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Mandato VD, Paterlini M, Torricelli F, Rabitti E, Mastrofilippo V, Aguzzoli L. Perceived social support and quality of life in endometrial cancer patients: a longitudinal study. Front Oncol 2024; 14:1447644. [PMID: 39156703 PMCID: PMC11327120 DOI: 10.3389/fonc.2024.1447644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Objective This study aimed to assess the influence of medical history, perceived physician-patient communication, and perceived social support on changes in the quality of life (QoL) during the first year of follow-up in patients undergoing surgery for endometrial cancer (EC), the most prevalent gynecological cancer in Western countries, especially in Central and Eastern Europe and North America. Methods This prospective longitudinal study included 98 EC patients. All participants completed the Short Form 36 (SF-36) and the Multidimensional Scale of Perceived Social Support (MSPSS) one month and one year after surgery. Additionally, one month after surgery, they responded to a questionnaire designed by the researchers concerning the key aspects of physician-patient communication. Results Our findings revealed that patients reporting high social support one month after surgery demonstrated significantly improved emotional well-being (EWB) at both one month and one year after the surgery, with statistically significant higher scores in the dimension of EWB (p<0.05). The support from a significant other at one year correlates with greater PF (p<0.005), fewer limitations due to physical health (p<0.05), less pain (p<0.05), less fatigue (p<0.05), and better general and EWB (p<0.05). Conclusion This study underscores the significance of perceived social support for patients cross endometrial cancer. The multifaceted nature of social support, encompassing emotional assistance and information sharing, emerges as a pivotal factor aiding patients in confronting the challenges inherent to EC. This form of support contributes to bolstering psychological well-being and enhancing overall QoL.
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Affiliation(s)
- Vincenzo Dario Mandato
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Marcella Paterlini
- Department of Obstetrics and Pediatrics, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Rabitti
- Psycho-oncology Unit, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
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McKenzie ND, Ahmad S. Impact of Lifestyle Interventions on Gynecologic Cancers: Beyond Diet and Exercise. Am J Lifestyle Med 2024; 18:7-20. [PMID: 39184272 PMCID: PMC11339763 DOI: 10.1177/15598276221123764] [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: 08/27/2024] Open
Abstract
A Lifestyle Medicine approach to compliment cancer care is less commonly researched or implemented for women with gynecologic cancers as compared to better funded malignancies such as breast, prostate, and colorectal. Yet, several gynecologic malignancies are linked to obesity, estrogen/metabolic signaling pathways, and altered tumor microenvironment which could benefit greatly from a lifestyle medicine program. Lifestyle medicine, an evidenced-based branch of science, has expanded to the prevention and treatment of disorders caused by lifestyle factors (including cancer). Modifiable lifestyle factors such as obesity, lack of physical activity/nutrient density, microbial dysbiosis, sleep disturbance, and chronic stressors contribute greatly to cancer morbidity and mortality worldwide. This overarching area of research is evolving with some subtopics in their infancy requiring further investigation. Modern tools have allowed for better understanding of mechanisms by which adiposity and inactivity affect tumor promoting signaling pathways as well as the local tumor environment. Through the evolving use of these sophisticated techniques, novel prognostic biomarkers have emerged to explore efficacy of pharmacologic and lifestyle interventions in cancer. This state-of-the-art review article appraises recent evidence for a lifestyle medicine approach, beyond diet and exercise, to optimize survivorship and quality of life for patients with gynecologic cancers and introduces the 8-week web-based comprehensive HEAL-GYN program.
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Affiliation(s)
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
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Armbruster SD, Brow K, Locklear T, Frazier M, Harden SM. Mixed-method approach to informing a lifestyle intervention to improve the survivorship of patients with endometrial cancer. Gynecol Oncol 2024; 180:160-167. [PMID: 38091776 PMCID: PMC10977604 DOI: 10.1016/j.ygyno.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To identify endometrial cancer survivors' (ECS) barriers and facilitators for participation in lifestyle interventions to improve their dietary and exercise behaviors. Our secondary objective is to determine baseline information: physical activity level, quality of life (QoL), and impact of COVID-19 on exercise, diet, and mental health. METHODS Obese, early-stage ECS participated in 2-part mixed-methods data collection; Part 1: survey gathering sample characteristics, QoL, exercise, and basic endometrial cancer- related knowledge. Part 2: virtual focus group or individual interviews using a brainwriting premortem protocol. Statistical analysis was performed using SAS (version 8.3). Qualitative data were analyzed using deductive thematic coding guided by the RE-AIM framework. RESULTS Twenty percent (70/358) of ECS from a survivorship database and clinic recruitment completed the survey; 16 ECS provided qualitative feedback. Common barriers to intervention participation included time and resource costs, meeting frequency, and pessimism about weight loss maintenance. Facilitators included an opportunity to connect with other survivors and a focus on health rather than weight loss. Most ECS could not identify exercise guidelines (60%) and 83% were not meeting these guidelines. Higher BMI was correlated with a lower confidence in completing in moderate physical activity (p-value = 0.0206). Post-COVID-19 pandemic, physical activity, nutritional decisions, and/or mental health worsened for 67% of ECS. CONCLUSION ECS are a disparate population, with worsening behaviors and mental health following the pandemic. The identified ECS-specific barriers and facilitators to behavioral intervention participation are being used to simultaneously improve the reach of and adherence to a lifestyle intervention aimed at improving their health and QoL.
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Affiliation(s)
- Shannon D Armbruster
- Division of Gynecologic Oncology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Katie Brow
- Virginia Tech School of Medicine, Roanoke, VA, USA
| | - Tonja Locklear
- Carilion Clinic Health Analytics Research Team, Roanoke, VA, USA
| | - Mary Frazier
- Translational Biology, Medicine, and Health Program, Virginia Tech, Roanoke, VA, USA
| | - Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 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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5
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Courneya KS, An KY, Arthuso FZ, Bell GJ, Morielli AR, McNeil J, Wang Q, Allen SJ, Ntoukas SM, McNeely ML, Vallance JK, Culos-Reed SN, Kopciuk K, Yang L, Matthews CE, Filion M, Dickau L, Mackey JR, Friedenreich CM. Associations between health-related fitness and quality of life in newly diagnosed breast cancer patients. Breast Cancer Res Treat 2023; 199:533-544. [PMID: 37055681 DOI: 10.1007/s10549-023-06935-x] [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: 01/05/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Newly diagnosed breast cancer patients face substantial stress and uncertainty that may undermine their quality of life (QoL). The purpose of the present study was to examine the associations between health-related fitness (HRF) and QoL in newly diagnosed breast cancer patients from the Alberta Moving Beyond Breast Cancer Study. METHODS Newly diagnosed breast cancer patients with early-stage disease (n = 1458) were recruited between 2012 and 2019 in Edmonton and Calgary, Canada to complete baseline HRF and QoL assessments within 90 days of diagnosis. HRF assessments included cardiorespiratory fitness (VO2peak treadmill test), muscular fitness (upper and lower body strength and endurance tests), and body composition (dual x-ray absorptiometry). QoL was assessed by the Medical Outcomes Study Short Form 36 (SF-36) version 2. We used logistic regression analyses to examine the associations between quartiles of HRF and poor/fair QoL (bottom 20%) after adjusting for key covariates. RESULTS In multivariable analysis, the least fit groups compared to the most fit groups for relative upper body strength (OR = 3.19; 95% CI = 1.98-5.14), lean mass percentage (OR = 2.31; 95% CI = 1.37-3.89), and relative VO2peak (OR = 2.08; 95% CI = 1.21-3.57) were independently at a significantly higher risk of poor/fair physical QoL. No meaningful associations were found for mental QoL. CONCLUSIONS The three main components of HRF (muscular fitness, cardiorespiratory fitness, and body composition) were independently associated with physical QoL in newly diagnosed breast cancer patients. Exercise interventions designed to improve these components of HRF may optimize physical QoL and help newly diagnosed breast cancer patients better prepare for treatments and recovery.
