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Bodelon C, Sung H, Mitchell EL, Deubler EL, Newton CC, Jemal A, Teras LR, Patel AV. Excess Body Weight and the Risk of Second Primary Cancers Among Cancer Survivors. JAMA Netw Open 2024; 7:e2433132. [PMID: 39287946 PMCID: PMC11409156 DOI: 10.1001/jamanetworkopen.2024.33132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Importance Little is known about the causes of second primary cancers among individuals with a history of cancer. Descriptive studies have suggested that lifestyle factors, including excess body weight, may be important. Objective To investigate whether excess body weight is associated with the risk of a second primary malignant neoplasm among cancer survivors. Design, Setting, and Participants This cohort study of adults in 21 states in the US used data from the Cancer Prevention Study II Nutrition cohort, a large prospective study that invited participants to respond to a survey in 1992 and biennial surveys starting in 1997, and who were followed-up through 2017. Eligible participants included those who received a diagnosis of a first primary nonmetastatic invasive cancer between 1992 and 2015. Data analysis occurred from September 2023 to March 2024. Exposure Body mass index (BMI), computed from self-reported height and weight at the time of the first primary cancer diagnosis (mean [SD] years to diagnosis, 1.7 [1.5] years). Main Outcome and Measures Main outcomes included a second primary cancer or an obesity-related second cancer. Cancer diagnoses were reported on biennial surveys and verified through medical record abstraction or linkage with state cancer registries. Results This cohort included 26 894 participants who received a diagnosis of a first nonmetastatic primary cancer (mean [SD] age at first cancer diagnosis, 72.2 [6.5] years; 15 920 male [59.2%]). At the time of first diagnosis, 11 497 participants (42.8%) had overweight and 4684 (17.2%) had obesity. During a median (IQR) follow-up time of 7.9 (3.4-13.6) years, 3749 (13.9%) participants received a diagnosis of a second primary cancer, of which 1243 (33.2%) were obesity-related second primary cancers. Compared with cancer survivors whose BMI was in the normal range (18.5 to <25), there was 15% increased risk of any second primary cancer for those who had overweight (25 to <30; adjusted hazard ratio [aHR], 1.15; 95% CI, 1.07-1.25) and a 34% increased risk for those who had obesity (BMI ≥30; aHR, 1.34; 95% CI, 1.21-1.48), with greater risk for obesity-related second primary cancers, including a 40% increased risk for those with overweight (aHR, 1.40; 95% CI, 1.22,-1.61) and a 78% increased risk for those with obesity (aHR, 1.78; 95% CI, 1.51-2.11). Conclusions and Relevance In this cohort study of older survivors of nonmetastatic cancer, those who had overweight or obesity at the time of their first cancer diagnosis were at higher risk of developing a second cancer, especially an obesity-related second cancer. Given the high prevalence of overweight and obesity among cancer survivors, it is important to promote survivorship care guidelines recommending weight management and increase awareness of second cancers among physicians and cancer survivors.
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Affiliation(s)
- Clara Bodelon
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Hyuna Sung
- Department of Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Ellen L Mitchell
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Emily L Deubler
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Christina C Newton
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Lauren R Teras
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
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Babicki M, Kłoda K, Ledwoch J, Malchrzak W, Janiak S, Krzyżanowski F, Zieliński T, Grabska P, Gajowiak D, Pokorna-Kałwak D, Mastalerz-Migas A. Prevalence of Obesity among Polish Primary Care Population Considered Healthy. Nutrients 2024; 16:2973. [PMID: 39275288 PMCID: PMC11397732 DOI: 10.3390/nu16172973] [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: 07/30/2024] [Revised: 08/27/2024] [Accepted: 08/30/2024] [Indexed: 09/16/2024] Open
Abstract
Obesity is a complex disease with numerous health complications, influenced by factors such as genetics, lifestyle, mental health, societal impact, economic status, comorbidities, and treatments. This multicenter study included adults aged ≥35 years referred to a CVD prevention program, where sociodemographic data, anthropometric examinations, laboratory tests, and HLPCQ responses were collected. The study analyzed 1044 patients with a mean age of 47.9 years. Among them, 22.2% (232 patients) were diagnosed with obesity. These patients exhibited higher blood pressure, non-HDL cholesterol, triglycerides, and glucose levels (all p < 0.001). A comparative analysis showed that obese patients had significantly lower scores in healthy dietary choices, dietary harm avoidance, daily routine, organized physical exercise, and overall HLPCQ scores. These results indicate that individuals considered healthy were actually living with obesity and its associated complications. Consequently, family physicians should proactively identify patients at risk of obesity using existing programs. The Polish healthcare system urgently needs systemic solutions, including effective health promotion and the creation of obesity prevention programs at an early stage of adult life. These measures are essential to address the growing obesity epidemic and improve public health outcomes.
