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Warring S, Yost KJ, Cheville AL, Dowdy SC, Faubion SS, Kumar A, Lemens MA, Van Oort CC, Fought AJ, Mc Gree ME, Mariani A, Glaser G. The Quality of Life after Endometrial Cancer Study: Baseline Characteristics and Patient-Reported Outcomes. Curr Oncol 2024; 31:5557-5572. [PMID: 39330040 DOI: 10.3390/curroncol31090412] [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: 08/21/2024] [Revised: 09/08/2024] [Accepted: 09/13/2024] [Indexed: 09/28/2024] Open
Abstract
Endometrial cancer (EC) patients make up the second largest group of female cancer survivors. Patient-reported outcomes (PROs) including quality of life (QOL) and sexual function and satisfaction (SF and S) are critical facets of survivorship. This prospective, longitudinal study assesses associations between baseline characteristics and PROs after treatment. Herein, we report the baseline clinical characteristics and PROs prior to treatment initiation. Outcomes post-treatment over time will be reported separately. Patients with planned surgery for EC were prospectively enrolled in 2019-2021 and administered the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 30 (QLQ-C30), EORTC QLQ EC Module (EN24), Patient-Reported Outcomes Measurement Information System (PROMIS), and the Mayo Clinic lower extremity lymphedema (LEL) questionnaire. This study enrolled 198 patients with a mean (SD) age of 63.6 (9.8) years and body mass index of 35.5 (8.3) kg/m2. No significant differences in the PROs for the QOL were seen when compared to the reference means (SD) except for the lower interest in sexual activity (31.9 (9.8) vs. 47.5 (SE0.70)) and lower fatigue (21.3 (19.8) vs. 31.7 (25.9)). Increased obesity was associated with an increased likelihood of LEL (p < 0.01) and multiple QOL scales, including poorer global health status (p < 0.01) and physical functioning (p < 0.01). Prior to treatment initiation for EC, the patients had a similar QOL compared to that of the general population. The patients with increasing obesity, a known risk factor for EC, had worse overall global health status and physical functioning. A better understanding of these QOL measures is imperative for earlier identification and intervention of patients at risk of chronic impairments from EC treatment.
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Affiliation(s)
- Simrit Warring
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN 55902, USA
| | - Kathleen J Yost
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55902, USA
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN 55902, USA
| | - Stephanie S Faubion
- Women's Health Research Center, Mayo Clinic, Rochester, MN 55902, USA
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Amanika Kumar
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN 55902, USA
| | - Maureen A Lemens
- Surgery Research, Division of Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55902, USA
| | - Chelsie C Van Oort
- Surgery Research, Division of Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55902, USA
| | - Angela J Fought
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, USA
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55902, USA
| | - Michaela E Mc Gree
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, USA
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55902, USA
| | - Andrea Mariani
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN 55902, USA
| | - Gretchen Glaser
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN 55902, USA
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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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Jónsdóttir B, Wikman A, Sundström Poromaa I, Stålberg K. Advanced gynecological cancer: Quality of life one year after diagnosis. PLoS One 2023; 18:e0287562. [PMID: 37352193 PMCID: PMC10289468 DOI: 10.1371/journal.pone.0287562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE Gynaecological cancer treatment impacts women's physical and psychological health. Our objective was to examine quality of life (QoL) in women with advanced gynaecological cancer at diagnosis and one year later, and to identify sociodemographic and clinical characteristics associated with QoL. METHODS Women with endometrial, ovarian or cervical cancer treated in Uppsala, Sweden 2012-2019 were included. FIGO stage ≥II was considered advanced gynaecological cancer, whereas women in FIGO stage I were used as a control group. QoL was assessed with SF-36. We obtained information on sociodemographic and clinical characteristics from medical records and health questionnaires. Differences in QoL domains were tested with t-tests, a mixed model ANOVA and multiple linear regression analyses. RESULTS The study population (n = 372) included 150 (40.3%) women with advanced gynaecological cancer. At diagnosis, women with advanced cancer reported lower physical (71.6 vs 81.8 (mean) p<0.05) and role functioning/physical scores (62.6 vs 77.2 (mean) p<0.05) than women in FIGO stage I. One year later, women with advanced cancer reported higher scores in the mental health domain (78.3 vs 73.2 (mean) p<0.05) than women in FIGO stage I. However, no difference was found in the QoL scores of women with advanced disease one year after diagnoses when stratified by diagnosis. Women with a history of psychiatric illness and higher BMI reported poorer physical and mental QoL at follow-up, while advanced stage, level of education and smoking were not associated with QoL. CONCLUSION Women with advanced gynaecological cancer have equally good QoL one year after diagnosis as women with limited disease. Women with previous psychiatric illness and high BMI, are at risk of impaired physical and mental health.
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Affiliation(s)
- Björg Jónsdóttir
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Anna Wikman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Karin Stålberg
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Banning K, Fucinari J, Fielder A, Ruterbusch JJ, Beebe-Dimmer JL, Schwartz AG, Wallbillich JJ, Cote ML. Quality of life in endometrial cancer survivors by grade of disease. Cancer Med 2023. [PMID: 37148545 DOI: 10.1002/cam4.5987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries, with overall incidence increasing, particularly high-grade disease. There is sparse information regarding quality of life (QOL) in EC survivors with a focus on grade of disease. METHODS A total of 259 women with EC diagnosed between 2016 and 2020 were identified via the Metropolitan Detroit Cancer Surveillance System and consented to enroll in the Detroit Research on Cancer Survivors cohort study (if African American, n = 138) or completed the baseline interview (if non-Hispanic white, n = 121). Each respondent provided information about their health history, educational attainment, health behaviors, and demographics. The Functional Assessment of Cancer Therapy-General (FACT-G) and Endometrial-specific (FACT-En) were used to assess QOL. RESULTS Women diagnosed with high-grade (n = 112) and low-grade (n = 147) EC participated in this study. EC survivors with high-grade disease reported significantly lower QOL compared to survivors with low-grade disease (85 vs. 91, respectively, p value = 0.025) as assessed by the FACT-G. This difference was driven by lower physical and functional subscales among women with high-grade disease compared to those with low-grade disease (p value = 0.016 and p = 0.028, respectively). Interestingly, EC-specific QOL measures, as assessed by the FACT-En, did not differ by grade. CONCLUSION Grade of disease impacts QOL in EC survivors, as well as socioeconomic, psychological, and physical factors. Most of these factors are amenable to interventions and should be assessed in patients after an EC diagnosis.
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Affiliation(s)
- K Banning
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - J Fucinari
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - A Fielder
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - J J Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - J L Beebe-Dimmer
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Population Studies and Disparities Research Program, The Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - A G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Population Studies and Disparities Research Program, The Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - J J Wallbillich
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Molecular Therapeutics Program, The Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - M L Cote
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Population Studies and Disparities Research Program, The Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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Smits A, Galaal K, Winnan S, Lopes A, Bekkers RLM. Feasibility and Effectiveness of the Exercise Program in Endometrial Cancer; Feasibility and Acceptability Survivorship Trial (EPEC-FAST). Cancers (Basel) 2022; 14:cancers14225579. [PMID: 36428675 PMCID: PMC9688636 DOI: 10.3390/cancers14225579] [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: 10/12/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
To evaluate the feasibility of an individualized exercise program in the standard care for endometrial cancer patients aimed to improve quality of life and other health outcomes. This was a single-arm prospective intervention trial to assess the feasibility of an individualized exercise intervention in endometrial cancer patients after treatment. The exercise intervention consisted of weekly individualized training sessions, for 10 weeks, at a local gym facility. The program started six weeks post-operatively. Primary outcomes were feasibility aspects including number of eligible patients, recruitment and adherence rates. Secondary outcomes included quality of life outcomes and anthropometric measures. A total of 54 women were eligible for participation, of which 22 (41%) consented to the study. Overall attendance was 86%, and there were no adverse events. There was a significant improvement in quality of life outcomes, including role (p = 0.02), emotional (p = 0.02) and cognitive functioning (p = 0.04). In addition, there was a significant improvement in visceral fat percentage (p = 0.039) and physical fitness (six-minute walk test p < 0.001). The maximum weight loss achieved was 6.0 kg after 3 months and 8.4 kg after 6 months. An individualized one-to-one exercise intervention in endometrial cancer patients is feasible in terms of recruitment, adherence and safety.