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Affiliation(s)
- Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Ki-Yong An
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Fernanda Z Arthuso
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Gordon J Bell
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Andria R Morielli
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Jessica McNeil
- Department of Kinesiology, School of Health and Human Sciences, University of North Carolina, Greensboro, NC, USA
| | - Qinggang Wang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Spencer J Allen
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephanie M Ntoukas
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | - S Nicole Culos-Reed
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Karen Kopciuk
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD, USA
| | - Myriam Filion
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Leanne Dickau
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - John R Mackey
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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6
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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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7
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Lee H, Reilly M, Bruner DW, Bai J, Hu Y, Yeager KA. Obesity and patient‐reported sexual health outcomes in gynecologic cancer survivors: A systematic review. Res Nurs Health 2022; 45:664-679. [DOI: 10.1002/nur.22272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Haerim Lee
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Megan Reilly
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Deborah W. Bruner
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Winship Cancer Institute Emory University Atlanta Georgia USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Winship Cancer Institute Emory University Atlanta Georgia USA
| | - Yi‐Juan Hu
- Department of Biostatistics and Bioinformatics Emory University Rollins School of Public Health Atlanta Georgia USA
| | - Katherine A. Yeager
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Winship Cancer Institute Emory University Atlanta Georgia USA
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8
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Dhanis J, Keidan N, Blake D, Rundle S, Strijker D, van Ham M, Pijnenborg JMA, Smits A. Prehabilitation to Improve Outcomes of Patients with Gynaecological Cancer: A New Window of Opportunity? Cancers (Basel) 2022; 14:cancers14143448. [PMID: 35884512 PMCID: PMC9351657 DOI: 10.3390/cancers14143448] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Surgery is an important mainstay in the treatment of gynaecological cancers but is associated with operative complications, especially for those with poor physical and mental health. Prehabilitation is a new and upcoming strategy to optimise patients’ functional capacity, nutritional status and psychosocial wellbeing in order to reduce complications and enhance recovery. In this review, we assessed the evidence on prehabilitation programmes for patients with gynaecological cancer. The limited evidence shows that prehabilitation may reduce length of hospital stay for ovarian cancer patients, and may result in significant weight loss in patients with endometrial and cervical cancer. Comparative prospective studies are required to determine the effectiveness of prehabilitation on reducing operative complications and improving quality of life, and to further specify the content of such a programme for patients with gynaecological cancer. Abstract The literature evaluating the effect of prehabilitation programmes on postoperative outcomes and quality of life of patients with gynaecological cancer undergoing surgery was reviewed. Databases including Pubmed, Medline, EMBASE (Ovid) and PsycINFO were systematically searched to identify studies evaluating the effect of prehabilitation programmes on patients with gynaecological cancer. Both unimodal and multimodal prehabilitation programmes were included encompassing physical exercise and nutritional and psychological support. Primary outcomes were surgical complications and quality of life. Secondary outcomes were anthropometric changes and adherence to the prehabilitation programme. Seven studies fulfilled the inclusion criteria, comprising 580 patients. Included studies were nonrandomised prospective studies (n = 4), retrospective studies (n = 2) and one case report. Unimodal programmes and multimodal programmes were included. In patients with ovarian cancer, multimodal prehabilitation resulted in significantly reduced hospital stay and time to chemotherapy. In patients with endometrial and cervical cancer, prehabilitation was associated with significant weight loss, but had no significant effects on surgical complications or mortality. No adverse events of the programmes were reported. Evidence on the effect of prehabilitation for patients with gynaecological cancer is limited. Future studies are needed to determine the effects on postoperative complications and quality of life.
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Affiliation(s)
- Joëlle Dhanis
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
- Faculty of Medical Sciences, Radboud University, 6526 GA Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-644404756
| | - Nathaniel Keidan
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| | - Dominic Blake
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| | - Stuart Rundle
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| | - Dieuwke Strijker
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Maaike van Ham
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
| | - Johanna M. A. Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
| | - Anke Smits
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
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9
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Modifiable pre-treatment factors are associated with quality of life in women with gynaecological cancers at diagnosis and one year later: Results from the HORIZONS UK national cohort study. Gynecol Oncol 2022; 165:610-618. [DOI: 10.1016/j.ygyno.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/09/2022]
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10
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Kranz S, Hasan F, Kennedy E, Zoellner J, Guertin KA, Shivappa N, Hébert JR, Anderson R, Cohn W. Diet Quality and Dietary Inflammatory Index Score among Women's Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041916. [PMID: 35206105 PMCID: PMC8871885 DOI: 10.3390/ijerph19041916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to investigate Healthy Eating Index 2015 (HEI-2015) and Energy-Adjusted Dietary Inflammatory Index (E-DIITM) scores in women's cancer survivors and to examine socio-economic (SES) characteristics associated with these two diet indices. In this cross-sectional study, survivors of women's cancers completed a demographic questionnaire and up to three 24-h dietary recalls. HEI-2015 and E-DII scores were calculated from average intakes. One-way ANOVA was used to examine the association of various demographic factors on HEI-2015 and E-DII scores. Pearson Correlation was used to calculate the correlation between the two scores. The average HEI-2015 score was 55.0 ± 13.5, lower than the national average, and average E-DII was -1.14 ± 2.24, with 29% of women having a more pro-inflammatory and 71% a more anti-inflammatory diet. Diets with higher HEI-2015 scores were associated with more anti-inflammatory diets (r = -0.67, p < 0.001). Those having a graduate degree (F(2,49) = 3.6, p = 0.03) and completing cancer treatment > 4 years ago (F(2,49) = 4.8, p = 0.01) had higher HEI-2015 scores. There were no associations between SES and E-DII scores. The diet quality of women's cancer survivors is comparatively low, but many achieved an anti-inflammatory diet; a promising avenue for preventing recurrence. There is an urgent need to involve health care professionals in the guidance of women's cancer survivors to improve diet quality and prevent cancer recurrence.