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Affiliation(s)
- Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | | | | | - Wojciech Malchrzak
- Department of Family Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Sandra Janiak
- Department of Family Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Filip Krzyżanowski
- Department of Family Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Tomasz Zieliński
- NZOZ PROMED A. Szendała, T. Zieliński Lekarze Sp. p., 23-145 Wysokie, Poland
| | - Patrycja Grabska
- Przychodnia Lekarska Rodzina Jerzy Rajewski Sp. j., 86-008 Koronowo, Poland
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3
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Kitahara CM. Excess Weight and Risk of Second Cancers Among Cancer Survivors-Sounding the Alarm on Future Trends. JAMA Netw Open 2024; 7:e2433122. [PMID: 39287951 DOI: 10.1001/jamanetworkopen.2024.33122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Affiliation(s)
- Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Kumar S, Blandon C, Sikorskii A, Kaplan DE, Mehta SJ, Su GL, Goldberg DS, Crane TE. Investigating the Obesity Paradox in Colorectal Cancer: An Analysis of Prospectively Collected Data in a Diverse Cohort. Cancers (Basel) 2024; 16:2950. [PMID: 39272808 PMCID: PMC11394385 DOI: 10.3390/cancers16172950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/14/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Prior studies are inconclusive regarding the effect of obesity on mortality in persons with colorectal cancer (CRC). We sought to determine the association of pre-diagnosis body mass index (BMI) trajectories on mortality after CRC diagnosis. METHODS Utilizing the Multiethnic Cohort, we included adults aged 18-75 between 1 January 1993 and 1 January 2019 with a diagnosis of CRC and at least three available BMIs. The primary exposure, BMI, was subjected to group-based trajectory modeling (GBTM). We evaluated all-cause and CRC-specific mortality, using Cox proportional hazard (PH) models. RESULTS Of 924 persons, the median age was 60 years, and 54% were female. There was no statistically significant association between pre-cancer BMI trajectory and either all-cause or cancer-specific mortality. In competing risk analysis, the risk of CRC-specific mortality was higher for African Americans (HR = 1.56, 95% CI [1.00-2.43], p = 0.048) and smokers (HR = 1.59, 95% CI [1.10-2.32], p = 0.015). Risk of all-cause mortality was higher for Hawaiian persons (HR = 2.85, 95% CI [1.31-6.21], p = 0.009) and persons with diabetes (HR = 1.83, 95% CI [1.08-3.10], p = 0.026). CONCLUSIONS Pre-diagnosis BMI trajectories were not associated with mortality after CRC diagnosis, whereas race/ethnicity, diabetes, and smoking were associated with an increased risk of death. Our findings suggest the obesity paradox alone does not account for mortality after CRC diagnosis.
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Affiliation(s)
- Shria Kumar
- Division of Digestive Health and Liver Diseases, Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA
| | - Catherine Blandon
- Division of Digestive Health and Liver Diseases, Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, MI 48824, USA
| | - David E Kaplan
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Shivan J Mehta
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Grace L Su
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, USA
- Medicine Service, Lieutenant Colonel Charles S. Kettles VA Medical Center, Ann Arbor, MI 48105, USA
| | - David S Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA
| | - Tracy E Crane
- Sylvester Comprehensive Cancer Center, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA
- Division of Medical Oncology, Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL 33136, USA
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Markozannes G, Becerra-Tomás N, Cariolou M, Balducci K, Vieira R, Kiss S, Aune D, Greenwood DC, Gunter MJ, Copson E, Renehan AG, Bours M, Demark-Wahnefried W, Hudson MM, May AM, Odedina FT, Skinner R, Steindorf K, Tjønneland A, Velikova G, Baskin ML, Chowdhury R, Hill L, Lewis SJ, Seidell J, Weijenberg MP, Krebs J, Cross AJ, Tsilidis KK, Chan DSM. Post-diagnosis physical activity and sedentary behaviour and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2024; 155:426-444. [PMID: 38692650 DOI: 10.1002/ijc.34903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024]
Abstract
Low physical activity and high sedentary behaviour have been clearly linked with colorectal cancer development, yet data on their potential role in colorectal cancer survival is limited. Better characterisation of these relationships is needed for the development of post-diagnosis physical activity and sedentary behaviour guidance for colorectal cancer survivors. We searched PubMed and Embase through 28 February 2022 for studies assessing post-diagnosis physical activity, and/or sedentary behaviour in relation to all-cause and cause-specific mortality and recurrence after colorectal cancer diagnosis. Total and recreational physical activity were assessed overall and by frequency, duration, intensity, and volume using categorical, linear, and non-linear dose-response random-effects meta-analyses. The Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel interpreted and graded the likelihood of causality. We identified 16 observational studies on 82,220 non-overlapping patients from six countries. Physical activity was consistently inversely associated with colorectal cancer morbidity and mortality outcomes, with 13%-60% estimated reductions in risk. Sedentary behaviour was positively associated with all-cause mortality. The evidence had methodological limitations including potential confounding, selection bias and reverse causation, coupled with a limited number of studies for most associations. The CUP Global Expert panel concluded limited-suggestive evidence for recreational physical activity with all-cause mortality and cancer recurrence. Total physical activity and its specific domains and dimensions, and sedentary behaviour were all graded as limited-no conclusion for all outcomes. Future research should focus on randomised trials, while observational studies should obtain objective and repeated physical activity measures and better adjustment for confounders.
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Affiliation(s)
- Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Nerea Becerra-Tomás
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sonia Kiss
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martijn Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Rajiv Chowdhury
- Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Lynette Hill
- World Cancer Research Fund International, London, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jaap Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - John Krebs
- Department of Biology, University of Oxford, Oxford, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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6
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Koivisto HAM, Nevala AO, Miettinen JM, Pitkäniemi JM, Malila NK, Heikkinen SMM. Relative risk of second malignant neoplasms highest among young adult cancer patients - a population-based registry study in Finland. Acta Oncol 2024; 63:418-425. [PMID: 38850051 PMCID: PMC11332513 DOI: 10.2340/1651-226x.2024.34138] [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: 12/04/2023] [Accepted: 04/05/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE The objective of this study was to explore the incidence of second malignant neoplasms (SMNs) among adult cancer patients in Finland diagnosed with their first primary cancer (FPC) in 1992-2021. MATERIAL AND METHODS The study used data from the population-based Finnish Cancer Registry (FCR). Risk estimates were calculated using the standardised incidence ratio (SIR), the ratio of observed second cancers compared to the expected numbers assuming the same cancer incidence as the corresponding sex-age-calendar year -split of the general population. RESULTS A total of 573,379 FPCs were diagnosed during 1992-2021. During the follow-up, 60,464 SMNs were diagnosed. Male cancer patients had neither a decreased nor an increased risk (SIR 1.00 [95% CI, 0.99-1.01]) and female patients had an 8% increased risk (SIR 1.08 [95% CI, 1.06-1.09]) of developing any SMN compared to a FPC in the general population. The highest SIR of any SMN was observed in patients aged 20-39 -years at FPC diagnosis, and the SIR decreased by increasing age at diagnosis. Patients with lymphoid and haematopoietic tissue neoplasms, cancers of the mouth and pharynx, endocrine glands, respiratory and intrathoracic organs, skin, and urinary organs had the highest SIRs, while patients with cancers of the male genital organs and the female breast had the lowest SIRs. INTERPRETATION Elevated SIRs were observed in cancer patients diagnosed at an early age and for FPCs known to be in large part attributable to lifestyle factors, which highlights the importance of monitoring and encouraging lifestyle changes.