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Affiliation(s)
- Anke Smits
- Gynecological Oncology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-24-309-79-58
| | - Khadra Galaal
- Gynecological Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Seeb 999046, Oman
| | - Steve Winnan
- Royal Cornwall Hospital Trust, Penryn TR10 9FE, UK
| | - Alberto Lopes
- Gynecological Oncology, Royal Cornwall Hospital Trust, Truro TR1 3HD, UK
| | - Ruud L. M. Bekkers
- Gynecological Oncology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Gynecological Oncology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
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Elassall GM, Sayed EG, Abdallah NA, El-Zohiry MM, Radwan AA, AlMahdy AM, Sedik AS, Elazeem HASA, Shazly SA. Levonorgestrel-releasing intrauterine system versus systemic progestins in management of endometrial hyperplasia: A systemic review and meta-analysis. J Gynecol Obstet Hum Reprod 2022; 51:102432. [PMID: 35760334 DOI: 10.1016/j.jogoh.2022.102432] [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: 03/09/2021] [Revised: 05/15/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Endometrial hyperplasia is associated with varying risk of endometrial cancer. The aim of this review is to assess effectiveness of levonorgestrel-releasing intrauterine system (LNG-IUS), compared to systemic progestins, in management of endometrial hyperplasia MATERIALS AND METHODS: A search on studies comparing LNG-IUS to systemic progestins was conducted on Scopus, Web of science, Cochrane, PubMed and Embase databases, from the date of inception to September 20th, 2020. Studies were excluded if they were non-comparative, animal studies, review articles, case reports, case series, and conference papers. Primary outcomes include resolution/regression rate, failure rate, and hysterectomy rate. Analysis was pooled using random effect model and was expressed as pooled odds ratios (OR) and 95% confidence interval (CI). Quality assessment was performed using Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale (NOS) assessment tool. MOGGE Meta-analysis Matrix was used to illustrate multiple subgroup analyses. RESULTS Out of 341 studies retrieved from literature search, 12 were eligible. LNG-IUS yielded significantly higher resolution/regression rate (91.3% vs 68.6%, OR 3.42, 95% CI 1.86-6.30). Failure and hysterectomy rates were significantly lower in LNG-IUS group compared to systemic progestins' group (19.2% vs. 32.3%, OR 0.34, 95% CI 0.20-0.57 and 9.3% vs. 24.1%, OR 0.41, 95% CI 0.29-0.57, respectively). Subgroup analysis of studies including complex hyperplasia only did not show significant difference in resolution/regression rate was not statistically significant. CONCLUSION LNG-IUS is associated with high success rate in management of women with endometrial hyperplasia. However, specific effectiveness of LNG-IUS on more advanced histologic subtypes is less studied.
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Affiliation(s)
- Gena M Elassall
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa G Sayed
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nada A Abdallah
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mariam M El-Zohiry
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Radwan
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - AlBatool M AlMahdy
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed S Sedik
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hossam Aldein S Abd Elazeem
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sherif A Shazly
- Middle-East Obstetrics and Gynecology Graduate Education (MOGGE) Foundation Research Office, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Melendez B, Shah S, Jiang Y, Dottino J, Watson E, Pearce H, Borthwick M, Schmandt RE, Zhang Q, Cumpian K, Celestino J, Fellman B, Yuan Y, Lu KH, Mikos AG, Yates MS. Novel polymer-based system for intrauterine delivery of everolimus for anti-cancer applications. J Control Release 2021; 339:521-530. [PMID: 34648891 DOI: 10.1016/j.jconrel.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022]
Abstract
Non-surgical treatment options for low-grade endometrial cancer and precancerous lesions are a critical unmet need for women who wish to preserve fertility or are unable to undergo hysterectomy. The PI3K/AKT/mTOR pathway is frequently activated in endometrial cancers and has been associated with resistance to endocrine therapy, making it a compelling target for early stage disease. Oral everolimus, an inhibitor against mTORC1, has shown clinical benefit in advanced or recurrent disease but has severe adverse effects that may lead to treatment interruption or dose reduction. To overcome this, we developed a polymer-based intrauterine delivery system to achieve persistent, local delivery of everolimus without systemic exposure. In vivo studies, using a rat model, showed that a poly(propylene fumarate)-based rod loaded with everolimus achieved everolimus delivery to the endometrium with levels similar to oral administration, but with limited systemic exposure and up to 84 days of release. Biological activity of everolimus delivered with this system was confirmed, measured by reduced lumen epithelial cell height and PI3K pathway biomarkers. This study shows a promising new delivery approach for anti-cancer drugs for non-surgical treatment of low-grade endometrial cancer.
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Affiliation(s)
- Brenda Melendez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America
| | - Sarita Shah
- Department of Bioengineering, Rice University, 6500 Main St, Houston, TX 77030, United States of America
| | - Yunyun Jiang
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America
| | - Joseph Dottino
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America
| | - Emma Watson
- Department of Bioengineering, Rice University, 6500 Main St, Houston, TX 77030, United States of America
| | - Hannah Pearce
- Department of Bioengineering, Rice University, 6500 Main St, Houston, TX 77030, United States of America
| | - Mikayla Borthwick
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America
| | - Rosemarie E Schmandt
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America
| | - Qian Zhang
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America
| | - Kayleah Cumpian
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America
| | - Joseph Celestino
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030, United States of America
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030, United States of America
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America
| | - Antonios G Mikos
- Department of Bioengineering, Rice University, 6500 Main St, Houston, TX 77030, United States of America
| | - Melinda S Yates
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States of America.
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8
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Janda M, Forder P, Gebski V, Sandjia S, Armfield N, Obemair A. 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. Cancer Med 2021; 10:4896-4904. [PMID: 34145977 PMCID: PMC8290251 DOI: 10.1002/cam4.4032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Monika Janda
- Faculty of MedicineCentre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| | - Peta Forder
- HMRI Public Health ProgramSchool of Medicine and Public HealthThe University of NewcastleNewcastleAustralia
| | - Val Gebski
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Saira Sandjia
- Faculty of MedicineCentre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| | - Nigel Armfield
- Queensland Centre for Gynaecological CancerBrisbaneQueenslandAustralia
| | - Andreas Obemair
- Queensland Centre for Gynaecological CancerBrisbaneQueenslandAustralia
- Faculty of MedicineCentre for Clinical ResearchThe University of QueenslandBrisbaneQueenslandAustralia
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Yang D, Ma X, Xu J, Jia K, Liu X, Zhang P. Zfx-induced upregulation of UBE2J1 facilitates endometrial cancer progression via PI3K/AKT pathway. Cancer Biol Ther 2021; 22:238-247. [PMID: 33632059 DOI: 10.1080/15384047.2021.1883186] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Emerging documents revealed that E2 enzyme family has been implicated in regulating the progression of numerous human cancers. Ubiquitin-conjugating enzyme E2 J1 (UBE2J1), a member of E2 enzyme family, has been reported to participate in the biological process of medulloblastoma, while little is known about its functionality in endometrial cancer (EC). Gene expression at the mRNA and protein levels were identified using RT-qPCR and western blot analysis, separately. The alteration on cell proliferation, adhesion, migration, invasion, and epithelial-mesenchymal transition (EMT) process was determined through 5-Ethynyl-2'-deoxyuridine, cell adhesion, wound healing and transwell assays as well as western blot analysis. The role of UBE2J1 in xenograft tumor in mice was determined. Luciferase reporter and chromatin immunoprecipitation assays were conducted to reveal the undering mechanism of UBE2J1. Our results indicated that UBE2J1 displayed high level in EC tissues and cells and predicted poor prognosis of EC patients. In addition, UBE2J1 depletion inhibited cell proliferation, adhesion, motion, EMT process invitro, and repressed tumor growth invivo. Rescue assays manifested that ethyl 2-amino-6-chloro-4-(1-cyano-2-ethoxy-2-oxoethyl)-4H-chromene-3-carboxylate treatment reversed the effects of UBE2J1 on PI3K/AKT pathway activation and malignant phenotypes of EC cells. Finally, zinc finger X-chromosomal protein (zfx), with high expression in EC tissues, was verified to activate UBE2J1 transcription by binding to UBE2J1 promoter. In conclusion, all facts signified that zfx-induced upregulation of UBE2J1 accelerated the progression of EC via regulating the PI3K/AKT signaling pathway, which suggested that UBE2J1 might be of great significance in probing into the underlying therapeutic strategies of EC.