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Affiliation(s)
- Sibylle Kranz
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA;
- Correspondence:
| | - Faten Hasan
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA;
| | - Erin Kennedy
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA; (E.K.); (J.Z.); (K.A.G.); (R.A.); (W.C.)
| | - Jamie Zoellner
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA; (E.K.); (J.Z.); (K.A.G.); (R.A.); (W.C.)
| | - Kristin A Guertin
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA; (E.K.); (J.Z.); (K.A.G.); (R.A.); (W.C.)
| | - Nitin Shivappa
- Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (N.S.); (J.R.H.)
| | - James R Hébert
- Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (N.S.); (J.R.H.)
| | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA; (E.K.); (J.Z.); (K.A.G.); (R.A.); (W.C.)
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA; (E.K.); (J.Z.); (K.A.G.); (R.A.); (W.C.)
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Thorpe CS, DeWees TA, Golafshar MA, Bhangoo RS, Vern-Gross TZ, McGee LA, Wong WW, Halyard MY, Keole SR, Vargas CE. Patient-reported outcomes version of the common terminology criteria for adverse events and quality-of-life linear analogue self-assessment in breast cancer patients receiving radiation therapy: single-institution prospective registry. J Patient Rep Outcomes 2022; 6:3. [PMID: 35006393 PMCID: PMC8748600 DOI: 10.1186/s41687-021-00408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose/objectives We sought to investigate the impact of patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE) on overall quality-of-life (QOL) employing linear analogue self-assessment (LASA) in breast cancer (BC) patients undergoing radiation therapy (RT). Materials/methods All patients treated with RT for BC with curative intent from 2015 to 2019 at our institution were included. Breast specific PRO-CTCAE and overall QOL LASA questionnaires were administered at baseline, end-of-treatment, 3, 6, 12 months, and then annually. Minimal clinically important difference in overall QOL was a 10-point change in LASA. Hypofractionation was any treatment > 2 Gy per fraction. Mixed models for repeated measures were used to determine the association of PRO-CTCAE and overall QOL LASA. Results Three hundred thirty-one (331) patients with a median follow-up of 3.1 years (range 0.4–4.9) were included. Average overall QOL LASA scores were 78.5 at baseline, 79.8 at end-of-treatment, 79.8 at 3 months, 77.1 at 6 months, 79.4 at 12 months, and 79.7 at 24 months. On univariate analysis, patients reporting a grade ≥ 3 PRO-CTCAE had, on average, a 10.4-point reduction in overall LASA QOL (p < 0.0001). On multivariate analysis, not being treated with hypofractionation and higher BMI were predictive for worse overall LASA QOL with a 10-point reduction in LASA for patients reporting a grade ≥ 3 PRO-CTCAE (p < 0.0001). Conclusions Patients reporting a grade ≥ 3 PRO-CTCAE experienced statistically significant and clinically meaningful deterioration in overall QOL LASA. Hypofractionation improved QOL while higher BMI predicted for worse QOL. PRO-CTCAE should be integrated into future clinical trials.
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Affiliation(s)
- C S Thorpe
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA
| | - T A DeWees
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA.,Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | - M A Golafshar
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA
| | - R S Bhangoo
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA
| | - T Z Vern-Gross
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA
| | - L A McGee
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA
| | - W W Wong
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA
| | - M Y Halyard
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA
| | - S R Keole
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA
| | - C E Vargas
- Department of Radiation Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, USA.
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Forsse D, Barbero ML, Werner HMJ, Woie K, Nordskar N, Berge Nilsen E, Ellstrøm Engh M, Vistad I, Rege A, Sævik-Lode M, Andreasen S, Haldorsen IS, Trovik J, Krakstad C. Longitudinal effects of adjuvant chemotherapy and lymph node staging on patient-reported outcomes in endometrial cancer survivors: a prospective cohort study. Am J Obstet Gynecol 2022; 226:90.e1-90.e20. [PMID: 34400137 DOI: 10.1016/j.ajog.2021.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most patients with endometrial cancer with localized disease are effectively treated and survive for a long time. The primary treatment is hysterectomy, to which surgical staging procedures may be added to assess the need for adjuvant therapy. Longitudinal data on patient-reported outcomes comparing different levels of primary treatment are lacking, especially when adjuvant radiotherapy is omitted. OBJECTIVE We assessed the impact of lymphadenectomy and adjuvant chemotherapy on patient-reported symptoms, function, and quality of life. We hypothesized that these treatment modalities would substantially affect patient-reported outcomes at follow-up. STUDY DESIGN We prospectively included patients with endometrial cancer enrolled in the ongoing MoMaTEC2 study (ClinicalTrials.gov Identifier: NCT02543710). Patients were asked to complete the patient-reported outcome questionnaires European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EN24 preoperatively and at 1 and 2 years of follow-up. Functional domains and symptoms were analyzed for the whole cohort and by treatment received. To assess the effect of the individual treatment modifications, we used mixed regression models. RESULTS Baseline data were available for 448 patients. Of these patients, 339 and 219 had reached 1-year follow-up and 2-year follow-up, respectively. Treatment included hysterectomy (plus bilateral salpingo-oophorectomy) alone (n=177), hysterectomy and lymph node staging without adjuvant therapy (n=133), or adjuvant chemotherapy irrespective of staging procedure (n=138). Overall, patients reported improved global health status and quality of life (+9 units; P<.001), increased emotional and social functioning, and increased sexual interest and activity (P<.001 for all) from baseline to year 1, and these outcomes remained stable at year 2. Means of functional scales and quality of life were similar to age- and sex-weighted reference cohorts. Mean tingling and numbness and lymphedema increased after treatment. The group who received adjuvant chemotherapy had a larger mean reduction in physical functioning (-6 vs +2; P=.002) at year 1, more neuropathy (+30 vs +5; P<.001; year 1) at years 1 and 2, and more lymphedema at year 1 (+11 vs +2; P=.007) than the group treated with hysterectomy and salpingo-oophorectomy only. In patients not receiving adjuvant chemotherapy, patient-reported outcomes were similar regardless of lymph node staging procedures. Adjuvant chemotherapy independently increased fatigue, lymphedema, and neuropathy in mixed regression models. CONCLUSION Patients with endometrial cancer receiving adjuvant chemotherapy reported significantly reduced functioning and more symptoms up to 2 years after treatment. For patients treated by surgery alone, surgical staging did not seem to affect the quality of life or symptoms to a measurable degree at follow-up. Therefore, subjecting patients to lymph node removal to tailor adjuvant therapy seems justified from the patient's viewpoint; however, efforts should increase to find alternatives to traditional chemotherapy.