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Affiliation(s)
| | - Aapeli O Nevala
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | | | - Janne M Pitkäniemi
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland; Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Nea K Malila
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
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Liu L, Ji J, Ge X, Ji Z, Li J, Wu J, Zhu J, Yao J, Zhu F, Mao B, Cao Z, Zhou J, Miao L, Ji G, Hang D. Prognostic value of tumor deposits and positive lymph node ratio in stage III colorectal cancer: a retrospective cohort study. Int J Surg 2024; 110:3470-3479. [PMID: 38498367 PMCID: PMC11175780 DOI: 10.1097/js9.0000000000001295] [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: 09/05/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND In colorectal cancer (CRC), tumor deposits (TD) have been used to guide the N staging only in node-negative patients. It remains unknown about the prognostic value of TD in combination with positive lymph node ratio (LNR) in stage III CRC. PATIENTS AND METHODS The authors analyzed data from 31 139 eligible patients diagnosed with stage III CRC, including 30 230 from the Surveillance, Epidemiology, and End Results (SEER) database as a training set and 909 from two Chinese hospitals as a validation set. The associations of TD and LNR with cancer-specific survival (CSS) and overall survival (OS) were evaluated using the Kaplan-Meier method and Cox regression models. RESULTS Both TD-positive and high LNR (value ≥0.4) were associated with worse CSS in the training [multivariable hazard ratio (HR), 1.50; 95% CI: 1.43-1.58 and HR, 1.74; 95% CI: 1.62-1.86, respectively] and validation sets (HR, 1.90; 95% CI: 1.41-2.54 and HR, 2.01; 95% CI: 1.29-3.15, respectively). Compared to patients with TD-negative and low LNR (value<0.4), those with TD-positive and high LNR had a 4.09-fold risk of CRC-specific death in the training set (HR, 4.09; 95% CI: 3.54-4.72) and 4.60-fold risk in the validation set (HR, 4.60; 95% CI: 2.88-7.35). Patients with TD-positive/H-LNR CRC on the right side had the worst prognosis ( P <0.001). The combined variable of TD and LNR contributed the most to CSS prediction in the training (24.26%) and validation (32.31%) sets. A nomogram including TD and LNR showed satisfactory discriminative ability, and calibration curves indicated favorable consistency in both the training and validation sets. CONCLUSIONS TD and LNR represent independent prognostic predictors for stage III CRC. A combination of TD and LNR could be used to identify those at high-risk of CRC deaths.
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Affiliation(s)
- Lei Liu
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
- Department of Gastroenterology, The Affiliated Yixing Hospital of Jiangsu University, Yixing
| | - Jie Ji
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Xianxiu Ge
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
| | - Zuhong Ji
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
| | - Jiacong Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing
| | - Jie Wu
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
| | - Juntao Zhu
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
| | - Jianan Yao
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
| | - Fangyu Zhu
- Department of Non-Communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention
| | - Boneng Mao
- Department of Gastroenterology, The Affiliated Yixing Hospital of Jiangsu University, Yixing
| | - Zhihong Cao
- Department of Gastroenterology, The Affiliated Yixing Hospital of Jiangsu University, Yixing
| | - Jinyi Zhou
- Department of Non-Communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention
| | - Lin Miao
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
| | - Guozhong Ji
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University
| | - Dong Hang
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine and China International Cooperation Center for Environment and Human Health, Gusu School
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing
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8
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Hufstedler H, Mauer N, Yeboah E, Carr S, Rahman S, Danzer AM, Debray TPA, de Jong VMT, Campbell H, Gustafson P, Maxwell L, Jaenisch T, Matthay EC, Bärnighausen T. Application of causal inference methods in individual-participant data meta-analyses in medicine: addressing data handling and reporting gaps with new proposed reporting guidelines. BMC Med Res Methodol 2024; 24:91. [PMID: 38641771 PMCID: PMC11027270 DOI: 10.1186/s12874-024-02210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/28/2024] [Indexed: 04/21/2024] Open
Abstract
Observational data provide invaluable real-world information in medicine, but certain methodological considerations are required to derive causal estimates. In this systematic review, we evaluated the methodology and reporting quality of individual-level patient data meta-analyses (IPD-MAs) conducted with non-randomized exposures, published in 2009, 2014, and 2019 that sought to estimate a causal relationship in medicine. We screened over 16,000 titles and abstracts, reviewed 45 full-text articles out of the 167 deemed potentially eligible, and included 29 into the analysis. Unfortunately, we found that causal methodologies were rarely implemented, and reporting was generally poor across studies. Specifically, only three of the 29 articles used quasi-experimental methods, and no study used G-methods to adjust for time-varying confounding. To address these issues, we propose stronger collaborations between physicians and methodologists to ensure that causal methodologies are properly implemented in IPD-MAs. In addition, we put forward a suggested checklist of reporting guidelines for IPD-MAs that utilize causal methods. This checklist could improve reporting thereby potentially enhancing the quality and trustworthiness of IPD-MAs, which can be considered one of the most valuable sources of evidence for health policy.
