS The Modified SAMANTA is a 10-item questionnaire that was implemented to identify patients with APUB, specifically combining tools designed to identify anovulatory/postmenopausal and heavy menstrual bleeding. Demographic (age, race), body mass index, and questionnaire data were analyzed with respect to positive screening using data from March 2021 through May 2023. RESULTS Of 1371 eligible women presenting for surgical evaluation, 664 (48.4%) positive screens were identified and referred for gynecologic evaluation to rule out endometrial hyperplasia/cancer or other endometrial pathology. The likelihood of positive screening for APUB was associated with increasing BMI (P = .001) and Black/African American race (P = .003), as well as increasing SAMANTA score (P < .001). In contrast, risk of positive screening was negatively associated with increasing age (P < .001). CONCLUSIONS Women presenting for metabolic/bariatric surgery have a high prevalence of APUB and, given this dysfunctional bleeding and concurrent obesity, are at greater risk for underlying EC. Potential risk factors for APUB, given their associations with screening positive, include increased body mass index, younger age, and Black/African American race. Standardized screening with appropriate gynecologic referral should be a routine part of the overall evaluation for women with severe obesity.
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Affiliation(s)
- Maggie Ducote
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - Teresa Schauer
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - Robert Ross
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Laura M Boyer
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - M Patrick Stagg
- Our Lady of the Lake Regional Medical Center, Franciscan Missionaries of Our Lady Healthcare System, Baton Rouge, Louisiana
| | - Emma Domangue
- Department of Obstetrics & Gynecology, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Breyanah Graham
- Department of Obstetrics & Gynecology, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Jesus Garcia
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Clinton Stillwell
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Kimberly L Drews
- Department of Biostatistics, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - Philip R Schauer
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana; Our Lady of the Lake Regional Medical Center, Franciscan Missionaries of Our Lady Healthcare System, Baton Rouge, Louisiana
| | - Michael W Cook
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana; University Medical Center, New Orleans, Louisiana
| | - Amelia Jernigan
- Department of Obstetrics & Gynecology, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana; University Medical Center, New Orleans, Louisiana
| | - Vance L Albaugh
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana; Our Lady of the Lake Regional Medical Center, Franciscan Missionaries of Our Lady Healthcare System, Baton Rouge, Louisiana.
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Johnston EA, Ekberg S, Jennings B, Jagasia N, van der Pols JC. Discussing diet, nutrition, and body weight after treatment for gynecological cancer: a conversation analytic study of outpatient consultations. J Cancer Surviv 2024; 18:1016-1031. [PMID: 36897546 PMCID: PMC11081991 DOI: 10.1007/s11764-023-01345-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To generate direct observational evidence for understanding how diet, nutrition, and weight-related topics are discussed during follow-up after treatment for gynecological cancer, as recommended by survivorship care guidelines. METHODS Conversation analysis of 30 audio-recorded outpatient consultations, involving 4 gyne-oncologists, 30 women who had completed treatment for ovarian or endometrial cancer, and 11 family members/friends. RESULTS From 21 instances in 18 consultations, diet, nutrition, or weight-related talk continued beyond initiation if the issue raised was ostensibly relevant to the clinical activity being undertaken at the time. These instances led to care-related outcomes (i.e., general dietary recommendations, referral to support, behavior change counseling) only when the patient identified needing further support. Diet, nutrition, or weight-related talk was not continued by the clinician if it was not apparently related to the current clinical activity. CONCLUSIONS The continuation of diet, nutrition, or weight-related talk during outpatient consultations after treatment for gynecological cancer, and the subsequent delivery of care-related outcomes, depends on its immediate clinical relevance and the patient indicating needing further support. The contingent nature of these discussions means there can be missed opportunities for the provision of dietary information and support post-treatment. IMPLICATIONS FOR CANCER SURVIVORS If seeking information or support for diet, nutrition, or weight-related issues post-treatment, cancer survivors may need to be explicit regarding their need for this during outpatient follow-up. Additional avenues for dietary needs assessment and referral should be considered to optimize the consistent delivery of diet, nutrition, and weight-related information and support after treatment for gynecological cancer.
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Affiliation(s)
- Elizabeth A Johnston
- Cancer Council Queensland, Fortitude Valley, Brisbane, QLD, Australia.
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, QLD, Australia.