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Affiliation(s)
- David Forsse
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Mark L Barbero
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Henrica M J Werner
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Kathrine Woie
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Nina Nordskar
- Department of Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Berge Nilsen
- Department of Obstetrics and Gynecology, Helse Stavanger-Stavanger University Hospital, Stavanger, Norway
| | - Marie Ellstrøm Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway; Faculty Division Akershus University Hospital, University of Oslo
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway; Clinical Institute II, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Astri Rege
- Department of Obstetrics and Gynecology, District General Hospital of Førde, Førde, Norway
| | - Margaret Sævik-Lode
- Department of Obstetrics and Gynecology, Helse Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Stine Andreasen
- Department of Obstetrics and Gynecology, Nordland Hospital, Bodø, Norway
| | - Ingfrid S Haldorsen
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Helse Bergen, Haukeland University Hospital, Bergen, Norway; Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Camilla Krakstad
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
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13
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Hasan FO, Hamilton KP, Angadi SS, Kranz S. Effects of Vinegar/Acetic Acid Intake on Appetite Measures and Energy Consumption: Systematic Review. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022. [DOI: 10.1249/tjx.0000000000000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Ibrahim AH, Abd El Wahab MH, Shash E. Quality of Life and Endometrial Cancer. HANDBOOK OF QUALITY OF LIFE IN CANCER 2022:425-437. [DOI: 10.1007/978-3-030-84702-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Alanazi MT, Alanazi NT, Alfadeel MA, Bugis BA. Sleep deprivation and quality of life among uterine cancer survivors: systematic review. Support Care Cancer 2021; 30:2891-2900. [PMID: 34595604 DOI: 10.1007/s00520-021-06589-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/21/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION While cancer survival might be a relief from a near-death health condition, the after-recovery period also predisposes the survivors to deteriorated quality of life as well as sleep deprivation. Patients with cancer may experience post-traumatic stress disorder (PTSD) throughout the diagnostic process and even after diagnosis is completed, especially when facing the possibility of tumor recurrence. Survivors, in particular, are frequently in a condition of uncertainty due to the 15 to 20% chance of recurrence within 3 years of the main treatment. Despite the high rate of cancer survival, which is believed to be around 83%, assessing quality of life after a cancer diagnosis can help to improve such results. PURPOSE This article aimed to describe the sleep patterns among uterine cancer survivors and verify psychological and physical factors affecting their general qualities of life. According to the qualitative study, uterine cancer survivors who receive treatment, whether pharmaceutical or therapeutic, have a higher quality of life than those who do not. METHOD PRISMA reporting was used for this systematic review. Electronic databases that were searched include PubMed, Cochrane Trial Register, and ScienceDirect for studies evaluating the sleep deprivation and quality of life among uterine cancer survivors. Ten publications were chosen based on inclusion criteria that included uterine cancer survivors who had finished their treatments and addressed sleep quality or overall quality of life. RESULTS The main finding of the systematic review is that 61% of uterine cancer survivors had poor sleep quality, and 81% have a decreased quality of life. CONCLUSION According to the most recent research, uterine cancer survivors suffer from sleep deprivation, which leads to a lower quality of life. However, the same study reveals that uterine cancer survivors suffering with sleep loss use a variety of cognitive behavioral therapy to improve their quality of life. Maintaining a healthy diet, incorporating physical activity into daily routines, receiving cognitive behavior therapy, participating in relevant training programs, and obtaining frequent depression and sexual health screenings are just a few of the CBT mechanisms mentioned.
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Affiliation(s)
| | | | - Mona A Alfadeel
- Department of Community Medicine, Collage of Medicine, Almaarefa University, Riyadh, Saudi Arabia
| | - Bussma Ahmed Bugis
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Dammam, Saudi Arabia
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Collins A, Taylor A, Guttery DS, Moss EL. Innovative Follow-up Strategies for Endometrial Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e383-e392. [PMID: 34172343 DOI: 10.1016/j.clon.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/26/2021] [Accepted: 06/01/2021] [Indexed: 01/22/2023]
Abstract
Increasing recognition of the heterogeneous nature of endometrial cancer, the excellent prognosis of low-risk cases and improvements in risk stratification offer opportunities for innovative, personalised follow-up strategies. This review article outlines the evidence base for alternative follow-up strategies in the different risk categories of endometrial cancer, cancer survivorship programmes and considers future directions in endometrial cancer follow-up, including emerging new techniques, such as the liquid biopsy, and opportunities for combining molecular and clinicopathological features to personalise endometrial cancer follow-up.
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Affiliation(s)
- A Collins
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - A Taylor
- Royal Marsden NHS Foundation Trust, London, UK
| | - D S Guttery
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - E L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK.
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17
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Smrz SA, Calo C, Fisher JL, Salani R. An ecological evaluation of the increasing incidence of endometrial cancer and the obesity epidemic. Am J Obstet Gynecol 2021; 224:506.e1-506.e8. [PMID: 33127429 DOI: 10.1016/j.ajog.2020.10.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The prevalence of obesity has increased significantly in recent decades, particularly among younger women, and is a known risk factor for endometrial cancer. OBJECTIVE This study aimed to evaluate the trend in the prevalence of obesity and the incidence of type I endometrial cancer over time in various age categories to determine whether an ecological relationship exists. STUDY DESIGN Data from the Surveillance, Epidemiology, and End Results Program and the National Health and Nutrition Examination Survey were used. The overall trend in the incidence of type 1 endometrial cancer and prevalence of obesity were observed over time from 1988 to 2016 and further categorized by age group (<45, 45-54, and ≥55 years). RESULTS The prevalence of obesity has increased for all women, but most significantly for women younger than 45 years with a 16.3% increase among women aged 20 to 34 years and a 17.9% increase for women aged 35 to 44 years. The incidence of endometrial cancer has also increased across all age categories, and although it has increased in patients younger than 45 years by more than 14-fold (from <0.1 per 100,000 in 1988 to 1.4 per 100,000 in 2016), a more pronounced increase of 63-fold and 50-fold was observed among women aged 45 to 54 years (0.2 per 100,000 in 1988 to 12.6 per 100,000 in 2016) and women aged 55 years and older (from 0.6 per 100,000 in 1988 to 30 per 100,000 in 2016), respectively. The mean age of women diagnosed as having endometrial cancer also decreased from 64.1 years from 1988 to 1990 to 61.0 years from 2014 to 2016. CONCLUSION The prevalence of obesity has increased significantly in women of all ages. This increase, particularly among women aged <45 years, occurred simultaneously with an increase in the incidence of endometrial cancer in young women, with an even more pronounced increase among women aged ≥45 years.