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Affiliation(s)
- Heather Hufstedler
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
| | - Nicole Mauer
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Edmund Yeboah
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sinclair Carr
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sabahat Rahman
- University of Massachusetts Medical School, University of Massachusetts, Worcester, USA, MA
| | - Alexander M Danzer
- KU Eichstätt-Ingolstadt, Ingolstadt School of Management and Economics (WFI), Ingolstadt, Germany
- IZA, Bonn, Germany
- CESifo, Munich, Germany
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Smart Data Analysis and Statistics B.V, Utrecht, The Netherlands
| | - Valentijn M T de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Harlan Campbell
- Department of Statistics, University of British Columbia, Vancouver, Canada, BC
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, Canada, BC
| | - Lauren Maxwell
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Center for Global Health, Colorado School of Public Health, Aurora, USA, CO
- Department of Epidemiology, Colorado School of Public Health, Aurora, USA
| | - Ellicott C Matthay
- Department of Population Health, New York University Grossman School of Medicine, New York City, USA, NY
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard T H Chan School of Public Health, Harvard University, Boston, USA, MA
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Behrooz AB, Cordani M, Fiore A, Donadelli M, Gordon JW, Klionsky DJ, Ghavami S. The obesity-autophagy-cancer axis: Mechanistic insights and therapeutic perspectives. Semin Cancer Biol 2024; 99:24-44. [PMID: 38309540 DOI: 10.1016/j.semcancer.2024.01.003] [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: 09/20/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
Autophagy, a self-degradative process vital for cellular homeostasis, plays a significant role in adipose tissue metabolism and tumorigenesis. This review aims to elucidate the complex interplay between autophagy, obesity, and cancer development, with a specific emphasis on how obesity-driven changes affect the regulation of autophagy and subsequent implications for cancer risk. The burgeoning epidemic of obesity underscores the relevance of this research, particularly given the established links between obesity, autophagy, and various cancers. Our exploration delves into hormonal influence, notably INS (insulin) and LEP (leptin), on obesity and autophagy interactions. Further, we draw attention to the latest findings on molecular factors linking obesity to cancer, including hormonal changes, altered metabolism, and secretory autophagy. We posit that targeting autophagy modulation may offer a potent therapeutic approach for obesity-associated cancer, pointing to promising advancements in nanocarrier-based targeted therapies for autophagy modulation. However, we also recognize the challenges inherent to these approaches, particularly concerning their precision, control, and the dual roles autophagy can play in cancer. Future research directions include identifying novel biomarkers, refining targeted therapies, and harmonizing these approaches with precision medicine principles, thereby contributing to a more personalized, effective treatment paradigm for obesity-mediated cancer.
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Affiliation(s)
- Amir Barzegar Behrooz
- Department of Human Anatomy and Cell Science, University of Manitoba, College of Medicine, Winnipeg, Manitoba, Canada; Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marco Cordani
- Department of Biochemistry and Molecular Biology, School of Biology, Complutense University, Madrid, Spain; Instituto de Investigaciones Sanitarias San Carlos (IdISSC), Madrid, Spain
| | - Alessandra Fiore
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Biochemistry, University of Verona, Verona, Italy
| | - Massimo Donadelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Biochemistry, University of Verona, Verona, Italy
| | - Joseph W Gordon
- Department of Human Anatomy and Cell Science, University of Manitoba, College of Medicine, Winnipeg, Manitoba, Canada; Children Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Daniel J Klionsky
- Life Sciences Institute and Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Saeid Ghavami
- Life Sciences Institute and Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA; Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800 Zabrze, Poland; Research Institute of Oncology and Hematology, Cancer Care Manitoba-University of Manitoba, Winnipeg, Manitoba, Canada; Children Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada.
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10
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Chan H, Savoie MB, Munir A, Moslehi J, Anwar M, Laffan A, Rowen T, Salmon R, Varma M, Van Loon K. Multi-Disciplinary Management in Rectal Cancer Survivorship: A Clinical Practice Review. J Gastrointest Cancer 2023; 54:1102-1115. [PMID: 36622517 PMCID: PMC10754749 DOI: 10.1007/s12029-022-00885-1] [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] [Accepted: 11/11/2022] [Indexed: 01/10/2023]
Abstract
Colorectal cancer (CRC) is the third most common cancer in the USA and worldwide. In the USA, nearly one-third of CRC cases are anatomically classified as rectal cancer. Over the past few decades, continued refinement of multimodality treatment and the introduction of new therapeutic agents have enhanced curative treatment rates and quality of life outcomes. As treatments improve and the incidence of young onset rectal cancer rises, the number of rectal cancer survivors grows each year. This trend highlights the growing importance of rectal cancer survivorship. Multimodality therapy with systemic chemotherapy, chemoradiation, and surgery can result in chronic toxicities in multiple organ systems, requiring a multi-disciplinary care model with services ranging from appropriate cancer surveillance to management of long-term toxicities and optimization of modifiable risk factors. Here, we review the evidence on these long-term toxicities and provide management considerations from consensus guidelines. Specific topics include bowel dysfunction from radiation and surgery, oxaliplatin-induced neuropathy, accelerated bone degeneration, the impact of fluoropyrimidines on long-term cardiovascular health, urinary incontinence, sexual dysfunction, and psychosocial distress. Additionally, we review modifiable risk factors to inform providers and rectal cancer survivors of various lifestyle and behavioral changes that can be made to improve their long-term health outcomes.
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Affiliation(s)
- Hilary Chan
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco (UCSF), 550 16th Street, Floor 06, Room 6803, Box 3211, San Francisco, CA, 94158, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Marissa B Savoie
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Amir Munir
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, UCSF, San Francisco, CA, USA
| | - Javid Moslehi
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, UCSF, San Francisco, CA, USA
| | - Mekhail Anwar
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Radiation Oncology, UCSF, San Francisco, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Angela Laffan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Tami Rowen
- Department of Obstetrics and Gynecology, UCSF, San Francisco, CA, USA
| | - Rebeca Salmon
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Madhulika Varma
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Section of Colorectal Surgery, Department of Surgery, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Katherine Van Loon
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco (UCSF), 550 16th Street, Floor 06, Room 6803, Box 3211, San Francisco, CA, 94158, USA.