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, QLD, Australia.
| | - Stuart Ekberg
- Faculty of Health, School of Psychology and Counselling, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, QLD, Australia
| | - Bronwyn Jennings
- Department of Gynaecological Oncology, Mater Hospital Brisbane, South Brisbane, QLD, Australia
| | - Nisha Jagasia
- Department of Gynaecological Oncology, Mater Hospital Brisbane, South Brisbane, QLD, Australia
| | - Jolieke C van der Pols
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, QLD, Australia
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, QLD, Australia
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Tagai EK, Mantia‐Smaldone GM, Belfiglio A, Chu CS, Lapitan E, Santos H, Hernandez E, Sarwer DB, Miller SM. Perceived importance of weight loss and exercise among endometrial cancer survivors with overweight or obesity: Implications for lifestyle modification interventions. Obes Sci Pract 2023; 9:661-669. [PMID: 38090692 PMCID: PMC10712408 DOI: 10.1002/osp4.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/23/2023] [Accepted: 07/17/2023] [Indexed: 02/01/2024] Open
Abstract
Objective Type 1 endometrial cancer (EC) survivors who are overweight or obese are at increased risk of comorbidities and reduced quality of life. Lifestyle modification interventions (e.g., healthy eating, exercise) may help these women reduce excess weight and improve their quality of life. However, existing interventions have shown limited success. Guided by Self-Determination Theory, the proposed study sought to identify factors associated with perceived importance of weight loss and exercise as well as interest in lifestyle modification interventions (components of extrinsic and intrinsic motivation) among EC survivors with overweight or obesity to inform future intervention development. Methods One hundred type 1 EC survivors [body mass index (BMI) ≥ 25 kg/m2] completed a cross-sectional survey assessing sociodemographics, medical factors, exercise, risk perceptions and provider communication, quality of life, barriers to dieting and exercise, perceived importance of healthy lifestyles, and desired intervention content. Results EC survivors who were aware obesity is a risk factor for EC were significantly more likely to perceive weight loss as important and were interested in weight loss programs and receiving information about exercise (ps < 0.05). Additionally, EC survivors who reported their provider discussed the importance of a healthy weight after their diagnosis were significantly more likely to perceive exercise as important and were interested in receiving dieting information. Conclusions EC survivors expressed interest in lifestyle modification interventions. Increasing awareness about the risk of obesity and provider discussions about healthy weight during routine appointments may motivate EC survivors to engage in lifestyle modification interventions.
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Affiliation(s)
- Erin K. Tagai
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Gina M. Mantia‐Smaldone
- Division of Gynecologic OncologyFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Andrew Belfiglio
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Christina S. Chu
- Division of Gynecologic OncologyFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Emmanuel Lapitan
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Heather Santos
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
- Department of Epidemiology and BiostatisticsDornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Enrique Hernandez
- Obstetrics, Gynecology, and Reproductive SciencesLewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
| | - David B. Sarwer
- College of Public HealthCenter for Obesity Research and EducationTemple UniversityPhiladelphiaPAUSA
| | - Suzanne M. Miller
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
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Brummel B, van Heumen C, Smits A, van den Berg M, Ezendam NPM, Pijnenborg JMA, de van der Schueren MAE, Wilkinson SA, van der Meij BS. Barriers to and facilitators of a healthy lifestyle for patients with gynecological cancer: a systematic review of qualitative and quantitative research with healthcare providers and patients. Maturitas 2023; 177:107801. [PMID: 37541112 DOI: 10.1016/j.maturitas.2023.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023]
Abstract
The prevalence of an unhealthy lifestyle among patients with gynecological cancer is high and associated with increased risk of all-cause mortality. Although lifestyle changes have the potential to improve outcomes, lifestyle counseling is not routinely integrated into standard care. This review explores research on the barriers to and facilitators of both the promotion of healthy lifestyles by healthcare providers (HCPs) and healthy lifestyle changes by patients with gynecological cancer. The Theoretical Domains Framework (TDF) was used to deductively code the identified factors for a comprehensive understanding of the barriers and facilitators. A search across five databases yielded a total of 12,687 unique studies, of which 43 were included in the review. Of these 43, 39 included gynecological cancer patients and only 6 included HCPs. Among the barriers identified for HCPs, most studies evaluated barriers regarding weight loss counseling. Limited knowledge, reluctance to address weight loss, skepticism about the benefits, and workload concerns were commonly reported barriers for HCPs. HCPs will benefit from education and training in lifestyle counseling, including effective communication skills like motivational interviewing. Gynecological cancer patients lacked tools, support, knowledge, and faced mental health issues, environmental constraints, and physical limitations. The review emphasizes the importance of addressing these barriers and utilizing identified facilitators, such as social support, to promote and support healthy lifestyle behaviors on the part of patients and their promotion by HCPs. Future research should focus not only on patients but also on supporting HCPs and implementing necessary changes in current practices.
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Affiliation(s)
- Bo Brummel
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, the Netherlands
| | - Cindy van Heumen
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands
| | - Anke Smits
- Department of Obstetrics & Gynecology, Radboudumc, 6525 GA Nijmegen, the Netherlands
| | - Manon van den Berg
- Department of Gastroenterology and Hepatology- Dietetics, Radboudumc, 6525 GA Nijmegen, the Netherlands
| | - Nicole P M Ezendam
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, the Netherlands; Netherlands Comprehensive Cancer Organisation, 5612 HZ Eindhoven, the Netherlands
| | | | - Marian A E de van der Schueren
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands; Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6525 EN Nijmegen, the Netherlands
| | - Shelley A Wilkinson
- Department of Obstetric Medicine, Mater Mothers Hospital, South Brisbane 4101, Australia; Lifestyle Maternity, Brisbane, QLD 4069, Australia
| | - Barbara S van der Meij
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands; Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6525 EN Nijmegen, the Netherlands; Bond University Nutrition and Dietetics Research Group, Bond University, Gold Coast, QLD 4226, Australia.