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Affiliation(s)
- Stacy A Smrz
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH.
| | - Corinne Calo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - James L Fisher
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA
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18
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Saltaouras G, Lightowler H, Coe S, Horne A, Matthews S, Caulfield L, Watson EK. Diet and nutrition in patients who have received pelvic radiotherapy: A mixed-methods study to explore dietary habits, nutritional awareness, and experiences of nutritional care. Nutrition 2021; 89:111309. [PMID: 34166893 DOI: 10.1016/j.nut.2021.111309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Individuals who have survived cancer may benefit from dietary modifications to improve quality of life and future health outcomes. The aim of this study was to explore dietary habits and experiences of nutritional support in patients with a cancer diagnosis who have received radiotherapy to the pelvic area. METHODS A mixed-methods approach was used. Individuals diagnosed with a pelvic cancer (anal, bladder, rectal, and cancers of the reproductive organs), either undergoing or having completed pelvic radiotherapy 6 to 24 mo previously, were invited to participate in a postal survey. A purposive subsample was also invited to take part in telephone interviews. Thematic analysis of interview data was undertaken and integrated with data from quantitative analysis. RESULTS The survey was completed by 254 (38%) respondents. Two-thirds of respondents (170) reported dietary changes since diagnosis; most notable changes were reduction of sugary foods (48%) and alcohol (41%). Receipt of support from the health care team was significantly associated with dietary change (odds ratio, 3.26; 95% confidence interval, 1.58-6.75); however, only 43% (108) had received dietary support from the health care team. Of the respondents, 68% (171) said they would like to receive additional dietary support. The effect of the condition on diet was highlighted in the theme "Impact of diagnosis and treatments on dietary choices." Self-management of disease was influenced by personal resources, social resources, comorbidities and disabilities, influence of work, regaining normality, and barriers to dietary changes. CONCLUSION Lack of routine provision of nutritional care to patients after a cancer diagnosis and patient interest in this area highlighted unmet needs in managing diet-related problems and leading a healthy future lifestyle.
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Affiliation(s)
- Georgios Saltaouras
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK; Oxford School of Nursing and Midwifery, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford, UK.
| | - Helen Lightowler
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Shelly Coe
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Amanda Horne
- Department of Radiotherapy, Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sara Matthews
- Oxford School of Nursing and Midwifery, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford, UK; Department of Radiotherapy, Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Loryn Caulfield
- Department of Radiotherapy, Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eila K Watson
- Oxford School of Nursing and Midwifery, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford, UK
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Ueno T, Watanabe K, Ikemoto T, Matsushita H, Kawanami K, Arai YC, Wakatsuki A. Patient-reported outcomes after surgery among patients with gynecological diseases in Japan. J Psychosom Obstet Gynaecol 2021; 42:22-28. [PMID: 31894721 DOI: 10.1080/0167482x.2019.1708321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study aimed to investigate quality of life (QOL) and psychological distress based on patient-reported outcomes (PROs) after surgery among patients with gynecological diseases in Japan. METHODS We recruited 100 women from patients who underwent gynecological surgery followed by regimens standard for each disease. Subjects completed a questionnaire relating to life interferences, the Hospital Anxiety and Depression Scale (HADS) and the EuroQol 5 Dimension (EQ-5D) questionnaire. We compared differences in PROs between patients with benign tumors (n = 30) and malignant tumors (n = 70), and subsequently examined correlations between PROs after surgery and related variables. RESULTS Although the EQ-5D score was significantly higher in patients with benign tumors compared to those with malignant tumors, this association disappeared after controlling for confounders such as adjuvant therapies. Multiple regression analysis revealed that the number of months after surgery was positively correlated with the EQ-5D score, while the number of chemotherapy series was positively correlated with the number of life interferences. Moreover, the total number of drugs used in chemotherapy was positively correlated with the HADS-depression score and negatively correlated with the EQ-5D score. CONCLUSIONS The QOLs among gynecological cancer survivors may be associated with the chemotherapy and the term after surgery.
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Affiliation(s)
- Taiki Ueno
- Department of Obstetrics and Gynecology, Aichi Medical University, Nagakute, Japan
| | - Kazushi Watanabe
- Department of Obstetrics and Gynecology, Aichi Medical University, Nagakute, Japan
| | - Tatsunori Ikemoto
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan
| | - Hiroshi Matsushita
- Department of Obstetrics and Gynecology, Aichi Medical University, Nagakute, Japan
| | - Katsuhisa Kawanami
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan
| | - Young-Chang Arai
- Multidisciplinary pain center, School of Medicine, Aichi Medical University Nagakute, Nagakute, Japan
| | - Akihiko Wakatsuki
- Department of Obstetrics and Gynecology, Aichi Medical University, Nagakute, Japan
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Zuo Y, Luo BR, Peng WT, Liu XR, He YL, Zhang JJ. Informal caregiver burden and influencing factors in gynaecological oncology patients hospitalized for chemotherapy: a cross-sectional study. J Int Med Res 2020; 48:300060520974927. [PMID: 33259238 PMCID: PMC7711233 DOI: 10.1177/0300060520974927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the level and influencing factors of informal caregiver burden in gynaecological oncology inpatients receiving chemotherapy. METHODS This cross-sectional study enrolled gynaecological oncology patients and their informal caregivers between May 2018 and November 2018 and measured the caregivers' burden using the Caregiver Burden Inventory. The influencing factors were evaluated with univariate regression analysis and multivariate linear stepwise regression analysis. RESULTS A total of 138 patients and their informal caregivers completed the questionnaire. The mean ± SD total informal caregiver burden score was 53.18 ± 10.97. The highest mean ± SD score was recorded in the dimension of time-dependent burden (14.28 ± 2.74), followed by developmental burden (13.65 ± 2.15), physical burden (10.52 ± 2.07), social burden (7.61 ± 2.58) and emotional burden (7.12 ± 1.43). Multivariate analysis showed that the informal caregiver's sex, relationship to the patient, daily duration of care, presence of chronic health problems and the duration of the patient's disease were factors influencing the level of caregiver burden. CONCLUSIONS The informal caregivers of gynaecological cancer patients hospitalized for chemotherapy experience a moderate level of burden. Nursing measures should be considered to reduce informal caregiver burden and improve the quality of lives of both patients and their caregivers.