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
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11
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Abstract
Obesity has been recognized to be increasing globally and is designated a disease with adverse consequences requiring early detection and appropriate care. In addition to being related to metabolic syndrome disorders such as type 2 diabetes, hypertension, stroke, and premature coronary artery disease. Obesity is also etiologically linked to several cancers. The non-gastrointestinal cancers are breast, uterus, kidneys, ovaries, thyroid, meningioma, and thyroid. Gastrointestinal (GI) cancers are adenocarcinoma of the esophagus, liver, pancreas, gallbladder, and colorectal. The brighter side of the problem is that being overweight and obese and cigarette smoking are mostly preventable causes of cancers. Epidemiology and clinical studies have revealed that obesity is heterogeneous in clinical manifestations. In clinical practice, BMI is calculated by dividing a person's weight in kilograms by the square of the person's height in square meters (kg/m2). A BMI above 30 kg/m2 (defining obesity in many guidelines) is considered obesity. However, obesity is heterogeneous. There are subdivisions for obesity, and not all obesities are equally pathogenic. Adipose tissue, in particular, visceral adipose tissue (VAT), is endocrine and abdominal obesity (a surrogate for VAT) is evaluated by waist-hip measurements or just waist measures. Visceral Obesity, through several hormonal mechanisms, induces a low-grade chronic inflammatory state, insulin resistance, components of metabolic syndrome, and cancers. Metabolically obese, normal-weight (MONW) individuals in several Asian countries may have BMI below normal levels to diagnose obesity but suffer from many obesity-related complications. Conversely, some people have high BMI but are generally healthy with no features of metabolic syndrome. Many clinicians advise weight loss by dieting and exercise to metabolically healthy obese with large body habitus than to individuals with metabolic obesity but normal BMI. The GI cancers (esophagus, pancreas, gallbladder, liver, and colorectal) are individually discussed, emphasizing the incidence, possible pathogenesis, and preventive measures. From 2005 to 2014, most cancers associated with overweight and Obesity increased in the United States, while cancers related to other factors decreased. The standard recommendation is to offer or refer adults with a body mass index (BMI) of 30 or more to intensive, multicomponent behavioral interventions. However, the clinicians have to go beyond. They should critically evaluate BMI with due consideration for ethnicity, body habitus, and other factors that influence the type of obesity and obesity-related risks. In 2001, the Surgeon General's ``Call to Action to Prevent and Decrease Overweight and Obesity'' identified obesity as a critical public health priority for the United States. At government levels reducing obesity requires policy changes that improve the food and physical activity for all. However, implementing some policies with the most significant potential benefit to public health is politically tricky. The primary care physician, as well as subspecialists, should identify overweight and Obesity based on all the variable factors in the diagnosis. The medical community should address the prevention of overweight and Obesity as an essential part of medical care as much as vaccination in preventing infectious diseases at all levels- from childhood, to adolescence, and adults.
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Affiliation(s)
- Yuntao Zou
- Department of Medicine, Saint Peter's University Hospital, 125 Andover DR, Kendall Park, New Brunswick, NJ 08901, USA
| | - Capecomorin S Pitchumoni
- Department of Medicine, Saint Peter's University Hospital, 125 Andover DR, Kendall Park, New Brunswick, NJ 08901, USA.
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12
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Liang LA, Tseng YJ, Tanaka LF, Klug SJ. Second primary cancer among 217702 colorectal cancer survivors: An analysis of national German cancer registry data. Int J Cancer 2023; 153:1459-1471. [PMID: 37392091 DOI: 10.1002/ijc.34638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/02/2023]
Abstract
With improvements in survival after colorectal cancer (CRC), more survivors are at risk of developing a second cancer, particularly in younger populations where CRC incidence is increasing. We estimated the incidence of second primary cancer (SPC) in CRC survivors and its potential risk factors. We identified CRC cases diagnosed between 1990 and 2011 and SPCs until 2013 from nine German cancer registries. Standardized incidence ratios (SIR) and absolute excess risk (AER) per 10 000 person-years were calculated and were stratified by index site: colon cancer (CC) and rectal cancer (RC), age and sex. Cox regression assessed potential SPC risk factors, including primary tumor-related therapy considering death as a competing risk. We included 217 202 primary CRC cases. SPC occurred in 18 751 CRC survivors (8.6%; median age: 69 years). Risk of cancer was significantly higher in CRC survivors than in the general population (SIR males 1.14, 95% confidence interval [CI] 1.12-1.17, AER = 24.7; SIR females 1.20, 95% CI 1.17-1.23, AER = 22.8). Increased risks of SPCs were observed for the digestive system, urinary system and female and male reproductive organs. CRC incidence increased in younger persons (<50 years) and SPC incidence was 4-fold in this group (SIR males 4.51, 95% CI 4.04-5.01, AER = 64.2; SIR females 4.03, 95% CI 3.62-4.48, AER = 77.0). Primary tumor-related factors associated with SPC risk were right-sided cancer and smaller primary tumor size. Treatment and risk of SPC differed for CC (no effect) and RC (lower risk after chemotherapy). CRC survivors have excess risk of developing SPC, with particular characteristics that could guide targeted surveillance.