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Ross RC, Akinde YM, Schauer PR, le Roux CW, Brennan D, Jernigan AM, Bueter M, Albaugh VL. The role of bariatric and metabolic surgery in the development, diagnosis, and treatment of endometrial cancer. Front Surg 2022; 9:943544. [PMID: 36117808 PMCID: PMC9470773 DOI: 10.3389/fsurg.2022.943544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022] Open
Abstract
The obesity pandemic continues to contribute to a worsening burden of disease worldwide. The link between obesity and diseases such as diabetes, cardiovascular disease, and cancer has been well established, yet most patients living with obesity remain untreated or undertreated. Metabolic and bariatric surgery is the most effective and durable treatment for obesity, is safe, and may have a protective benefit with respect to cancer incidence. In this review, an overview of the link between obesity, metabolic surgery, and cancer is discussed with emphasis on indications for endometrial cancer, the malignancy most strongly associated with obesity. Considerable evidence from retrospective and prospective cohort studies supports a decreased risk of endometrial cancer in patients with obesity who undergo bariatric surgery compared with nonsurgical controls. Survivors of endometrial cancer are at increased risk of poor health outcomes associated with obesity, and women with endometrial cancer are more likely to die of cardiovascular disease and other obesity-related illnesses than of the malignancy itself. Recent advances in anticancer drug therapies have targeted pathways that may also be therapeutically altered with metabolic surgery. Metabolic surgery has significant potential to enter the treatment paradigm for endometrial cancer, and gynecologic oncologist visits present an opportunity to identify patients who may benefit the most.
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Affiliation(s)
- Robert C. Ross
- Translational and Integrative Gastrointestinal and Endocrine Research Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Yetunde M. Akinde
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Philip R. Schauer
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Carel W. le Roux
- School of Medicine, St. Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Donal Brennan
- UCD Gynecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin, Ireland
| | - Amelia M. Jernigan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Marco Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Vance L. Albaugh
- Translational and Integrative Gastrointestinal and Endocrine Research Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
- Correspondence: Vance L. Albaugh
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Nyrop KA, Lee JT, Deal AM, Ki Choi S, Muss HB. Weight-Related Communications Between Oncology Clinicians and Women With Obesity at Early Breast Cancer Diagnosis: Findings From a Review of Electronic Health Records. Nutr Cancer 2019; 72:576-583. [DOI: 10.1080/01635581.2019.1645863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kirsten A. Nyrop
- Division of Hematology and Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan T. Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison M. Deal
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seul Ki Choi
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hyman B. Muss
- Division of Hematology and Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ligibel JA, Jones LW, Brewster AM, Clinton SK, Korde LA, Oeffinger KC, Bender CM, Tan W, Merrill JK, Katta S, Alfano CM. Oncologists' Attitudes and Practice of Addressing Diet, Physical Activity, and Weight Management With Patients With Cancer: Findings of an ASCO Survey of the Oncology Workforce. J Oncol Pract 2019; 15:e520-e528. [PMID: 31095436 DOI: 10.1200/jop.19.00124] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Obesity and related factors have been linked to cancer risk and outcomes, but little information exists with regard to oncologists' attention to these issues as a part of clinical care. METHODS Oncology providers actively caring for patients with cancer in the United States and internationally were asked to complete an online survey about practice patterns and perceptions with regard to obesity and weight management during and after active cancer treatment. RESULTS Nine hundred seventy-one practicing oncology providers completed the survey. The majority of respondents indicated a belief that the evidence linking obesity to cancer outcomes was strong and that weight and related factors should be addressed as a part of cancer treatment. The majority of respondents also reported that they frequently assessed body weight and related factors as well as counsel their patients to exercise, consume a healthy diet, and lose weight, if applicable. However, referral to providers and programs to support weight loss and increased physical activity occurred less frequently, and a number of barriers were identified for the incorporation of weight management and physical activity programs in the treatment of patients with cancer. CONCLUSION In a survey of oncology providers, attention to weight management, physical activity, and diet in patients with cancer was high during and after cancer treatment but often did not result in referrals to support lifestyle change. Future work is needed to support education and training of oncology providers to facilitate referrals and overcome barriers to implementation of weight management and physical activity programs for patients with cancer.