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Affiliation(s)
- Dexin Yang
- Institute of Science and Technology for Brain-inspired Intelligence (ISTBI), Fudan University, Shanghai, China
| | - Xin Ma
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
| | - Jie Xu
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
| | - Ke Jia
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
| | - Xiaoli Liu
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
| | - Ping Zhang
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
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10
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Vlooswijk C, Oerlemans S, Ezendam NPM, Schep G, Slot S, Thong MSY, Vissers PAJ, Beijer S. Physical Activity is Associated with Health Related Quality of Life in Lymphoma Survivors Regardless of Body Mass Index; Results from the Profiles Registry. Nutr Cancer 2021; 74:158-167. [PMID: 33554640 DOI: 10.1080/01635581.2021.1881570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Being obese and having a sedentary lifestyle is associated with impaired health-related quality of life (HRQoL) among cancer survivors. The aim of the present study is to investigate the combined influence of body mass index (BMI) and physical activity on HRQoL in lymphoma survivors. METHODS Lymphoma survivors diagnosed between 1999 and 2012 were invited to complete questionnaires about body height and weight, physical activity and HRQoL using the EORTC QLQ-C30. Multivariable analyses were conducted to evaluate the association of BMI and physical activity on HRQoL. RESULTS 1.339 lymphoma survivors responded (response rate of 72%) of whom 43% had a healthy weight, 41% were overweight and 14% were obese. They spent on average 10 h, on moderate to vigorous physical activity (MVPA) per week. Multivariable linear regression analysis shows that relatively high active survivors reported higher HRQoL scores and less fatigue compared to relatively low active lymphoma survivors, regardless of BMI. CONCLUSION MVPA was associated with higher HRQoL in lymphoma survivors regardless of BMI. Further studies, are needed to investigate effects of healthy lifestyle changes to improve HRQoL in lymphoma survivors. Research in understanding association of lifestyle factors may guide future support for lymphoma cancer survivors.
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Affiliation(s)
- Carla Vlooswijk
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Simone Oerlemans
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Nicole P M Ezendam
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical psychology, Tilburg University, Tilburg, The Netherlands
| | - Goof Schep
- Department of Sports Medicine, Maxima Medical Center, Veldhoven, The Netherlands
| | - Stefanie Slot
- Department of Hematology, UMC, location VUmc, Amsterdam, The Netherlands
| | - Melissa S Y Thong
- Department of Medical Psychology, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
| | - Pauline A J Vissers
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Sandra Beijer
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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Inflammation Is a Mediating Factor in the Association between Lifestyle and Fatigue in Colorectal Cancer Patients. Cancers (Basel) 2020; 12:cancers12123701. [PMID: 33317113 PMCID: PMC7763620 DOI: 10.3390/cancers12123701] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 01/30/2023] Open
Abstract
Simple Summary Fatigue is common among colorectal cancer patients. A healthier lifestyle may beneficially affect fatigue, although data are sparse. A healthier lifestyle may result in lower levels of inflammation, which is one of the suggested mechanisms by which lifestyle could influence fatigue. In an observational study, we investigated 1) whether a healthier lifestyle was associated with less fatigue among colorectal cancer patients, and 2) whether this association could be explained by inflammation. We showed that a healthier lifestyle was associated with less fatigue, and that inflammation levels mediated this association. Future intervention studies should investigate whether improving lifestyle after cancer diagnosis results in lowering of inflammation markers and subsequent fatigue. Abstract Fatigue is very common among colorectal cancer (CRC) patients. We examined the association between adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and fatigue among stage I-III CRC patients, and whether inflammation mediated this association. Data from two prospective cohort studies were used. Adherence to the WCRF/AICR recommendations was expressed as a score ranging from 0–7, and assessed shortly after diagnosis. Six months post-diagnosis, fatigue was assessed with the European Organization for Research and Treatment of Cancer quality of life questionnaire C30 (EORTC QLQ-C30), and in a subpopulation, the plasma levels of inflammation markers (IL6, IL8, TNFα, and hsCRP) were assessed. Multiple linear regression analyses were performed to investigate the association between adherence to the WCRF/AICR recommendations and fatigue. To test mediation by inflammation, the PROCESS analytic tool developed by Hayes was used. A higher WCRF/AICR adherence score was associated with less fatigue six months after diagnosis (n = 1417, β −2.22, 95%CI −3.65; −0.78). In the population of analysis for the mediation analyses (n = 551), the total association between lifestyle and fatigue was (β −2.17, 95% CI −4.60; 0.25). A statistically significant indirect association via inflammation was observed (β −0.97, 95% CI −1.92; −0.21), explaining 45% of the total association between lifestyle and fatigue (−0.97/−2.17 × 100). Thus, inflammation is probably one of the underlying mechanisms linking lifestyle to fatigue.
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12
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Buchanan A, Roddy M, Badr H. Patient-reported outcomes of non-pharmacological interventions for endometrial cancer survivors: a systematic review. J Cancer Surviv 2020; 15:526-535. [PMID: 33140266 DOI: 10.1007/s11764-020-00946-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/18/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE The objective of this review was to assess the efficacy of non-pharmacological interventions on endometrial cancer (EC) survivors' QOL, and their use of patient-reported outcome measures (PROMs). METHODS We conducted a systematic review of randomized controlled trials (RCTs) of non-pharmacological interventions that assessed the impact of intervention on EC survivors' general and domain-specific QOL (i.e., physical, psychological, and social well-being) using PROMs. RESULTS Of the 3178 studies identified, 28 full-text articles were reviewed, and 10 were included in the review. Nine RCTs assessed at least one PROM as a primary outcome and six assessed a PROM as a secondary outcome, but few studies used validated PROMs. Significant improvements in general QOL were found in two studies, domain-specific QOL in three studies, and both general and domain-specific QOL in three studies; however, effect sizes ranged from small to large and no significant effects were found for social well-being and few were found for psychological well-being. CONCLUSIONS Few non-pharmacological interventions for EC survivors targeted QOL, even though QOL was assessed as either a primary or secondary outcome of the RCT. Despite this, findings suggest that non-pharmacological interventions for EC survivors hold promise for improving general and domain-specific QOL. Use of validated PROMs would greatly enhance outcome reporting and facilitate comparisons across studies. More interventions are also needed that address social and psychological functioning in this population. IMPLICATIONS FOR CANCER SURVIVORS Our review highlights a need to (1) expand non-pharmacological RCTs for EC survivors, (2) increase the use of validated PROMs measuring QOL, and (3) address psychosocial domains of QOL when developing interventions for this population.
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Affiliation(s)
- Ashley Buchanan
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - McKenzie Roddy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Hoda Badr
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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13
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Body composition and its association with fatigue in the first 2 years after colorectal cancer diagnosis. J Cancer Surviv 2020; 15:597-606. [PMID: 33067775 PMCID: PMC8272706 DOI: 10.1007/s11764-020-00953-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/06/2020] [Indexed: 01/07/2023]
Abstract
Purpose Persistent fatigue among colorectal cancer (CRC) patients might be associated with unfavorable body composition, but data are sparse and inconsistent. We studied how skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at diagnosis are associated with fatigue up to 24 months post-diagnosis in stage I–III CRC patients. Methods SMI, SMR, VAT, and SAT were assessed among 646 CRC patients using pre-treatment computed tomography images. Fatigue at diagnosis, at 6, and 24 months post-diagnosis was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The association of SMI, SMR, VAT, and SAT with fatigue (yes/no) was assessed using confounder-adjusted restricted cubic spline analyses. Results Prevalence of fatigue at diagnosis was 18%, at 6 months 25%, and at 24 months 12%. At diagnosis, a significant (p = 0.01) non-linear association of higher levels of SAT with higher prevalence of fatigue was observed. Lower levels of SMR were linearly associated with higher prevalence of fatigue at 6 months post-diagnosis (overall association p = 0.02). None of the body composition parameters were significantly associated with fatigue at 24 months. Conclusion Having more SAT was associated with more fatigue at diagnosis, while low levels of SMR were associated with more fatigue at 6 months post-diagnosis. Implications for Cancer Survivors Our results suggest that it may be interesting to investigate whether interventions that aim to increase SMR around the time of diagnosis may help to lower fatigue. However, more knowledge is needed to understand the mechanisms behind the association of SMR with fatigue. Electronic supplementary material The online version of this article (10.1007/s11764-020-00953-0) contains supplementary material, which is available to authorized users.