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Affiliation(s)
- Linda A Liang
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Ying-Ju Tseng
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Luana F Tanaka
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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13
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Kang X, Ng SK, Liu C, Lin Y, Zhou Y, Kwong TNY, Ni Y, Lam TYT, Wu WKK, Wei H, Sung JJY, Yu J, Wong SH. Altered gut microbiota of obesity subjects promotes colorectal carcinogenesis in mice. EBioMedicine 2023; 93:104670. [PMID: 37343363 DOI: 10.1016/j.ebiom.2023.104670] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Obesity is a risk factor for colorectal cancer (CRC). The role of gut microbiota in mediating the cancer-promoting effect of obesity is unknown. METHODS Azoxymethane (AOM)-treated, ApcMin/+ and germ-free mice were gavaged with feces from obese individuals and control subjects respectively. The colonic tumor load and number were recorded at the endpoint in two carcinogenic models. The gut microbiota composition and colonic transcriptome were assessed by metagenomic sequencing and RNA sequencing, respectively. The anticancer effects of bacteria depleted in fecal samples of obese individuals were validated. FINDINGS Conventional AOM-treated and ApcMin/+ mice receiving feces from obese individuals showed significantly increased colon tumor formation compared with those receiving feces from control subjects. AOM-treated mice receiving feces from obese individuals showed impaired intestinal barrier function and significant upregulation of pro-inflammatory cytokines and activation of oncogenic Wnt signaling pathway. Consistently, transferring feces from obese individuals to germ-free mice led to increased colonic cell proliferation, intestinal barrier function impairment, and induction of oncogenic and proinflammatory gene expression. Moreover, germ-free mice transplanted with feces from obese human donors had increased abundance of potential pathobiont Alistipes finegoldii, and reduced abundance of commensals Bacteroides vulgatus and Akkermansia muciniphila compared with those receiving feces from human donors with normal body mass index (BMI). Validation experiments showed that B. vulgatus and A. muciniphila demonstrated anti-proliferative effects in CRC, while A. finegoldii promoted CRC tumor growth. INTERPRETATION Our results supported the role of obesity-associated microbiota in colorectal carcinogenesis and identified putative bacterial candidates that may mediate its mechanisms. Microbiota modulation in obese individuals may provide new approaches to prevent or treat obesity-related cancers including CRC. FUNDING This work was funded by National Key Research and Development Program of China (2020YFA0509200/2020YFA0509203), National Natural Science Foundation of China (81922082), RGC Theme-based Research Scheme Hong Kong (T21-705/20-N), RGC Research Impact Fund Hong Kong (R4632-21F), RGC-CRF Hong Kong (C4039-19GF and C7065-18GF), RGC-GRF Hong Kong (14110819, 14111621), and NTU Start-Up Grant (021337-00001).
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Affiliation(s)
- Xing Kang
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siu-Kin Ng
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Changan Liu
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yufeng Lin
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yunfei Zhou
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas N Y Kwong
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yunbi Ni
- Department of Anatomical and Cellular Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Y T Lam
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - William K K Wu
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Hong Wei
- Department of Laboratory Animal Science, College of Basic Medical Sciences, Third Military Medical University, Chongqing, China; Department of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Jun Yu
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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14
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Takeda FR, Sallum RAA, Ribeiro U, Cecconello I. Laparoscopic transhiatal esophagectomy in esophageal cancer patients with high-risk post-operative complications. Dis Esophagus 2022; 35:6231772. [PMID: 33870430 DOI: 10.1093/dote/doab022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/17/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022]
Abstract
Surgical treatment of esophageal cancer is challenging, due to considerable morbidity, especially in high surgical risk patients. While transhiatal esophagectomy leads to good oncological outcomes and reduced postoperative complications, less invasive techniques might further improve outcomes. Our goal was to compare results of laparoscopic transhiatal esophagectomy (LTE) with open transhiatal esophagectomy (OTE) in esophageal cancer patients at high surgical risk. From 2014 to 2020, 128 patients were identified. Seventy received OTE while 51 received LTE. After propensity score matching (1:1), postoperative complications, analysis of overall and disease-free survival, and survival-related prognostic factors were assessed in two groups of 48 patients. Ninety-one (77%) patients were men with a mean age of 65 ± 10.3 years. Those who underwent OTE experienced more clinical and surgical complications. In LTE patients, the number of mean resected lymph nodes was 25.9, and in patients who had OTE, it was 17.4 (P < 0.001). Overall survival was 56.0% in the LTE group and 33.6% (P = 0.023) in the OTE group. In multivariable analysis of overall survival, open surgery and incomplete pathological response were seen as worse negative factors. In multivariable analysis, metastatic lymph nodes, incomplete pathologic response, surgical complications, and a Charlson's index > 2 (P = 0.014) were associated with poor prognosis. Both surgical methods are safe with similar morbidity and mortality; however, LTE was associated with fewer complications, a higher number of resected lymph nodes, better overall survival, and more prognostic factors related to global and disease-free overall survival in high-risk patients.
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Affiliation(s)
- Flavio Roberto Takeda
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rubens Antonio Aissar Sallum
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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15
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de Winter J, Ezendam NPM, Bours MJL, Winkels RM, Weijenberg MP, Kampman E, Vissers PAJ, Mols F, Beijer S. Is sleep associated with BMI, waist circumference, and diet among long-term colorectal cancer survivors? Results from the population-based PROFILES registry. Support Care Cancer 2021; 29:7225-7235. [PMID: 34228174 DOI: 10.1007/s00520-021-06393-5] [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: 02/25/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE In the general population, poor sleep quality and short sleep duration are associated with a higher body mass index (BMI) and waist circumference (WC), and an unhealthy diet. The aim of this study was to assess if the association between sleep quality and duration and BMI, WC, and diet quality also exists among colorectal cancer (CRC) survivors, as many CRC survivors have an unhealthy weight and diet. METHODS Cross-sectional data from a longitudinal CRC cohort were used. In this study, survivors were 4-13 years post diagnosis. The Pittsburgh Sleep Quality Index (PSQI) was used to assess both sleep quality and sleep duration. Diet quality was assessed by scoring adherence (low, moderate, high) to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations of five food groups and nutrients: fruit and vegetables, dietary fiber, red and processed meat, alcoholic beverages, and sugary drinks, using a brief diet screener. BMI and WC were self-measured. Associations were analyzed by multivariable linear and multinomial logistic regression analyses. RESULTS Among 1002 CRC survivors, 23% reported poor sleep quality (PSQI score ≥ 8) and 24% reported short sleep duration (≤ 6 h). No associations between sleep and BMI, WC, and diet quality were found. CONCLUSION Sleep problems are common in long-term CRC survivors; however, sleep quality and duration was not associated with BMI, WC, and diet quality in this population. It is unknown why the results differ from findings in the general population.