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Affiliation(s)
| | - Lee W Jones
- 2 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | - Sweatha Katta
- 9 American Society of Clinical Oncology, Alexandria, VA
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Black KZ, Johnson LS, Samuel-Hodge CD, Gupta L, Sundaresan A, Nicholson WK. Perceived barriers and preferred components for physical activity interventions in African-American survivors of breast or endometrial cancer with type 2 diabetes: the S.U.C.C.E.S.S. framework. Support Care Cancer 2018; 26:231-240. [PMID: 28766098 DOI: 10.1007/s00520-017-3839-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/24/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE African-American (AA) female cancer survivors share a disproportionate burden of diabetes compared to their white counterparts. Our objectives were to explore the perspectives of AA survivors with type 2 diabetes on perceived barriers to physical activity (PA) and preferences for a PA intervention and develop a framework for a PA program after cancer treatment. METHODS Trained interviewers conducted semi-structured interviews with AA survivors of breast or endometrial cancer with diabetes (total n = 20; 16 breast, 4 endometrial). Thirteen open-ended questions were posed to stimulate discussions, which were audio recorded and transcribed verbatim. Two investigators independently reviewed transcriptions and extracted coded quotations to identify major themes. RESULTS Median age of participants was 63 years. Nine themes were identified that focused on post-treatment physical symptoms (e.g., lymphedema, bone/joint pain, depression symptoms and self-motivation as barriers to PA, exercise routines tailored to physical limitations and peer partners and program leaders who understand their emotional health needs). The S.U.C.C.E.S.S. framework summarizes the survivors' preferences for an effective lifestyle intervention: Support efforts to maintain PA, Understand physical and depression symptoms, Collaborate with multi-disciplinary provider, Coordinate in-person intervention activities, Encourage partnerships among survivors for comorbidity risk reduction, develop Sustainable coping strategies for side effects of treatment, and Share local community resources. CONCLUSIONS Survivors verbalized the need for a multi-disciplinary team to assist with their psychosocial needs and physical limitations to achieve their PA goals, as integrated into the S.U.C.C.E.S.S. FRAMEWORK IMPLICATIONS FOR CANCER SURVIVORS The S.U.C.C.E.S.S. framework reflects the perspectives of survivors with type 2 diabetes and may help to inform post-treatment programs.
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Affiliation(s)
- Kristin Z Black
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box #7440, Chapel Hill, NC, 27599-7440, USA
| | - La-Shell Johnson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Old Clinic Building 3027, Campus Box #7570, Chapel Hill, NC, 27599-7570, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Old Clinic Building 3027, Campus Box #7570, Chapel Hill, NC, 27599-7570, USA
| | - Carmen D Samuel-Hodge
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box #7426, Chapel Hill, NC, 27599-7426, USA
| | - Lavanya Gupta
- Division of Public Health, Cancer Prevention and Control Branch, North Carolina Department of Health and Human Services, 100 Dickens Court #4, Chapel Hill, NC, 27514, USA
| | - Aditi Sundaresan
- Patient-Centered Program on Women's Endocrine and Reproductive Health (PoWER), University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27517, USA
| | - Wanda K Nicholson
- Department of Obstetrics and Gynecology Center for Women's Health Research, University of North Carolina at Chapel Hill, 3027 Old Clinic Building, Campus Box #7570, Chapel Hill, NC, 28599, USA.
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Lucas AR, Focht BC, Cohn DE, Buckworth J, Klatt MD. A Mindfulness-Based Lifestyle Intervention for Obese, Inactive Endometrial Cancer Survivors: A Feasibility Study. Integr Cancer Ther 2017; 16:263-275. [PMID: 27627985 PMCID: PMC5532075 DOI: 10.1177/1534735416668257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/19/2016] [Accepted: 07/24/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mindfulness-based interventions (MBIs) to address self-regulation and lifestyle behaviors (diet, physical activity) may benefit endometrial cancer survivors (ECS), who are at increased risk for morbidity and mortality associated with obesity. However, the acceptability of mindfulness training and whether it can augment behavior change in ECS is unknown. We aimed to examine; 1) the feasibility of the Mindfulness in Motion + Diet (MIM+D) intervention and 2) the preliminary efficacy of MIM+D for improving mindfulness, diet, PA and health-related quality of life (HRQL). METHODS ECS (Mage=62.4, ±5yrs from diagnosis) completed assessments at baseline, 8 and 14 weeks. Feasibility was determined by intervention completion surveys, attendance and adherence data. We used repeated measures ANOVA's (SPSS 22.0) and effect size estimates (Cohen's d) to examine changes in mindfulness, diet, PA, and HRQL over time. RESULTS Thirteen ECS (76%) completed the MIM+D program and attendance (≥6/8 sessions) was 90%. Women reported favorably on the overall quality (mean of 4.75/5) and benefits of the MIM+D program; however, would have preferred receiving MIM+D closer to diagnosis. Intention to treat analyses found MIM+D did not significantly improve any outcomes. However, an intervention completers analysis showed significant change in mindfulness (p=.0039) and small to moderate estimates for change in fruits and vegetable intake (d=.23), MVPA (d=.45), RAND SF-36: MCS (d=.46), and sleep quality (d=.68). CONCLUSIONS Integrating mindfulness training into behavioral interventions is feasible and ECS that adhere to these lifestyle programs may benefit. However, to future research should examine the-long term effects of mindfulness-based behavioral lifestyle interventions.