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Affiliation(s)
- Yan Zuo
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan Province, China
| | - Bi-Ru Luo
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan Province, China
| | - Wen-Tao Peng
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan Province, China
| | - Xin-Ru Liu
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan Province, China
| | - Ya-Lin He
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan Province, China
| | - Jian-Jun Zhang
- Department of Gynaecology and Obstetrics, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan Province, China
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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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22
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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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Inamoto T, Sassa N, Hattori R, Ibuki N, Komura K, Minami K, Takai T, Uchimoto T, Saito K, Tanda N, Tsujino T, Sano T, Kato M, Tsuzuki T, Gotoh M, Azuma H. Influence of the Body Mass Index and its Effect on Tumor Characteristics and Survival among a Population with Access to Surgical Management of Upper Tract Urothelial Carcinoma. Curr Urol 2019; 12:201-209. [PMID: 31602186 DOI: 10.1159/000499305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/29/2018] [Indexed: 01/07/2023] Open
Abstract
Objective To examine the association between the body mass index (BMI) and the risk of survival, and to evaluate whether tumor characteristics differ by BMI in patients with upper tract urothelial carcinoma (UTUC) managed by surgery. Methods A clinical series on 876 patients with localized UTUC following nephroureterectomy with a bladder cuff, with data from Osaka Medical College registry (discovery cohort) and the Nagoya group (validation cohort) was examined. In addition to analyzing the overall survival and cancer-specific survival (CSS), the survival impact adjusted by pathological variables was also assessed by the BMI group. Results The percentage of high risk features including positive lymphovascular invasion was doubled in the discovery cohort compared to the validation cohort. The group of BMI ≥ 25 kg/m<sup>2</sup> was associated with improved CSS in the discovery cohort (p = 0.004), and this tendency was verified in the validation cohort (p = 0.006). Nonproportional hazards existed for the group of BMI ≥ 25 kg/m<sup>2</sup> and the BMI 18.5-25 kg/m<sup>2</sup> relative to the group of BMI < 18.5 kg/m<sup>2</sup>, with a change in the CSS hazard. In multivariable Cox models, the BMI group had a superior predictive value compared with other pre-clinical factors both in the discovery cohort (HR = 3.85, p = 0.01; 95%CI: 0.09-0.73) and the validation cohort (HR = 1.56, p = 0.01; 95%CI: 0.45-0.91). When adjusted by lymphovascular invasion, the concordance of the model proposed by the discovery cohort (0.52) challenged in the validation cohort was 0.59. Conclusions We found a clinically relevant signature for high risk patients with BMI grouping. Further research is necessary on whether tailoring recommendations for weight and nutrition management to tumor characteristics will improve outcomes.
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Affiliation(s)
| | - Naoto Sassa
- Department of Urology, Nagoya University Graduate School of Medicine
| | - Ryohei Hattori
- Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya
| | | | | | | | | | | | | | - Naoki Tanda
- Department of Urology, Osaka Medical College, Osaka
| | | | - Tomoyasu Sano
- Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine
| | | | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine
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24
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Dilator Use After Vaginal Brachytherapy for Endometrial Cancer: A Randomized Feasibility and Adherence Study. Cancer Nurs 2019; 41:200-209. [PMID: 28437283 DOI: 10.1097/ncc.0000000000000500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vaginal brachytherapy, a common treatment of endometrial cancer, is associated with high rates of vaginal stenosis. Recommendations for vaginal dilator use to minimize stenosis generally include 3 times per week for approximately 10 minutes per use. However, adherence rates range widely and are generally well less than 50%. OBJECTIVES The aims of this study were to assess feasibility of recruitment to a study of dilator use and test a theoretically driven enhanced educational program (EEP) to increase adherence. METHODS Eligibility included women treated with postoperative vaginal brachytherapy for stage I to IIIc endometrial cancer. Patients were randomized to either nurse-delivered standard institutional instruction or EEP. RESULTS Of eligible patients, 76% consented, 42 were randomized, and 69% completed the 6-month assessment. Mean age was 58.2 years; 48% were sexually active. There was no difference in adherence between arms. Overall, 20% and 8.3% were adherent to the prescribed use of 3 times per week, and 64% and 16% were adherent to use at least once per week at 6 weeks and 6 months, respectively. Adherence was greater among those motivated by vaginal health and having lower body mass index. Nonadherence was significantly higher among those who are college educated, in the EEP group, and with higher weight. CONCLUSIONS Feasibility of recruitment into a study of vaginal dilator use was high. Adherence was low, and there was no difference between groups. Adherence to vaginal dilator use requires novel interventions to test. IMPLICATIONS FOR PRACTICE Nursing education that includes how dilators may maintain vaginal health may improve use because it was a motivator for adherence in this study.
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25
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Advancing Uterine Cancer Survivorship Among African American Women. J Natl Med Assoc 2018; 110:391-395. [PMID: 30126566 DOI: 10.1016/j.jnma.2017.08.002] [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: 09/23/2016] [Revised: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have examined health behavior interventions for African American women who are uterine cancer survivors. Black-white differences in uterine cancer survival suggest that there are unmet needs among these survivors. METHODS This article identifies opportunities to address disparities in uterine corpus cancer survival and quality of life, and thereby to increase uterine cancer survivorship among African American women. RESULTS For cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, lymphedema, and difficulty sleeping. A variety of interventions have been evaluated to address physical and mental health concerns, including exercise and dietary interventions. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among cancer survivors, but few studies have focused specifically on African American women with a uterine corpus cancer diagnosis. Research-tested culturally tailored lifestyle interventions are lacking. CONCLUSIONS There is a need for a better understanding of uterine cancer survivorship among African American women. Additional evaluations of interventions for improving the quality of life and survival of African American uterine cancer survivors are needed.
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26
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Kalliala I, Markozannes G, Gunter MJ, Paraskevaidis E, Gabra H, Mitra A, Terzidou V, Bennett P, Martin-Hirsch P, Tsilidis KK, Kyrgiou M. Obesity and gynaecological and obstetric conditions: umbrella review of the literature. BMJ 2017; 359:j4511. [PMID: 29074629 PMCID: PMC5656976 DOI: 10.1136/bmj.j4511] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 01/01/2023]
Abstract
Objective To study the strength and validity of associations between adiposity and risk of any type of obstetric or gynaecological conditions.Design An umbrella review of meta-analyses.Data sources PubMed, Cochrane database of systematic reviews, manual screening of references for systematic reviews or meta-analyses of observational and interventional studies evaluating the association between adiposity and risk of any obstetrical or gynaecological outcome.Main outcomes Meta-analyses of cohort studies on associations between indices of adiposity and obstetric and gynaecological outcomes.Data synthesis Evidence from observational studies was graded into strong, highly suggestive, suggestive, or weak based on the significance of the random effects summary estimate and the largest study in the included meta-analysis, the number of cases, heterogeneity between studies, 95% prediction intervals, small study effects, excess significance bias, and sensitivity analysis with credibility ceilings. Interventional meta-analyses were assessed separately.Results 156 meta-analyses of observational studies were included, investigating associations between adiposity and risk of 84 obstetric or gynaecological outcomes. Of the 144 meta-analyses that included cohort studies, only 11 (8%) had strong evidence for eight outcomes: adiposity was associated with a higher risk of endometrial cancer, ovarian cancer, antenatal depression, total and emergency caesarean section, pre-eclampsia, fetal macrosomia, and low Apgar score. The summary effect estimates ranged from 1.21 (95% confidence interval 1.13 to 1.29) for an association between a 0.1 unit increase in waist to hip ratio and risk endometrial cancer up to 4.14 (3.61 to 4.75) for risk of pre-eclampsia for BMI >35 compared with <25. Only three out of these eight outcomes were also assessed in meta-analyses of trials evaluating weight loss interventions. These interventions significantly reduced the risk of caesarean section and pre-eclampsia, whereas there was no evidence of association with fetal macrosomia.Conclusions Although the associations between adiposity and obstetric and gynaecological outcomes have been extensively studied, only a minority were considered strong and without hints of bias.