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Affiliation(s)
- Janne de Winter
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Nicole P M Ezendam
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Matty P Weijenberg
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Floortje Mols
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Sandra Beijer
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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16
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Feigelson HS, Bodelon C, Powers JD, Curtis RE, Buist DSM, Veiga LHS, Bowles EJA, Berrington de Gonzalez A, Gierach GL. Body Mass Index and Risk of Second Cancer Among Women With Breast Cancer. J Natl Cancer Inst 2021; 113:1156-1160. [PMID: 33823007 PMCID: PMC8757319 DOI: 10.1093/jnci/djab053] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/08/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Breast cancer survivors are at increased risk for developing second primary cancers compared with the general population. Little is known about whether body mass index (BMI) increases this risk. We examined the association between BMI and second cancers among women with incident invasive breast cancer. METHODS This retrospective cohort included 6481 patients from Kaiser Permanente Colorado and Washington of whom 822 (12.7%) developed a second cancer (mean follow-up was 88.0 months). BMI at the first cancer was extracted from the medical record. Outcomes included: 1) all second cancers, 2) obesity-related second cancers, 3) any second breast cancer, and 4) estrogen receptor-positive second breast cancers. Multivariable Poisson regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for second cancers associated with BMI adjusted for site, diagnosis year, treatment, demographic, and tumor characteristics. RESULTS The mean age at initial breast cancer diagnosis was 61.2 (SD = 11.8) years. Most cases were overweight (33.4%) or obese (33.8%) and diagnosed at stage I (62.0%). In multivariable models, for every 5 kg/m2 increase in BMI, the risk of any second cancer diagnosis increased by 7% (RR = 1.07, 95% CI = 1.01 to 1.14); 13% (RR = 1.13, 95% CI = 1.05 to 1.21) for obesity-related cancers, 11% (RR = 1.11, 95% CI = 1.02 to 1.21) for a second breast cancer, and 15% (RR = 1.15, 95% CI = 1.04 to 1.27) for a second estrogen receptor-positive breast cancer. CONCLUSIONS We observed a statistically significant increased risk of second cancers associated with increasing BMI. These findings have important public health implications given the prevalence of overweight and obesity in breast cancer survivors and underscore the need for effective prevention strategies.
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Affiliation(s)
- Heather Spencer Feigelson
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA,Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA,Correspondence to: Heather Spencer Feigelson, PhD, MPH, Kaiser Permanente, Institute for Health Research, 2550 S. Parker Rd, Ste 200, Aurora, CO 80014, USA (e-mail: )
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - J David Powers
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
| | - Rochelle E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Diana S M Buist
- Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA,Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Gretchen L Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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17
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Wu M, Huang M, He C, Chen C, Li H, Wang J, Liu M, Fu G, Lei Z, Chu X. Risk of Second Primary Malignancies Based on the Histological Subtypes of Colorectal Cancer. Front Oncol 2021; 11:650937. [PMID: 33777813 PMCID: PMC7988191 DOI: 10.3389/fonc.2021.650937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/15/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Previous studies have revealed an increased risk of second primary malignancies (SPMs) after colorectal cancer (CRC); however, no previous investigation has quantified differences in the risk of SPMs based on the histological subtypes of first primary CRC. Methods: Patients diagnosed with first primary CRC between 2000 and 2011 were identified from the Surveillance, Epidemiology, and End Results cancer registries. The patients were divided into three cohorts: classical adenocarcinoma (CA), mucinous adenocarcinoma (MA), and signet-ring cell carcinoma (SRCC). Standardized incidence ratios were calculated to assess the risk of SPMs among the patients. Results: Overall risk of SPMs was significantly higher among patients with three histological subtypes of CRC than in the general population. The risk of esophagus cancer was significantly increased in SRCC. The risk of small intestine, colon and rectum, and corpus uteri cancers was high in three histological subtypes, with the highest risk observed in SRCC, followed by MA. Increased risks of second stomach, uterus, urinary bladder, kidney, and thyroid cancers were only observed in CA patients, while increased risk of second renal pelvis cancer was limited to MA patients. Furthermore, the high overall risk of SPMs in CA patients persisted regardless of clinicopathological factors. After surgery combined with chemotherapy treatment, CA patients were more prone to developing second small intestine, colon and rectum cancers than those treated with surgery only. A lower second prostate cancer risk was observed in rectal CA patients treated with surgery combined with radiotherapy than in patients treated with surgery only. Conclusion: The present study revealed that the risk of developing SPMs after CRC varied based on the histological subtypes of the first primary CRC. Although the mechanisms underlying the observed patterns of SPM risk remain unknown, the study provided insights into future cancer surveillance based on the histological subtypes of CRC.
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Affiliation(s)
- Meijuan Wu
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mengxi Huang
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chenglong He
- Department of Medical Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Cheng Chen
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Medical Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Huiyu Li
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jing Wang
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mengyan Liu
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gongbo Fu
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Medical Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Zengjie Lei
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Medical Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xiaoyuan Chu
- Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Medical Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
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18
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Baicry F, Molinié F, Plouvier S, Colonna M, Daubisse-Marliac L, Grosclaude P, Trétarre B, Bara S, Lapôtre-Ledoux B, Woronoff AS, Guizard AV, Bouvier V, Troussard X, Marrer E, Klein D, Velten M, Jégu J. What is the most appropriate period to define synchronous cancers? Cancer Epidemiol 2021; 71:101900. [PMID: 33578073 DOI: 10.1016/j.canep.2021.101900] [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: 10/26/2020] [Revised: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Studies about second primary cancers (SPC) incidence exclude a period following the first cancer diagnosis given the high probability of diagnosing another primary cancer during this phase (synchronous cancers). However, definition of synchronicity period varies widely, from one to six months, without clear epidemiological justification. The objective of this study was to determine the most appropriate synchronicity period. METHODS Data from 13 French population-based cancer registries were used to establish a cohort of all patients diagnosed with a first cancer between 1989 and 2010. The incidence rate of subsequent cancer was computed by day within 1 year of follow-up after the first diagnosis. Incidence was modelized by joinpoint regression models with an initial quadratic trend and a second constant part (plateau). The joinpoint was the point from which the plateau began and defining the synchronicity period. RESULTS Our cohort included 696,775 patients with a first cancer, of which 12,623 presented a SPC. The median joinpoint for all sites combined was estimated at 120.5 days [112.0-129.0]. Analysis by gender reported a higher difference in 32 days for males (127.8 vs 96.1 days). Noteworthy differences were found depending on patient age and the site of first cancer, with joinpoint ranging from 84.7 (oesophagus cancer) to 250.1 days (bladder cancer). CONCLUSION Although some heterogeneity was observed based on the characteristic of the patients, the appropriate synchronicity period appears to be 4 months after the diagnosis of first cancer.