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Affiliation(s)
| | | | - David E. Cohn
- The Ohio State University College of Medicine, Columbus, OH, USA
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10
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Illness perceptions and changes in lifestyle following a gynecological cancer diagnosis: A longitudinal analysis. Gynecol Oncol 2017; 145:310-318. [PMID: 28279480 DOI: 10.1016/j.ygyno.2017.02.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study explores patterns of lifestyle change and whether more threatening illness perceptions are associated with lifestyle changes post-treatment for smoking, alcohol consumption and Body Mass Index (BMI) among gynecological cancer patients. METHODS In total, 395 cancer patients (N=221 endometrial; N=174 ovarian) were included in this secondary analysis of longitudinal data. Lifestyle outcomes were assessed through self-reported questionnaires after initial treatment and 6, 12, and 18months of follow-up. Illness perceptions were assessed with the Brief Illness Perception Questionnaire (BIPQ). Latent class growth curve analyses were conducted to identify patterns of lifestyle change and linear mixed models using between-subject and within-subject effects to explore the association between BIPQ items and alcohol consumption (glasses/week) and BMI (kg/m2). RESULTS After initial treatment, 15% (N=57) of the patients smoked, 53% (N=203) drank alcohol, and 60% (N=236) were overweight or obese. Overall, smokers made no considerable changes, but one subgroup of low level smokers reported positive decline. A slight decrease was observed for alcohol consumption among low and moderate level alcohol drinker subgroups, whereas BMI remained stable among endometrial cancer patients and increased for ovarian cancer patients. Moreover, patients with lower trust in their treatment to cure the disease drank more alcohol (β=0.32 glasses/week [95% CI 0.09; 0.56]). CONCLUSIONS Change in lifestyle after a gynecological cancer treatment is not self-evident. Moreover, more threatening illness perceptions were not related to a healthier lifestyle. This study underlines the need for lifestyle-promoting activities to facilitate lifestyle improvement among gynecological cancer patients.
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Machado KK, Fader AN. Approaches to Morbidly Obese Women with Gynecologic Cancer. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Endometrial Cancer Survivors' Perceptions of Provider Obesity Counseling and Attempted Behavior Change: Are We Seizing the Moment? Int J Gynecol Cancer 2016; 26:318-24. [PMID: 26588234 DOI: 10.1097/igc.0000000000000596] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine patients' perceptions of provider-based counseling and behavior changes made by endometrial cancer survivors. MATERIALS AND METHODS Endometrial cancer survivors (diagnosed from 2011 to 2012) from a single institution were surveyed. Exclusion criteria included persistent or recurrent disease or those actively undergoing treatment. Information collected included demographics, weight assessments, health behaviors, and physician counseling. Statistical analysis was performed using descriptive statistics, Fisher exact test, McNemar test, and the κ statistic as a measure of agreement. RESULTS Of 233 surveys sent, 46% were returned. Median body mass index was 29.8 kg/m (range, 17.1-64.8 kg/m). Comparing primary care providers with gynecologic oncologists (GOs), 47% (n = 46) versus 25% (n = 23) provided dietary counseling and 62% (n = 60) versus 37% (n = 34) provided physical activity counseling (Fisher exact test, P = 0.001 and P < 0.001, respectively). Only 29% (n = 30) reported being told of the link between endometrial cancer and obesity. Fifty-two percent of responders attempted weight loss after their diagnosis. Fifty-nine percent of responders reported making changes in their diet. Fifty-six percent of patients made dietary changes within 3 months of diagnosis. Forty-eight percent of responders increased physical activity, with 62% implementing changes within 3 to 6 months of their diagnosis. The responders most likely to attempt weight loss were those who received counseling by a provider. All patients reporting attempted weight loss after their cancer diagnosis report being counseled by either a primary care provider or a GO to lose weight. Weight loss counseling was significantly associated with attempting weight loss (P < 0.001). CONCLUSIONS One third of endometrial cancer survivors report counseling by their GO to lose weight. One half of endometrial cancer survivors reported attempted weight loss. All patients reporting weight loss counseling from their oncologist reported attempted weight loss. Most behavioral change occurred 3 to 6 months after a cancer diagnosis. Obesity in endometrial cancer survivors is not adequately addressed and represents a critical area for improvement.