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14
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Karataşlı V, Can B, Çakır İ, Erkılınç S, Kuru O, Gökçü M, Sancı M. Life quality of endometrioid endometrial cancer survivors: a cross-sectional study. J OBSTET GYNAECOL 2020; 41:621-625. [PMID: 32811229 DOI: 10.1080/01443615.2020.1787969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endometrial cancer is the most common gynaecologic malignancy in developed countries with increasing incidence worldwide. A total of 201 patients were enrolled and a cross-sectional study was performed using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and Female Sexual Functioning Index (FSFI) after the approval by an institutional review board (University of Health Sciences, Tepecik Education and Research Hospital, Turkey, March 13, 2019, Approval no. 2019/4-27). Morbidly obese patients (body mass index (BMI) ≥40 kg/m2) had lower physical functioning scores compared to non-obese (BMI < 30 kg/m2; p = .008) and non-morbidly obese patients (BMI < 40 kg/m2; p = .011). The overall sexual dysfunction rate was high (94.5%). No significant sexual function differences were observed among the study groups.IMPACT STATEMENTWhat is already known on this subject? Previous efforts to assess the influence of obesity and BMI on endometrial cancer patient quality of life have indicated that obesity adversely affects physical function and the effects of obesity on sexual function remains vague. In addition, the influence of patient age, surgical approach, adjuvant therapy type and time after diagnosis on quality of life and sexual function have not been clearly defined.What do the results of this study add? Increased BMI is associated with impaired physical function in endometrial cancer patients. However, BMI does not appear to affect sexual function in this population.What are the implications of these findings for clinical practice and/or further research? After endometrial cancer treatment, lifestyle interventions aimed at weight loss should be implemented to improve the quality of life.
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Affiliation(s)
- Volkan Karataşlı
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Behzat Can
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - İlker Çakır
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Selçuk Erkılınç
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Oğuzhan Kuru
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Muzaffer Sancı
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
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15
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Lajtman E. Quality of life in endometrial cancer survivors: single institution experience in Slovakia. Health Qual Life Outcomes 2020; 18:221. [PMID: 32650776 PMCID: PMC7350565 DOI: 10.1186/s12955-020-01474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/01/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate the association between body mass index (BMI) and quality of life among endometrial cancer survivors. METHODS Women diagnosed with endometrioid endometrial cancer at the Slovakian university hospital between January 2010 and December 2018 were identified. Three hundred ninety women diagnosed with endometrial cancer were invited to participate. Quality of life was measured using the EORTC (European Organisation for Reseach and Treatment of Cancer) quality of life questionnaires (QLQ-C30 and QLQ-EN24). Univariate and multiple regression analyses were used to determine associations between BMI and quality-of-life outcome variables. T-test was used to determine differences between groups. RESULTS 337 (95.2%) women completed the questionnaire. 131 (38.8%) were pre-obese, 111 (32.9%) were class I and II obese and 29 (8.6%) were class III obese. Women with highher BMI experienced poorer physical, emotional and social functioning compared to normal weignt and pre-obese pacients (p < 0.05). Class I-III obese women had significantly more lymphoedema (59% v. 41%, p = 0.048) and dyspnea (73% v. 27%, p = 0.029), and experienced more fatigue (68% v, 32%, p = 0.036) and pain (65% v. 35%, p = 0.041). CONCLUSIONS Class I-III obesity was associated with poorer quality of life in endometrial cancer survivors. Increasing BMI was inversely associated with QoL. Pre-obese and obese patients should be informed about greater incidence of pain, fatigue and dyspnea. Lifestyle changes (e.g., dietary interventions, physical activity) might reduce obesity and improve quality of life among endometrial cancer survivors.
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Affiliation(s)
- Erik Lajtman
- Gynecology and Obstetrics Department, Faculty Hospital Nitra and Constantine The Philosopher University in Nitra, Spitalska 6, 949 01, Nitra, Slovakia.
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Damiani GR, Villa M, Di Naro E, Signorelli M, Corso S, Trojano G, Loverro M, Capursi T, Muzzupapa G, Pellegrino A. Outcomes of robotic surgery performed in patients with high BMI class: experience by a single surgeon. ACTA ACUST UNITED AC 2020; 71:412-418. [PMID: 32064825 DOI: 10.23736/s0026-4784.19.04440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Advanced laparoscopic procedures have been shown to be safe in patients with high Body Mass Index (BMI), but conversion rates remain high. This analysis aimed to evaluate the feasibility and clinical outcomes in terms of long- and short-term complications, pain relief of robotic surgery in morbidly obese patients. METHODS Patients with BMI class I-II-III with endometrial cancer or hyperplasia were treated with robotic hysterectomy (RH). Patients' characteristics, operating room time (OT), type of surgery, length of hospital stay, and incidence of complications were recorded. Records were reviewed for demographic data, medical/surgical history and comorbidities, perioperative findings and outcomes, as well as long-term complications and recurrences. Regarding stage, according to 2009 FIGO, 26 of cases were IA, while eight and five of cases were, respectively, IB, II stage. RESULTS A total of 87 consecutive RH were analyzed. The more frequent comorbidity was hypertension. Twenty percent of the patients had multiple comorbidities (>2). The mean age was 63±10 years, with a mean BMI of 36±8.2 kg/m2. The more frequent BMI group treated was II class. The median OT was 114 minutes (range: 49-270). According to the Dindo Classification, there were no differences in major or minor complications between the 3 BMI classes. This series had a median follow-up of 60 months (range: 8-96) with an overall survival rate of 100%. The RRH+PLH was feasible and pathology confirmed the adequacy of the surgical specimen, with a median count of 20 nodes. CONCLUSIONS Our data support the adoption of the surgical management of the morbidly obese patient. Although short term complication rates are higher with increasing obesity (II-III class), a majority of procedures can still be completed with minimally invasive approach.
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Affiliation(s)
- Gianluca R Damiani
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy -
| | - Mario Villa
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy
| | - Mauro Signorelli
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Silvia Corso
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Matteo Loverro
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy
| | - Teresa Capursi
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy
| | - Giuseppe Muzzupapa
- Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
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Nock NL, Dimitropoulos A, Zanotti KM, Waggoner S, Nagel C, Golubic M, Michener CM, Kirwan JP, Alberts J. Sleep, quality of life, and depression in endometrial cancer survivors with obesity seeking weight loss. Support Care Cancer 2020; 28:2311-2319. [PMID: 31478164 PMCID: PMC7050326 DOI: 10.1007/s00520-019-05051-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/22/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE Incidence and mortality rates of uterine cancer are increasing and, obesity, which is also rising, has been associated with uterine cancer development and mortality. A recent study found that poor sleep quality is common among endometrial cancer survivors and those with obesity had more sleep disturbances than those having normal weight. However, it is unclear if higher levels of obesity (Class III, BMI ≥ 40 kg/m2), which are rising rapidly, are differentially associated with sleep as well as depression and quality of life in endometrial cancer survivors. METHODS We evaluated sleep, depression, and quality of life in 100 Stage I endometrial cancer survivors with obesity seeking weight loss enrolled in a lifestyle intervention (NCT01870947) at baseline. RESULTS The average age was 60 years and mean BMI was 42.1 kg/m2 with 58% having a BMI ≥ 40 kg/m2. Most survivors (72.3%) had poor sleep quality and most (71.2%) reported sleeping < 7 h/night. Survivors with class III compared with class I obesity had significantly more sleep disturbances and daytime dysfunction; and, those with poor sleep had higher depression and lower quality of life. Survivors with a BMI ≥ 50 kg/m2 (~ 25%) had the highest levels of depression and lowest physical and emotional well-being. CONCLUSIONS Our results reveal that endometrial cancer survivors with class III compared with class I obesity have poorer sleep quality, higher depression, and lower quality of life. Given the rising rates of obesity and uterine cancer mortality, interventions to combat both obesity and poor sleep are needed.
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Affiliation(s)
- Nora L Nock
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Wolstein Research Building, 2103 Cornell Road, Cleveland, OH, 44106, USA.