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Affiliation(s)
- Ilkka Kalliala
- Department of Surgery and Cancer, IRDB, Faculty of Medicine, Imperial College, London W12 0NN, UK
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Finland
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110, Ioannina, Greece
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Hani Gabra
- Department of Surgery and Cancer, IRDB, Faculty of Medicine, Imperial College, London W12 0NN, UK
- Clinical Discovery Unit, Early Clinical Development, AstraZeneca, Cambridge, UK
| | - Anita Mitra
- Department of Surgery and Cancer, IRDB, Faculty of Medicine, Imperial College, London W12 0NN, UK
- West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London W12 0HS, UK
| | - Vasso Terzidou
- Department of Surgery and Cancer, IRDB, Faculty of Medicine, Imperial College, London W12 0NN, UK
- West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London W12 0HS, UK
| | - Phillip Bennett
- Department of Surgery and Cancer, IRDB, Faculty of Medicine, Imperial College, London W12 0NN, UK
- West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London W12 0HS, UK
| | - Pierre Martin-Hirsch
- Department Gynaecologic Oncology, Lancashire Teaching Hospitals, Preston PR29HT, UK
- Department of Biophysics, University of Lancaster, Lancaster, UK
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Maria Kyrgiou
- Department of Surgery and Cancer, IRDB, Faculty of Medicine, Imperial College, London W12 0NN, UK
- West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London W12 0HS, UK
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27
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Disease burden and pain in obese cancer patients with chemotherapy-induced peripheral neuropathy. Support Care Cancer 2017; 25:1873-1879. [PMID: 28124735 DOI: 10.1007/s00520-017-3571-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/09/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) and obesity are prevalent in cancer survivors and decrease quality of life; however, the impact of the co-occurrence of these conditions has garnered little attention. This study investigated differences between obese and non-obese cancer survivors with CIPN and predictors of symptom burden and pain. METHODS Patients with CIPN were administered the MD Anderson Symptom Inventory and a modified version of pain descriptors from the McGill Pain Inventory. Independent t tests assessed group differences between obese and non-obese survivors, and linear regression analyses explored predictors of patient outcomes. RESULTS Results indicated a significant difference in symptom severity scores for obese (M = 32.89, SD = 25.53) versus non-obese (M = 19.35, SD = 16.08) patients (t(37.86) = -2.49, p = .02). Significant differences were also found for a total number of pain descriptors endorsed by obese (M = 4.21, SD = 3.45) versus non-obese (M = 2.42, SD = 2.69) participants (t(74) = -2.53, p = .01). Obesity was a significant predictor of symptom severity and total pain descriptors endorsed. Other significant predictors included age and months since treatment. CONCLUSIONS Cancer survivors with CIPN and co-occurring obesity may be more at risk for decreased quality of life through increased symptom severity and pain compared to non-obese survivors. This paper identified risk factors, including obesity, age, and months since treatment, that can be clinically identified for monitoring distress in CIPN patients. Future research should focus on the longitudinal relationship between obesity and CIPN, and robust interventions to address the multifaceted issues faced by cancer survivors.
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Stukan M, Zalewski K, Mardas M, Filarska D, Szajewski M, Kmieć A, Bińkowska P, Pietrzak-Stukan M, Dudziak M, Grabowski JP, Eskander RN, Greimel E. Independent psychometric validation of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Endometrial Cancer Module (EORTC QLQ-EN24). Eur J Cancer Care (Engl) 2017; 27. [PMID: 28058740 DOI: 10.1111/ecc.12639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 12/19/2022]
Abstract
The endometrial cancer (EC)-specific Quality of Life module of the European Organization for Research and Treatment of Cancer (EORTC QLQ-EN24), was developed and validated in one study. We independently validated and assessed the psychometric properties of the instrument. Two hundred and eight women with EC before surgery, during adjuvant treatment and follow-up; in three different cancer centres completed the EORTC QLQ-C30 and the EN24. The questionnaire's completion rate was 100%, except sexuality items, that were answered by 35% of patients. All item-scale correlations for the multi-item scales exceeded the .4 criterion and correlated well with their own scale, while correlations with the other scales were low. The internal consistency of all multi-item scales were satisfactory (Cronbach's alpha coefficients ranging from .77 to .97). Discriminance for single-item scales was low. The QLQ-EN24 module discriminated well between clinically different patients, and there were no differences in quality of life questionnaire scales between patients with body mass index ≤30 when compared to those with >30. This validation study supports the reliability, as well as convergent and divergent validity of the EORTC QLQ-EN24. The module is a useful instrument for the assessment of QOL in patients with EC. However, data concerning sexuality should be interpreted with caution.