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Koutoukidis D, Beeken R, Lopes S, Knobf M, Lanceley A. Attitudes, challenges and needs about diet and physical activity in endometrial cancer survivors: a qualitative study. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12531] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 02/01/2023]
Affiliation(s)
- D.A. Koutoukidis
- Department of Women's Cancer; EGA Institute for Women's Health; University College London; London UK
| | - R.J. Beeken
- Department of Epidemiology & Public Health; Health Behaviour Research Centre; University College London; London UK
| | - S. Lopes
- Department of Epidemiology & Public Health; Health Behaviour Research Centre; University College London; London UK
| | - M.T. Knobf
- Acute Care/Health Systems Division; Yale University School of Nursing; New Haven CT USA
| | - A. Lanceley
- Department of Women's Cancer; EGA Institute for Women's Health; University College London; London UK
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Karvinen K, Bruner B, Truant T. Lifestyle Counseling Practices of Oncology Nurses in the United States and Canada. Clin J Oncol Nurs 2015; 19:690-6. [DOI: 10.1188/15.cjon.690-696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Obesity Education Strategies for Cancer Prevention in Women's Health. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015; 4:249-258. [PMID: 26877893 DOI: 10.1007/s13669-015-0129-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Obesity is the cause of up to one-third of all cancers affecting women today, most notably endometrial, colon and breast cancer. Women's health providers are poised to advise women on obesity's link to cancer development, but often lack resources or training to provide appropriate counseling. Here, we review obesity's role in increasing the risk of several common reproductive system conditions faced by women, including polycystic ovarian syndrome, infertility, gynecologic surgical complications, and pregnancy complications. These events can be used as teachable moments to help frame the discussion of weight management and promote cancer prevention. We also review national guidelines and existing tangible weight-loss strategies that can be employed within the outpatient women's health setting to help women achieve weight loss goals and affect cancer prevention.
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Referring survivors of endometrial cancer and complex atypical hyperplasia to bariatric specialists: a prospective cohort study. Am J Obstet Gynecol 2015; 213:350.e1-10. [PMID: 25981846 DOI: 10.1016/j.ajog.2015.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/21/2015] [Accepted: 05/07/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the acceptability of bariatric referrals when offered by gynecologic oncologists to women with a history of complex atypical hyperplasia or early-stage endometrial cancer and to detail compliance with referrals and weight loss attempts that are initiated 3 months after the referral. STUDY DESIGN Obese women with complex atypical hyperplasia or early-stage endometrial cancer were approached for inclusion in this prospective cohort study. Those women who were not in the care of a bariatric specialist were offered a medical referral with or without a surgical referral. A survey was administered at inclusion and after 3 months. RESULTS Of 121 women who were approached, 106 women were consented. Women reported that it was acceptable for their gynecologic oncologist to discuss weight loss (91.09%) and that a 10% loss of body weight would be beneficial (86.14%). Six women were already in the care of a bariatric specialist. Of the remaining 100 women, 43 accepted a referral: 35 of 100 medical and 8 of 66 surgical referrals that were offered. At 3 months, 17 women complied with a referral (16 medical and 1 surgical), and 59 women had initiated any weight loss attempt. On multivariate analysis, a higher initial weight (P = .0403), Charlson Comorbidity Index ≥5 (P = .0278), and shorter time from surgery to bariatric referral (P = .0338) predicted acceptance of a referral. CONCLUSION Weight-loss counseling is well received by these women. After being offered bariatric referral, only 17% comply, but most women (59%) subsequently initiate a weight loss attempt. Referrals should be offered early in the course of cancer care to maximize acceptance.
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Kuroki LM, Benn TE, Dukes JL, Hagemann AR, Thaker PH, Powell MA, Mutch DG, Massad LS, Zighelboim I. Awareness of the association between obesity and peri-operative risk among newly diagnosed patients with complex atypical hyperplasia and endometrial cancer. Gynecol Oncol Rep 2015; 12:41-44. [PMID: 25995994 PMCID: PMC4435790 DOI: 10.1016/j.gore.2015.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives The aim of this study is to evaluate knowledge of obesity-related peri-operative risks in women newly diagnosed with complex atypical hyperplasia and endometrial cancer. Methods We conducted a cross sectional study of patients newly diagnosed with complex a typical hyperplasia or endometrial cancer who underwent preoperative counseling between 2011 and 2014, using a 17-item questionnaire. Obesity was defined as body mass index (BMI) of 30 kg/m2 or greater. Bivariate analysis was conducted using Pearson's Chi-Square or Fisher's Exact tests where appropriate and Mann–Whitney U for continuous variables. Results Of 98 patients recruited, mean age was 58 years, 87% were obese, 83% white, and 51% had grade 1 endometrioid adenocarcinomas. Sixty-four percent of obese women reported that their physicians had discussed surgical risks related to obesity. However, 17% of obese and 42% of non-obese patients responded that they were unsure of the peri-operative risks associated with obesity. There was a substantial lack of understanding among obese patients regarding their increased risks of respiratory problems (29%), thromboembolism (29%), heart attack (35%), or longer operating time (35%) and hospital stay (47%). However, obese patients were more aware of wound infection risks associated with obesity compared to their non-obese counterparts (72% vs. 31%, p = 0.004). Conclusions Pre-operative counseling for obese women with newly diagnosed endometrial cancer should incorporate more focused education about obesity-related risks. They report being knowledgeable about the risks associated with their surgery; however, more than a quarter are unaware of the impact obesity has on respiratory problems, thromboembolism, wound infection, heart attack or longer operating time and hospital stay. More patient education is needed to address the link between obesity and cancer. Endometrial cancer patients have limited awareness of peri-operative risks related to obesity. Preoperative counseling should incorporate specific obesity-related peri-operative risks.