- Case Comprehensive Cancer Center, Wolstein Research Building, 2103 Cornell Road, Cleveland, OH, 44106, USA.
| | | | - Kristine M Zanotti
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA
- Gynecologic Oncology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Steven Waggoner
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA
- Gynecologic Oncology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Christa Nagel
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA
- Gynecologic Oncology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mladen Golubic
- Center for Lifestyle Medicine, Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Chad M Michener
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - John P Kirwan
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jay Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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18
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Yu CH, Wang TJ, Chang CL, Liang SY, Wu SF, Liu CY, Lu YY. Healthy life styles, sleep and fatigue in endometrial cancer survivors: A cross-sectional study. J Clin Nurs 2020; 29:1372-1380. [PMID: 31970842 DOI: 10.1111/jocn.15189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/10/2019] [Accepted: 01/10/2020] [Indexed: 12/24/2022]
Abstract
AIMS AND OBJECTIVES The primary aim of this study is to explore the influence of obesity, healthy lifestyle and sleep quality of endometrial cancer survivors on their fatigue level. BACKGROUND As many as 30% of endometrial cancer survivors still suffer from fatigue 5 years after completing therapy. Fatigue may hinder cancer survivors from participating in daily activities or returning to their original roles and functions, thus affecting their health-related quality of life. DESIGN This study adopted a cross-sectional correlational research design. The STROBE checklist for cross-sectional studies was used as a reference for reporting the study. METHODS A consecutive sample of 134 endometrial cancer survivors was recruited from the outpatient clinics of a medical centre in Taipei, Taiwan. Data were collected using structured questionnaires. RESULTS Study subjects scored 44 points (SD = 7.09) on average for the fatigue levels. Results of linear regression showed that sleep quality (ß = -0.38), comorbidity index (ß = -0.024) and age (ß = 0.20) were important predictors of fatigue. However, differences in obesity, vegetable and fruit intake, physical activity did not lead to significant differences in fatigue level. CONCLUSIONS Survivors who had poorer sleep quality, higher comorbidity index and younger age reported higher fatigue. RELEVANCE TO CLINICAL PRACTICE The study findings are relevant for assessing and preventing fatigue in endometrial cancer survivors. Those with poorer sleep quality, higher comorbidity index and younger age are at a greater risk for fatigue and deserve further attention. Although the study results failed to support the link between obesity, vegetable and fruit intake, physical activity and fatigue, the ratio of survivors who comply with recommended healthy lifestyles was low. Hence, it is of urgent necessity that this population receives the help to maintain a healthy lifestyle.
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Affiliation(s)
- Chia-Hui Yu
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Chih-Long Chang
- Department of Medical Research, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Shu-Fang Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Science, Taipei, Taiwan, ROC
| | - Yu Ying Lu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
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19
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Yu EY, Nekeman D, Billingham LJ, James ND, Cheng KK, Bryan RT, Wesselius A, Zeegers MP. Health-related quality of life around the time of diagnosis in patients with bladder cancer. BJU Int 2019; 124:984-991. [PMID: 31077532 PMCID: PMC6907410 DOI: 10.1111/bju.14804] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To quantify the health-related quality of life (HRQoL) of patients with bladder cancer around the time of diagnosis and to test the hypotheses of a two-factor model for the HRQoL questionnaire QLQ-C30. METHODS From participants in the Bladder Cancer Prognoses Programme, a multicentre cohort study, sociodemographic data were collected using semi-structured face-to-face interviews. Answers to the QLQ-C30 were transformed into a scale from 0 to 100. HRQoL data were analysed in multivariate analyses. The hypothesized two-factor (Physical and Mental Health) domain structure of the QLQ-C30 was also tested with confirmatory factor analyses (CFA). RESULTS A total of 1160 participants (78%) completed the questionnaire after initial visual diagnosis and before pathological confirmation. Despite non-muscle-invasive bladder cancer (NMIBC) being associated with a higher HRQoL than carcinoma invading bladder muscle, only the domain Role Functioning was clinically significantly better in patients with NMIBC. Age, gender, bladder cancer stage and comorbidity all had a significant influence on QLQ-C30 scores. The CFA showed an overall good fit of the hypothesized two-factor model. CONCLUSION This study identified a baseline reference value for HRQoL for patients with bladder cancer, which allows better evaluation of any changes in HRQoL as disease progresses or after treatment. In addition, a two-factor (Physical and Mental Health) model was developed for the QLQ-C30.
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Affiliation(s)
- Evan Yi‐Wen Yu
- NUTRIM School for Nutrition and Translational Research in MetabolismUniversity of MaastrichtMaastrichtthe Netherlands
- CAPHRI School for Public Health and Primary CareUniversity of MaastrichtMaastrichtthe Netherlands
| | - Duncan Nekeman
- Department of Public Health, Epidemiology and BiostatisticsSchool of Health and Population SciencesUniversity of BirminghamBirminghamUK
| | - Lucinda J. Billingham
- MRC Midland Hub for Trials Methodology Research and Cancer Research UK Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | | | - KK Cheng
- Department of Public Health, Epidemiology and BiostatisticsSchool of Health and Population SciencesUniversity of BirminghamBirminghamUK
| | | | - Anke Wesselius
- NUTRIM School for Nutrition and Translational Research in MetabolismUniversity of MaastrichtMaastrichtthe Netherlands
| | - Maurice P. Zeegers
- CAPHRI School for Public Health and Primary CareUniversity of MaastrichtMaastrichtthe Netherlands
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Galaal K, Donkers H, Bryant A, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev 2018; 10:CD006655. [PMID: 30379327 PMCID: PMC6517108 DOI: 10.1002/14651858.cd006655.pub3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND This is an update of a previous Cochrane Review published in 2012, Issue 9.Surgery for endometrial cancer (hysterectomy with removal of both fallopian tubes and ovaries) is performed through laparotomy. It has been suggested that the laparoscopic approach is associated with a reduction in operative morbidity. Over the last two decades there has been a steady increase of the use of laparoscopy for endometrial cancer. This review investigated the evidence of benefits and harms of laparoscopic surgery compared with laparotomy for presumed early stage endometrial cancer. OBJECTIVES To compare overall survival (OS) and disease free survival (DFS) for laparoscopic surgery versus laparotomy in women with presumed early stage endometrial cancer. SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5) in the Cochrane Library, MEDLINE via Ovid (April 2012 to June 2018) and Embase via Ovid (April 2012 to June 2018). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. The trial registers included NHMRC Clinical Trials Register, UKCCCR Register of Cancer Trials, Meta-Register and Physician Data Query Protocol. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing laparoscopy and laparotomy for early stage endometrial cancer. DATA COLLECTION AND ANALYSIS We independently abstracted data and assessed risk of bias. We used hazard ratios (HRs) for OS and recurrence free survival (RFS), risk ratios (RR) for severe adverse events and mean differences (MD) for continuous outcomes in women who received laparoscopy or laparotomy with 9% confidence intervals (CI). These were pooled in random-effects meta-analyses. MAIN RESULTS We identified one new study in this update of the review. The review contains nine RCTs comparing laparoscopy with laparotomy for the surgical management of early stage endometrial cancer.All nine studies met the inclusion criteria and assessed 4389 women at the end of the studies. Six studies assessing 3993 participants with early stage endometrial cancer found no significant difference in the risk of death between women who underwent laparoscopy and women who underwent laparotomy (HR 1.04, 95% 0.86 to 1.25; moderate-certainty evidence) and five studies assessing 3710 participants found no significant difference in the risk of recurrence between the laparoscopy and laparotomy groups (HR 1.14, 95% CI 0.90 to 1.43; moderate-certainty evidence). There was no significant difference in the rate of perioperative death; women requiring a blood transfusion; and bladder, ureteric, bowel and vascular injury. However, one meta-analysis of three studies found that women in the laparoscopy group lost significantly less blood than women in the laparotomy group (MD -106.82 mL, 95% CI -141.59 to -72.06; low-certainty evidence). A further meta-analysis of two studies, which assessed 3344 women and included one very large trial of over 2500 participants, found that there was no clinical difference in the risk of severe postoperative complications in women in the laparoscopy and laparotomy groups (RR 0.78, 95% CI 0.44 to 1.38). Most studies were at moderate risk of bias. All nine studies reported hospital stay and results showed that on average, laparoscopy was associated with a significantly shorter hospital stay. AUTHORS' CONCLUSIONS This review found low to moderate-certainty evidence to support the role of laparoscopy for the management of early endometrial cancer. For presumed early stage primary endometrioid adenocarcinoma of the endometrium, laparoscopy is associated with similar OS and DFS. Furthermore, laparoscopy is associated with reduced operative morbidity and hospital stay. There is no significant difference in severe postoperative morbidity between the two modalities.The certainty of evidence for OS and RFS was moderate and was downgraded for unclear risk of bias profiles and imprecision in effect estimates. However, most studies used adequate methods of sequence generation and concealment of allocation so studies were not prone to selection bias. Adverse event outcomes were downgraded for the same reasons and additionally for low event rates and low power thus these outcomes provided low-certainty evidence.