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Affiliation(s)
- M Stukan
- Department of Gynaecologic Oncology, Gdynia Oncology Centre, Gdynia, Poland.,Medicover Outpatient Clinic, Gdańsk, Poland
| | - K Zalewski
- Department of Clinical Oncology, Holycross Cancer Centre, Kielce, Poland.,Clinical Department of Obstetrics, Female Diseases and Gynaecological Oncology, II Medical Faculty, Medical University of Warsaw, Warsaw, Poland
| | - M Mardas
- Department of Human Nutrition and Hygiene, Poznan University of Life Sciences, Poznan, Poland
| | - D Filarska
- Department of Radiotherapy, Gdynia Oncology Centre, Gdynia, Poland
| | - M Szajewski
- Department of Propaedeutics of Oncology, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland.,Department of Surgical Oncology, Gdynia Oncology Centre, Gdynia, Poland
| | - A Kmieć
- Department of Gynaecologic Oncology, Gdynia Oncology Centre, Gdynia, Poland
| | - P Bińkowska
- Department of Medical Oncology, Gdynia Oncology Centre, Gdynia, Poland
| | | | - M Dudziak
- Department of Gynaecologic Oncology, Gdynia Oncology Centre, Gdynia, Poland
| | - J P Grabowski
- Department of Gynaecology, Charite-University of Medicine, Berlin, Germany
| | - R N Eskander
- Department of Obstetrics & Gynaecology, University of California Irvine Medical Centre, Orange, CA, USA
| | - E Greimel
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
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Renehan AG, Harvie M, Cutress RI, Leitzmann M, Pischon T, Howell S, Howell A. How to Manage the Obese Patient With Cancer. J Clin Oncol 2016; 34:4284-4294. [DOI: 10.1200/jco.2016.69.1899] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Obesity (body mass index [BMI] ≥ 30 kg/m2) is common among patients with cancer. We reviewed management issues in the obese patient with cancer, focusing on how obesity influences treatment selection (including chemotherapy dosing), affects chemotherapy toxicity and surgical complications, and might be a treatment effect modifier. Methods The majority of evidence is drawn from observational studies and secondary analyses of trial data, typically analyzed in N × 3 BMI categories (normal weight, overweight, and obese) matrix structures. We propose a methodological framework for interpretation focusing on sample size and composition, nonlinearity, and unmeasured confounding. Results There is a common perception that obesity is associated with increased treatment-related toxicity. Accordingly, cytotoxic chemotherapy dose reduction is common in patients with elevated BMI. Contrary to this, there is some evidence that full dosing in obese patients does not result in increased toxicity. However, these data are from a limited number of regimens, and fail to fully capture cytotoxic drug pharmacodynamics and pharmacokinetic variability in obese patients. Among patients undergoing surgery, there is evidence that elevated BMI is associated with increased perioperative mortality and increased rates of infectious complications. A novel finding is that these relationships hold after surgery for malignancy, but not for benign indications. There are biologic plausibilities that obesity might be an effect modifier of treatment, but supporting evidence from clinical studies is inconsistent. Conclusion In line with the ASCO 2012 guidelines, chemotherapy dosing is probably best performed using actual body weight in obese patients. However, specific regimens known to be associated with increased toxicity in this group should be used with caution. There is no guidance on dose for obese patients treated with biologic agents. Currently, there are no specific recommendations for the surgical management of the obese patient with cancer.
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Affiliation(s)
- Andrew G. Renehan
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Michelle Harvie
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Ramsey I. Cutress
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Michael Leitzmann
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Tobias Pischon
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Sacha Howell
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Anthony Howell
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
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30
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Kawada T. Actigraphic evaluation in patients with endometrial cancer. Gynecol Oncol Rep 2016; 17:12. [PMID: 27354992 PMCID: PMC4899080 DOI: 10.1016/j.gore.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8602, Japan.Department of Hygiene and Public HealthNippon Medical School1-1-5 SendagiBunkyo-KuTokyo113-8602Japan
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31
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McAlpine JN, Temkin SM, Mackay HJ. Endometrial cancer: Not your grandmother's cancer. Cancer 2016; 122:2787-98. [DOI: 10.1002/cncr.30094] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Jessica N. McAlpine
- Department of Gynecology and Obstetrics, Division Gynecologic Oncology; University of British Columbia and British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Sarah M. Temkin
- Kelly Gynecologic Oncology Service, Johns Hopkins School of Medicine; Baltimore Maryland
| | - Helen J. Mackay
- Division of Medical Oncology and Hematology, Faculty of Medicine; University of Toronto, Sunnybrook Odette Cancer Center; Toronto Ontario Canada
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32
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Laskey RA, McCarroll ML, von Gruenigen VE. Obesity-related endometrial cancer: an update on survivorship approaches to reducing cardiovascular death. BJOG 2016; 123:293-8. [PMID: 26841334 DOI: 10.1111/1471-0528.13684] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 12/28/2022]
Abstract
As the rate of obesity increases worldwide, so will the number of women diagnosed with obesity-related malignancy. The strongest correlation between obesity and cancer is endometrial cancer (EC). Obesity is the most significant modifiable risk factor for development of EC and also contributes to the most common cause of death in EC survivors-cardiovascular disease (CVD). Most cancer survivors after diagnosis do not implement lifestyle changes aimed at weight-loss and CVD risk reduction. This selective review highlights recent novel and unique approaches for managing CVD co-morbidities in EC survivorship.
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Affiliation(s)
| | - M L McCarroll
- Summa Health System, Akron, OH, USA.,Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
| | - V E von Gruenigen
- Summa Health System, Akron, OH, USA.,Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
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Beavis AL, Smith AJB, Fader AN. Lifestyle changes and the risk of developing endometrial and ovarian cancers: opportunities for prevention and management. Int J Womens Health 2016; 8:151-67. [PMID: 27284267 PMCID: PMC4883806 DOI: 10.2147/ijwh.s88367] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Modifiable lifestyle factors, such as obesity, lack of physical activity, and smoking, contribute greatly to cancer and chronic disease morbidity and mortality worldwide. This review appraises recent evidence on modifiable lifestyle factors in the prevention of endometrial cancer (EC) and ovarian cancer (OC) as well as new evidence for lifestyle management of EC and OC survivors. For EC, obesity continues to be the strongest risk factor, while new evidence suggests that physical activity, oral contraceptive pills, and bariatric surgery may be protective against EC. Other medications, such as metformin and nonsteroidal anti-inflammatory drugs, may be protective, and interventional research is ongoing. For OC, we find increasing evidence to support the hypothesis that obesity and hormone replacement therapy increase the risk of developing OC. Oral contraceptive pills are protective against OC but are underutilized. Dietary factors such as the Mediterranean diet and alcohol consumption do not seem to affect the risk of either OC or EC. For EC and OC survivors, physical activity and weight loss are associated with improved quality of life. Small interventional trials show promise in increasing physical activity and weight maintenance for EC and OC survivors, although the impact on long-term health, including cancer recurrence and overall mortality, is unknown. Women's health providers should integrate counseling about these modifiable lifestyle factors into both the discussion of prevention for all women and the management of survivors of gynecologic cancers.
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Affiliation(s)
- Anna L Beavis
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Amanda Nickles Fader
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
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34
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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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Quinn GP, Sanchez JA, Sutton SK, Vadaparampil ST, Nguyen GT, Green BL, Kanetsky PA, Schabath MB. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J Clin 2015; 65:384-400. [PMID: 26186412 PMCID: PMC4609168 DOI: 10.3322/caac.21288] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/29/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022] Open
Abstract
This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.
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Affiliation(s)
- Gwendolyn P. Quinn
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Corresponding Author: Gwendolyn P. Quinn, Ph.D, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL 33612, | Fax: 1-813-449-8019
| | - Julian A. Sanchez
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Steven K. Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
| | - Giang T. Nguyen
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - B. Lee Green
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Diversity and Communication Relations, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Peter A. Kanetsky
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Department of Cancer Epidemiology; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Matthew B. Schabath
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Department of Cancer Epidemiology; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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