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Affiliation(s)
- Lindsay M Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center. St. Louis, MO
| | - Teri E Benn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center. St. Louis, MO
| | - Jonathan L Dukes
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine. St Louis, MO
| | - Andrea R Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center. St. Louis, MO
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center. St. Louis, MO
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center. St. Louis, MO
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center. St. Louis, MO
| | - L Stewart Massad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center. St. Louis, MO
| | - Israel Zighelboim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center. St. Louis, MO
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Ligibel JA, Alfano CM, Courneya KS, Demark-Wahnefried W, Burger RA, Chlebowski RT, Fabian CJ, Gucalp A, Hershman DL, Hudson MM, Jones LW, Kakarala M, Ness KK, Merrill JK, Wollins DS, Hudis CA. American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol 2014; 32:3568-74. [PMID: 25273035 DOI: 10.1200/jco.2014.58.4680] [Citation(s) in RCA: 358] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rates of obesity have increased significantly over the last three decades in the United States and globally. In addition to contributing to heart disease and diabetes, obesity is a major unrecognized risk factor for cancer. Obesity is associated with worsened prognosis after cancer diagnosis and also negatively affects the delivery of systemic therapy, contributes to morbidity of cancer treatment, and may raise the risk of second malignancies and comorbidities. Research shows that the time after a cancer diagnosis can serve as a teachable moment to motivate individuals to adopt risk-reducing behaviors. For this reason, the oncology care team--the providers with whom a patient has the closest relationships in the critical period after a cancer diagnosis--is in a unique position to help patients lose weight and make other healthy lifestyle changes. The American Society of Clinical Oncology is committed to reducing the impact of obesity on cancer and has established a multipronged initiative to accomplish this goal by 1) increasing education and awareness of the evidence linking obesity and cancer; 2) providing tools and resources to help oncology providers address obesity with their patients; 3) building and fostering a robust research agenda to better understand the pathophysiology of energy balance alterations, evaluate the impact of behavior change on cancer outcomes, and determine the best methods to help cancer survivors make effective and useful changes in lifestyle behaviors; and 4) advocating for policy and systems change to address societal factors contributing to obesity and improve access to weight management services for patients with cancer.
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Affiliation(s)
- Jennifer A Ligibel
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA.
| | - Catherine M Alfano
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Kerry S Courneya
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Wendy Demark-Wahnefried
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Robert A Burger
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Rowan T Chlebowski
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Carol J Fabian
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Ayca Gucalp
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Dawn L Hershman
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Melissa M Hudson
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Lee W Jones
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Madhuri Kakarala
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Kirsten K Ness
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Janette K Merrill
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Dana S Wollins
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Clifford A Hudis
- Jennifer A. Ligibel, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, National Cancer Institute, Bethesda, MD; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Robert A. Burger, University of Pennsylvania, Philadelphia, PA; Rowan T. Chlebowski, Harbor-University of California Los Angeles Medical Center, Torrance, CA; Carol J. Fabian, University of Kansas Medical Center, Westwood, KS; Ayca Gucalp, Lee W. Jones, and Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center; Dawn L. Hershman, Columbia University Medical Center, New York, NY; Melissa M. Hudson and Kirsten K. Ness, St Jude Children's Research Hospital, Memphis, TN; Madhuri Kakarala, Van Andel Institute, Grand Rapids, MI; and Janette K. Merrill and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA
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Neff R, McCann GA, Carpenter KM, Cohn DE, Noria S, Mikami D, Needleman BJ, O'Malley DM. Is bariatric surgery an option for women with gynecologic cancer? Examining weight loss counseling practices and training among gynecologic oncology providers. Gynecol Oncol 2014; 134:540-5. [PMID: 24933102 DOI: 10.1016/j.ygyno.2014.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/05/2014] [Accepted: 06/08/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate gynecologic oncology provider (GOP) practices regarding weight loss (WL) counseling, and to assess their willingness to initiate weight loss interventions, specifically bariatric surgery (WLS). METHODS Members of the Society of Gynecologic Oncology were invited to complete an online survey of 49 items assessing knowledge, attitudes, and behaviors related to WL counseling. RESULTS A total of 454 participants initiated the survey, yielding a response rate of 30%. The majority of respondents (85%) were practicing GOP or fellows. A majority of responders reported that >50% of their patient population is clinically obese (BMI ≥ 30). Only 10% reported having any formal training in WL counseling, most often in medical school or residency. Providers who feel adequate about WL counseling were more likely to offer multiple WL options to their patients (p<.05). Over 90% of responders believe that WLS is an effective WL option and is more effective than self-directed diet and medical management of obesity. Providers who were more comfortable with WL counseling were significantly more likely to recommend WLS (p<.01). Approximately 75% of respondents expressed interest in clinical trials evaluating WLS in obese cancer survivors. CONCLUSIONS The present study suggests that GOP appreciate the importance of WL counseling, but often fail to provide it. Our results demonstrate the paucity of formal obesity training in oncology. Providers seem willing to recommend WLS as an option to their patients but also in clinical trials examining gynecologic cancer outcomes in women treated with BS.