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Affiliation(s)
- Khadra Galaal
- Princess Alexandra Wing, Royal Cornwall HospitalGynaecological OncologyTruroUKTR1 3LJ
| | - Hannah Donkers
- Princess Alexandra Wing, Royal Cornwall HospitalGynaecological OncologyTruroUKTR1 3LJ
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
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Donkers H, Smits A, Eleuteri A, Bekkers R, Massuger L, Galaal K. Body mass index and sexual function in women with gynaecological cancer. Psychooncology 2018; 28:48-53. [DOI: 10.1002/pon.4908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022]
Affiliation(s)
| | - Anke Smits
- Royal Cornwall Hospital NHS Trust; Truro UK
| | - Antonio Eleuteri
- Royal Liverpool and Broadgreen University Hospitals NHS Trust; Liverpool UK
- Department of Physics; University of Liverpool; Liverpool UK
| | - Ruud Bekkers
- Radboud UMC; Nijmegen The Netherlands
- Catharina Hospital; Eindhoven The Netherlands
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LINC01016 promotes the malignant phenotype of endometrial cancer cells by regulating the miR-302a-3p/miR-3130-3p/NFYA/SATB1 axis. Cell Death Dis 2018; 9:303. [PMID: 29467441 PMCID: PMC5833433 DOI: 10.1038/s41419-018-0291-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/09/2017] [Accepted: 01/04/2018] [Indexed: 12/24/2022]
Abstract
Long noncoding RNAs (lncRNAs) have been implicated in tumorigenesis and cancer progression and are tightly associated with the phenotypes of numerous cancers. However, the functional roles underlying these effects are unknown. The expression levels of LINC01016, miR-302a-3p, miR-3130-3p, NFYA, and SATB1 were evaluated by quantitative real-time polymerase chain reaction (qRT-PCR) in 33 endometrial cancer tissues and 20 normal tissues. Bioinformatics analyses, luciferase reporter analyses, chromatin immunoprecipitation (ChIP) assays, and qRT-PCR assays were performed to verify potential binding sites. The qRT-PCR and western blot were used to identify the regulatory mechanisms of LINC01016 in cell biological behavior, which were also examined by cell counting kit -8 (CCK-8), 5-ethynyl-2′-deoxyuridine (EdU) assays, flow cytometry, wound healing assays, and transwell assays. LINC01016 was substantially upregulated in endometrial cancer tissues, and LINC01016 silencing abolished the malignant behavior of endometrial cancer cells. LINC01016 positively rescued the downstream gene nuclear factor YA (NFYA) by competitively “sponging” miR-302a-3p and miR-3130-3p. In turn, these two miRNAs could inhibit LINC01016 transcription, thus forming two reciprocal repression cycles, which influenced the biological behavior of endometrial cancer cells. MiR-302a-3p and miR-3130-3p could specifically bind with the 3′-UTR regions of NFYA, and NFYA could upregulate the expression of special AT-rich sequence-binding protein 1 (SATB1) as a transcriptional factor. This study was the first to show that the LINC01016–miR-302a-3p/miR-3130-3p/NFYA/SATB1 axis played a crucial role in the occurrence of endometrial cancer. These findings may provide relevant insights into the diagnosis and therapy of endometrial cancer.
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Life after endometrial cancer: A systematic review of patient-reported outcomes. Gynecol Oncol 2018; 148:403-413. [DOI: 10.1016/j.ygyno.2017.11.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 12/15/2022]
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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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Radiation-related toxicities and outcomes in endometrial cancer: are obese women at a disadvantage? Int J Clin Oncol 2017. [PMID: 28620815 DOI: 10.1007/s10147-017-1147-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the impact of body mass index (BMI) on radiotherapy toxicities in endometrial cancer patients. METHODS This was a retrospective cohort study of women diagnosed with endometrial cancer between January 2006 and December 2014 at the Royal Cornwall Hospital Trust. Women who received radiotherapy as part of their treatment, including external beam radiotherapy (EBRT) and/or vaginal brachytherapy were included. Radiation-related toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) guidelines. Toxicity outcomes were compared across BMI groups-non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2)-according to radiotherapy treatment received (EBRT, brachytherapy or a combination). RESULTS Of a total of 159 women who received radiotherapy, 110 were eligible for inclusion in the study. Sixty-three women had a BMI <30 kg/m2 and 47 women were obese. Obese women had poorer Eastern Cooperative Oncology Group performance status (P = 0.021) and more comorbidities (P < 0.001) compared to the non-obese group. Total (any) toxicity rates were 60.3, 72.7 and 52.0% for EBRT and brachytherapy (N = 63), single-mode EBRT (N = 22) and brachytherapy (N = 25), respectively. BMI was not associated with the incidence of acute and late radiation toxicities in the different radiotherapy groups, and there were no differences in individual complications between the BMI groups. CONCLUSION When comparing obese to non-obese women, obesity does not negatively impact the incidence of radiation toxicities in endometrial cancer. However, toxicities remain an important challenge as they are common and negatively influence the quality of life (QoL) of survivors. Future studies need to further explore the role of BMI and possible interventions to improve toxicities and QoL.
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Song J, Karlsten M, Yamal JM, Basen-Engquist K. Health-related quality of life factors associated with completion of a study delivering lifestyle exercise intervention for endometrial cancer survivors. Qual Life Res 2017; 26:1263-1271. [PMID: 27796772 PMCID: PMC8409014 DOI: 10.1007/s11136-016-1441-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to examine associations between participants' quality of life and study completion. This is a secondary analysis of an exercise intervention study for endometrial cancer survivors. METHODS We considered data for one-hundred post-treatment endometrial cancer survivors from a single-arm, six-month longitudinal exercise study. Participants received a home-based intervention consisting of exercise recommendations and telephone counseling sessions to encourage adherence. In addition to monitoring adherence to physical exercise recommendations, participants completed multiple psychological assessments, including health-related quality of life. Associations between study completion and health-related quality of life factors were analyzed using generalized additive models, to allow for possibly nonlinear associations. RESULTS Measures of bodily pain contributed to the odds of study completion in a nonlinear way (p = 0.025), suggesting that improvements in these factors were associated with study completion, especially for individuals reporting very high levels of pain. In addition, association between participants' levels of anxiety and study completion showed an inverse U-shaped relation: Whereas increase in anxiety was associated with higher odds of completion for individuals with low anxiety score (0-4), increase in anxiety contributed to lower odds of study completion for individuals with anxiety scores of approximately 5-10 (p = 0.035). CONCLUSIONS Results from this study indicate that baseline health-related quality of life factors may be associated with study completion in exercise intervention studies. In order to increase study completion rates, individually tailored study strategies may be prepared based on the baseline quality of life responses.
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Affiliation(s)
- Jaejoon Song
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St., Floor 4, FCT4.5009, Houston, TX, 77030, USA.
- Department of Biostatistics, School of Public Health, University of Texas Health Science Center, Houston, TX, USA.
| | - Melissa Karlsten
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - José-Miguel Yamal
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St., Floor 4, FCT4.5009, Houston, TX, 77030, USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Connor EV, Raker CA, Clark MA, Stuckey AR. Obesity risk awareness in women with endometrial cancer. Arch Gynecol Obstet 2017; 295:965-969. [DOI: 10.1007/s00404-017-4301-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/13/2017] [Indexed: 01/22/2023]
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Walker AJ, Benrubi ID, Ward KK. Care of survivors of gynecologic cancers. World J Obstet Gynecol 2016; 5:140-149. [DOI: 10.5317/wjog.v5.i2.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/16/2015] [Accepted: 02/24/2016] [Indexed: 02/05/2023] Open
Abstract
The number of cancer survivors is increasing and most healthcare providers will manage patients who have completed therapy for malignancy at some point. The care of survivors of gynecologic malignancies may seem daunting in a busy general gynecology practice. This paper intends to review the literature and suggest management of these women for the general gynecologist.
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Zomkowski K, Toryi AM, Sacomori C, Dias M, Sperandio FF. Sexual function and quality of life in gynecological cancer pre- and post-short-term brachytherapy: a prospective study. Arch Gynecol Obstet 2016; 294:833-40. [DOI: 10.1007/s00404-016-4099-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
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Smits A, Lopes A, Das N, Bekkers R, Massuger L, Galaal K. Exercise Programme in Endometrial Cancer; Protocol of the Feasibility and Acceptability Survivorship Trial (EPEC-FAST). BMJ Open 2015; 5:e009291. [PMID: 26674498 PMCID: PMC4691724 DOI: 10.1136/bmjopen-2015-009291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Obesity has been associated with impaired quality of life and poorer outcomes in endometrial cancer survivors. Lifestyle interventions promoting exercise and weight reduction have been proposed for survivorship care. However, studies evaluating exercise programmes for endometrial cancer survivors are lacking. PURPOSE The objective of this study is to evaluate the feasibility of an individualised exercise intervention for endometrial cancer survivors to improve quality of life. METHODS AND ANALYSIS This is a feasibility study in which women will undergo a 10-week exercise programme with a personal trainer. The study population comprises women with confirmed diagnosis of endometrial cancer, who have completed surgical treatment with curative intent, and are aged 18 years or older. The study will take place at the Royal Cornwall Hospital Trust, UK. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes are quality of life, psychological distress, fatigue, pain and complication rates. In addition, the acceptability of the programme will be assessed. ETHICS AND DISSEMINATION Ethical approval was obtained through the Exeter NRES Committee. The study results will be used to optimise the intervention content, and may serve as the foundation for a larger definitive trial. Results will be disseminated through peer-review journals, congresses, relevant clinical groups and presented on the Trust's website. TRIAL REGISTRATION NUMBER NCT02367950; pre-results.
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Affiliation(s)
- Anke Smits
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
| | - Alberto Lopes
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
| | - Nagindra Das
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
| | - Ruud Bekkers
- Department of Gynaecology, Radboud UMC, Nijmegen, The Netherlands
| | - Leon Massuger
- Department of Gynaecology, Radboud UMC, Nijmegen, The Netherlands
| | - Khadra Galaal
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
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The effect of lifestyle interventions on the quality of life of gynaecological cancer survivors: A systematic review and meta-analysis. Gynecol Oncol 2015; 139:546-52. [PMID: 26441008 DOI: 10.1016/j.ygyno.2015.10.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/02/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE We aimed to evaluate the effectiveness of lifestyle interventions in improving the quality of life (QoL) of endometrial and ovarian cancer survivors. METHODS The review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the Cochrane Handbook for Systematic Reviews of Interventions. We performed a search of MEDLINE (1946-2015), EMBASE (1980-2015), CINAHL (1981-2015), PsycINFO (1806-2015) and the Cochrane Trial Register to identify studies evaluating the effect of lifestyle interventions on the QoL of endometrial and ovarian cancer survivors. RESULTS Eight studies fulfilled the inclusion criteria and comprised a total of 413 patients. Three studies were randomised controlled trials (RCTs), which showed that lifestyle interventions may improve physical functioning and significantly reduce fatigue in endometrial cancer survivors. In addition, lifestyle interventions in endometrial cancer survivors resulted in significant weight loss and improved physical activity levels, but did not show improvements in global QoL in the meta-analysis (P=0.75, P=0.49). Non-randomised trials in ovarian cancer survivors support the feasibility of lifestyle interventions and suggest they may result in QoL improvements. CONCLUSIONS Lifestyle interventions have the potential to improve the QoL of endometrial cancer and ovarian cancer survivors, and may significantly reduce fatigue. However, the current evidence is limited and there is a need for future studies to further evaluate lifestyle interventions and their effect on QoL outcomes.
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Smits A, Smits E, Lopes A, Das N, Hughes G, Talaat A, Pollard A, Bouwman F, Massuger L, Bekkers R, Galaal K. Body mass index, physical activity and quality of life of ovarian cancer survivors: Time to get moving? Gynecol Oncol 2015; 139:148-54. [DOI: 10.1016/j.ygyno.2015.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 02/06/2023]
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Bouwman F, Smits A, Lopes A, Das N, Pollard A, Massuger L, Bekkers R, Galaal K. The impact of BMI on surgical complications and outcomes in endometrial cancer surgery--an institutional study and systematic review of the literature. Gynecol Oncol 2015; 139:369-76. [PMID: 26407479 DOI: 10.1016/j.ygyno.2015.09.020] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We aimed to evaluate the association between body mass index (BMI), perioperative complications and outcomes in endometrial cancer (EC) patients at our institution. In addition, we performed a systematic review to compare our results to the literature. METHODS This was a retrospective study of surgically managed EC patients between January 2006 and January 2015. Patient characteristics, surgical complications and intra- and postoperative outcomes were evaluated across BMI groups; BMI <30kg/m(2), BMI ≥30kg/m(2) and BMI ≥40kg/m(2). The systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS In total, we identified 627 women of which 514 were included; 249 women had a BMI of <30kg/m(2), 195 women had a BMI of 30-39.9kg/m(2), and 70 women were morbidly obese (BMI ≥40kg/m(2)). Obese women (BMI ≥30kg/m(2)) had significantly more postoperative surgical complications, including wound complications and antibiotics use, which was confirmed by the systematic review. The increase in complications mainly occurred in open surgery and morbidly obese patients were at highest risk. Obesity did not impact other outcomes including 30-day mortality. CONCLUSION Obesity is associated with an increased risk of surgical morbidity in EC patients, and is most profound in open surgery and among the morbidly obese. Laparoscopic surgery may well prevent the majority of postoperative complications in this group of patients, and should therefore be the favoured approach.
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Affiliation(s)
| | - Anke Smits
- Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom
| | - Alberto Lopes
- Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom
| | - Nagindra Das
- Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom
| | - Adam Pollard
- European Centre for the Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
| | | | | | - Khadra Galaal
- Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom.
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Conlon BA, Kahan M, Martinez M, Isaac K, Rossi A, Skyhart R, Wylie-Rosett J, Moadel-Robblee A. Development and Evaluation of the Curriculum for BOLD (Bronx Oncology Living Daily) Healthy Living: a Diabetes Prevention and Control Program for Underserved Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:535-545. [PMID: 25394834 PMCID: PMC4433444 DOI: 10.1007/s13187-014-0750-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Underserved minority communities have few resources for addressing comorbidity risk reduction among long-term cancer survivors. To address this community need, we developed and piloted the Bronx Oncology Living Daily (BOLD) Healthy Living program, the first known diabetes prevention and control program to target cancer survivors and co-survivors in Bronx County, NY. The program aimed to facilitate lifestyle change and improve health-related quality of life (HRQoL) through weekly group nutrition education (60-90 min) and exercise (60 min) classes. We examined baseline characteristics of participants using simple descriptive statistics and evaluated program implementation and impact using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. The curriculum, which drew from the social-ecological framework and motivational and cognitive behavioral strategies, consisted of 12 culturally and medically tailored modules with options for implementation as a 12- or 4-week program. Seven programs (four 12 weeks and three 4 weeks in length, respectively) were implemented at five community site locations. Sixty-six cancer survivors and 17 cancer co-survivors (mean age 60.5 ± 10.2 years) enrolled in one of the programs. Most participants were female (95.2 %) minority (55.4 % black, 26.5 % Hispanic/Latino) breast cancer survivors (75.7 %). Median program attendance was 62.5 % and did not significantly differ by program length; however, 67.3 % of participants achieved ≥60 % attendance among the 12-week programs, compared to 41.9 % among the 4-week programs, and this difference was statistically significant (p = 0.02). Overall, participants reported significant pre/post improvements in perceived health as good/excellent (66.0 to 75.5 %; p = 0.001) and borderline significant decreases in perceived pain as moderate/severe (45.5 to 38.2 %; p = 0.05). More than 90 % of participants reported that the program helped them to achieve their short-term goals, motivated them to engage in healthier behaviors, and felt that the nutrition and exercise classes were relevant to their needs. These results indicate that a short-term lifestyle intervention program for adult cancer survivors was acceptable in our community and motivated cancer survivors to improve their HRQoL. The curriculum can be used as a tool to facilitate development of similar programs in the future.