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Affiliation(s)
- Robert Neff
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Georgia A McCann
- University of Texas Health Sciences at San Antonio, San Antonio, TX, United States
| | - Kristen M Carpenter
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, United States
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Sabrena Noria
- Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, United States
| | - Dean Mikami
- Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, United States
| | - Bradley J Needleman
- Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, United States
| | - David M O'Malley
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States. David.O'
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Ferrandina G, Petrillo M, Mantegna G, Fuoco G, Terzano S, Venditti L, Marcellusi A, De Vincenzo R, Scambia G. Evaluation of quality of life and emotional distress in endometrial cancer patients: a 2-year prospective, longitudinal study. Gynecol Oncol 2014; 133:518-25. [PMID: 24637198 DOI: 10.1016/j.ygyno.2014.03.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to prospectively, and longitudinally assess Quality of Life (QoL) and emotional distress in a large series of endometrial cancer (EC) patients. METHODS Global Health Status of the EORTC QLQ-C30 (GHS), the EORTC QLQ-CX24 (CX24), and the Hospital Anxiety and Depression Scale (HADS) questionnaires were administered at diagnosis, and after 3, 6, 12, and 24months since surgery. The Generalized Linear Model and the Between Subject test were used to analyze QoL changes over time, and the association between factors and patient QoL. RESULTS GHS scores improved over time, although the statistical significance was not reached. Worse lymphedema scores were documented worsened over time with a trend to recover at the 12- and 24month evaluation (p-value=0.028). Scores for Menopausal Symptoms (MS) dramatically worsened over time reaching a 38.5 difference of mean±SE compared to baseline (p-value=0.011). Sexual Activity (SxA) scores improved until the 12-month evaluation (p-value=0.048), and showed a return to baseline levels at the last assessment (p-value=0.025). A significant improvement of anxiety scores was documented at the 3-month evaluation, and persisted over time. In multivariate analysis, unmarried status was associated with poor scores for sexual activity, while living with someone was associated with worse MS scores. CONCLUSIONS Menopausal and lymphedema symptoms heavily affect QoL in EC patients. Since socio-demographic features play a major role in deteriorating SxA and MS, psycho-social intervention and patient education should be considered as an integral part of EC patient treatment.
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Affiliation(s)
- Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University, Rome, Italy.
| | - Marco Petrillo
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University, Rome, Italy
| | - Giovanna Mantegna
- Psycho-Oncology Service, Fondazione "Giovanni Paolo II", Campobasso, Italy
| | - Gilda Fuoco
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University, Rome, Italy
| | - Serena Terzano
- Psycho-Oncology Service, Fondazione "Giovanni Paolo II", Campobasso, Italy
| | - Laura Venditti
- Psycho-Oncology Service, Fondazione "Giovanni Paolo II", Campobasso, Italy
| | - Andrea Marcellusi
- CEIS, Sanitá (CHEM-Centre for Health Economics and Management), University of Tor Vergata, Rome, Italy
| | - Rosa De Vincenzo
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University, Rome, Italy
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21
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Duska LR, Fader AN, Dizon DS. Survivorship in gynecologic cancer: enduring the treatment toward a new normal. Am Soc Clin Oncol Educ Book 2014:e288-e294. [PMID: 24857115 DOI: 10.14694/edbook_am.2014.34.e288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Women are living longer after a cancer diagnosis because of advances in early detection and treatment. However, although our ability to effectively treat gynecologic malignancies has improved, survivors of gynecologic cancer often face profound physical, emotional, sexual, and psychosocial challenges as a result of their cancer diagnosis and treatment. In this article, we discuss how patient comorbidities (i.e., obesity) and cancer treatment effects may adversely affect sexual health outcomes, gastrointestinal function, and general health among survivors of gynecologic cancer. The importance of a multidisciplinary, patient-centered approach to survivorship care is emphasized.
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Affiliation(s)
- Linda R Duska
- From the Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; Gillette Center for Gynecological Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Amanda N Fader
- From the Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; Gillette Center for Gynecological Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Don S Dizon
- From the Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; Gillette Center for Gynecological Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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22
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Gehrig PA. Patients, providers, and politicians: we all bear the weight of the obesity epidemic. Am J Obstet Gynecol 2013; 208:341-2. [PMID: 23416118 DOI: 10.1016/j.ajog.2013.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 01/30/2013] [Accepted: 02/03/2013] [Indexed: 11/19/2022]
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