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Affiliation(s)
- Beth A Conlon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA,
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Koutoukidis DA, Knobf MT, Lanceley A. Obesity, diet, physical activity, and health-related quality of life in endometrial cancer survivors. Nutr Rev 2015; 73:399-408. [PMID: 26011914 PMCID: PMC4477700 DOI: 10.1093/nutrit/nuu063] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Obesity, low-quality diet, and inactivity are all prevalent among survivors of endometrial cancer. The present review was conducted to assess whether these characteristics are associated with health-related quality of life (HRQoL). Electronic databases, conference abstracts, and reference lists were searched, and researchers were contacted for preliminary results of ongoing studies. The quality of the methodology and reporting was evaluated using appropriate checklists. Standardized mean differences were calculated, and data were synthesized narratively. Eight of the 4385 reports retrieved from the literature were included in the analysis. Four of the 8 studies were cross-sectional, 1 was retrospective, 1 was prospective, and 2 were randomized controlled trials. Obesity was negatively associated with overall HRQoL in 4 of 4 studies and with physical well-being in 6 of 6 studies, while it was positively associated with fatigue in 2 of 4 studies. Meeting the recommendations for being physically active, eating a diet high in fruit and vegetables, and abstaining from smoking were positively associated with overall HRQoL in 2 of 2 studies, with physical well-being in 2 of 3 studies, and with fatigue in 1 of 3 studies. Improvements in fatigue and physical well-being were evident after lifestyle interventions. The findings indicate a healthy lifestyle is positively associated with HRQoL in this population, but the number of studies is limited. Additional randomized controlled trials to test effective and practical interventions promoting a healthy lifestyle in survivors of endometrial cancer are warranted.
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Affiliation(s)
- Dimitrios A Koutoukidis
- D.A. Koutoukidis, A. Lanceley, and M.T. Knobf are with the Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK. M.T. Knobf is with the Acute Care/Health Systems Division, Yale University School of Nursing, New Haven, Connecticut, USA.
| | - M Tish Knobf
- D.A. Koutoukidis, A. Lanceley, and M.T. Knobf are with the Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK. M.T. Knobf is with the Acute Care/Health Systems Division, Yale University School of Nursing, New Haven, Connecticut, USA
| | - Anne Lanceley
- D.A. Koutoukidis, A. Lanceley, and M.T. Knobf are with the Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK. M.T. Knobf is with the Acute Care/Health Systems Division, Yale University School of Nursing, New Haven, Connecticut, USA
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Smits A, Lopes A, Bekkers R, Galaal K. Body mass index and the quality of life of endometrial cancer survivors—A systematic review and meta-analysis. Gynecol Oncol 2015; 137:180-7. [DOI: 10.1016/j.ygyno.2015.01.540] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/19/2015] [Indexed: 01/22/2023]
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Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application. Gynecol Oncol 2015; 137:508-15. [PMID: 25681782 DOI: 10.1016/j.ygyno.2014.12.025] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The study aimed to assess a one-month lifestyle intervention delivered via a web- and mobile-based weight-loss application (app) (LoseIt!) using a healthcare-provider interface. METHODS Early-stage overweight/obese (body mass index [BMI]≥25kg/m(2)) cancer survivors (CS) diagnosed in the past three years, and without recurrent disease were enrolled and received exercise and nutrition counseling using the LoseIt! app. Entry and exit quality of life (FACT-G) and Weight Efficacy Lifestyle Questionnaire (WEL) measuring self-efficacy were measured along with anthropometrics, daily food intake, and physical activity (PA) using the app. RESULTS Mean participant age was 58.4±10.3years (n=50). Significant reductions (p<0.0006) in anthropometrics were noted between pre- and post-intervention weight (105.0±21.8kg versus 98.6±22.5kg); BMI (34.9±8.7kg/m(2) versus 33.9±8.4kg/m(2)); and waist circumference (108.1±14.9cm versus 103.7±15.1cm). A significant improvement in pre- and post-intervention total WEL score was noted (99.38±41.8 versus 120.19±47.1, p=0.043). No significant differences were noted in FACT-G, macronutrient consumption, and PA patterns. CONCLUSION These results indicate that a lifestyle intervention delivered via a web- and mobile-based weight-loss app is a feasible option by which to elicit short-term reductions in weight. Though these results parallel the recent survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED) trial, it is notable that they were achieved without encumbering significant cost and barrier-access issues (i.e. time, transportation, weather, parking, etc.).
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Doll KM, Kalinowski AK, Snavely AC, Irwin DE, Bensen JT, Bae-Jump VL, Kim KH, Van Le L, Clarke-Pearson DL, Gehrig PA. Obesity is associated with worse quality of life in women with gynecologic malignancies: an opportunity to improve patient-centered outcomes. Cancer 2014; 121:395-402. [PMID: 25250951 DOI: 10.1002/cncr.29061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/26/2014] [Accepted: 08/25/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND The objective of the current study was to evaluate the effect of obesity on pretreatment quality of life (QoL) in gynecologic oncology patients. METHODS The authors analyzed collected data from an institution-wide cohort study of women with gynecologic cancers enrolled from August 2012 to June 2013. The Functional Assessment of Cancer Therapy-General, site-specific symptom scales, and the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) global mental and physical health tools were administered. Survey results were linked to clinical data abstracted from medical records (demographics and comorbid conditions). Bivariate tests and multivariate linear regression models were used to evaluate factors associated with QoL scores. RESULTS A total of 182 women with ovarian, uterine, cervical, and vulvar/vaginal cancers were identified; of these, 152 (84%) were assessed before surgery. Mean body mass index was 33.5 kg/m(2) and race included white (120 patients [79%]), black (22 patients [15%]), and other (10 patients [6.5%]). A total of 98 patients (64.5%) were obese (body mass index ≥30). On multivariate analysis, subscales for functional (17 vs 19; P = .04), emotional (16 vs 19; P = .008), and social (22 vs 24; P = .02) well-being as well as overall Functional Assessment of Cancer Therapy-General scores (77 vs 86; P = .002) and Patient-Reported Outcomes Measurement Information System global physical health scores (45 vs 49; P = .003) were found to be significantly lower in obese versus nonobese patients. CONCLUSIONS Before cancer treatment, obese patients with gynecologic malignancies appear to have worse baseline QoL than their normal-weight counterparts. Emerging models of QoL-based cancer outcome measures may disproportionately affect populations with a high obesity burden. The potential disparate impact of cancer therapy on longitudinal QoL in the obese versus nonobese patients needs to be evaluated.
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Affiliation(s)
- Kemi M Doll
- Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Cancer Care Quality Training Program, Division of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Popovic MD, Banicevic AC, Popovic B, Ceric A, Banicevic A, Popadic D. Treatment of endometrial cancer in patient with malignant obesity. Med Arch 2014; 68:69-70. [PMID: 24783920 PMCID: PMC4272475 DOI: 10.5455/medarh.2014.68.69-70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our 60-year-old patient menarche in 13-year, two delivery, last menstruation in 53-year, without uterine bleeding or any kind of symptomatology. The gynecological transvaginal ultrasound examination showed hyperplasio endometrii (20mm). After curettage, pathological examination was diagnostic polypus carcinomatoides. The patient with HTA and obesity was admitted to and operated on at the Gynecological Department due to endometrial carcinoma (FIGO stage IA1). Because of her giant obesity, BMI – 71.50 kg/m2, weight 219 kg and height 175cm, surgery by the abdominal approach was very difficult to perform, so vaginal hysterectomy was carried out. The procedure was completed within 127 minutes without any intraoperative complications. Blood loss was less than 100ml. The patient was discharged on postoperative day 7. The patient was followed up for 6 months after surgery. No complications or recurrence were reported during the 6-month follow up.
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Affiliation(s)
- Miroslav D. Popovic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
- Corresponding author: Miroslav D. Popovic, MD, Msc., gynecologist-oncologist, Head of Surgical-Oncology Department of the Clinic of Obstetrics and Gynecology. Clinical Center Banja Luka. Trive Amelice 30/3, Banja Luka, Bosnia and Herzegovina. Phone: +387 (0)51/342-204, Mob:+387 (0)65/188-888. E–mail : drpopovic.gin1 @ gmail.com;
| | - Arnela Ceric Banicevic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
| | - Biljana Popovic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
| | - Amela Ceric
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
| | - Andrija Banicevic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
| | - Danijela Popadic
- Department of Obstetrics and Gynecology, Clinical Center of Banja Luka, Bosnia and Herzegovina
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