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Affiliation(s)
- Florent Baicry
- Registre des Cancers du Bas-Rhin, Inserm UMR-S1113, FMTS, Université de Strasbourg, France; Service des Urgences Médico-chirurgicales Adultes, Hôpitaux Universitaires de Strasbourg, France.
| | - Florence Molinié
- Registre des Cancers de Loire-Atlantique et Vendée, CHU de Nantes, France
| | - Sandrine Plouvier
- Registre Général des Cancers de Lille et de sa Région, GCS C2RC, Lille, France
| | - Marc Colonna
- Registre des Cancers de l'Isère, CHU de Grenoble, France
| | - Laetitia Daubisse-Marliac
- Registre des Cancers du Tarn - Institut Claudius Regaud, Centre Régional de Lutte Contre le Cancer, UMR 1027 Inserm, Université Toulouse III, France
| | - Pascale Grosclaude
- Registre des Cancers du Tarn - Institut Claudius Regaud, Centre Régional de Lutte Contre le Cancer, UMR 1027 Inserm, Université Toulouse III, France
| | - Brigitte Trétarre
- Registre des Tumeurs de l'Hérault, Centre de Recherche, Montpellier, France
| | - Simona Bara
- Registre des Cancers de la Manche, Centre Hospitalier Public du Cotentin, Cherbourg-Octeville, France
| | - Bénédicte Lapôtre-Ledoux
- Registre du Cancer de la Somme, Service Épidémiologie Hygiène et Santé Publique, CHU Nord, Amiens, France
| | - Anne-Sophie Woronoff
- Registre des Tumeurs du Doubs et du Territoire de Belfort, EA3181, Centre Hospitalier Régional Universitaire, Besançon, France
| | - Anne-Valérie Guizard
- Registre Général des Tumeurs du Calvados, Cancers & Préventions - U1086 Inserm, Centre François Baclesse, Caen, France
| | - Véronique Bouvier
- Registre des Tumeurs Digestives du Calvados, Cancers & Préventions, U1086 Inserm, Centre François Baclesse, Caen, France
| | - Xavier Troussard
- Registre des Hémopathies Malignes de Basse-Normandie, Unité Fonctionnelle Hospitalo-Universitaire n° 0350, Centre Hospitalier Universitaire, Caen, France
| | | | - Delphine Klein
- Registre des Cancers du Bas-Rhin, Inserm UMR-S1113, FMTS, Université de Strasbourg, France
| | - Michel Velten
- Registre des Cancers du Bas-Rhin, Inserm UMR-S1113, FMTS, Université de Strasbourg, France; Service d'épidémiologie et de Biostatistique, Centre Paul Strauss, Strasbourg, France; Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, France
| | - Jérémie Jégu
- Registre des Cancers du Bas-Rhin, Inserm UMR-S1113, FMTS, Université de Strasbourg, France; Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, France
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19
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Halamkova J, Kazda T, Pehalova L, Gonec R, Kozakova S, Bohovicova L, Krakorova DA, Slaby O, Demlova R, Svoboda M, Kiss I. Second primary malignancies in colorectal cancer patients. Sci Rep 2021; 11:2759. [PMID: 33531585 PMCID: PMC7854629 DOI: 10.1038/s41598-021-82248-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
The prevalence of second primary malignancies (SPMs) in the western world is continually increasing with the risk of a new primary cancer in patients with previously diagnosed carcinoma at about 20%. The aim of this retrospective analysis is to identify SPMs in colorectal cancer patients in a single-institution cohort, describe the most frequent SPMs in colorectal cancer patients, and discover the time period to occurrence of second primary tumors. We identified 1174 patients diagnosed with colorectal cancer in the period 2003–2013, with follow-up till 31.12.2018, and median follow-up of 10.1 years, (median age 63 years, 724 men). A second primary neoplasm was diagnosed in 234 patients (19.9%). Older age patients, those with early-stage disease and those with no relapse have a higher risk of secondary cancer development. The median time from cancer diagnosis to development of CRC was 8.9 years for breast cancer and 3.4 years for prostate cancer. For the most common cancer diagnosis after primary CRC, the median time to development was 0–5.2 years, depending on the type of malignancy. Patients with a diagnosis of breast, prostate, or kidney cancer, or melanoma should be regularly screened for CRC. CRC patients should also be screened for additional CRC as well as cancers of the breast, prostate, kidney, and bladder. The screening of cancer patients for the most frequent malignancies along with systematic patient education in this field should be the standard of surveillance for colorectal cancer patients.
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Affiliation(s)
- Jana Halamkova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Medical Ethics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, Brno, 625 00, Czech Republic. .,Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Lucie Pehalova
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Gonec
- Department of Pharmacy, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Pharmaceutics, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic
| | - Sarka Kozakova
- Department of Pharmacy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Lucia Bohovicova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | - Ondrej Slaby
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Brno, Czech Republic
| | - Regina Demlova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Clinical Trial Unit, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Marek Svoboda
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Igor Kiss
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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20
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Halamkova J, Kazda T, Pehalova L, Gonec R, Kozakova S, Bohovicova L, Slaby O, Demlova R, Svoboda M, Kiss I. The Impact of Diabetes Mellitus on the Second Primary Malignancies in Colorectal Cancer Patients. Front Oncol 2021; 10:573394. [PMID: 33585194 PMCID: PMC7878972 DOI: 10.3389/fonc.2020.573394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction All colorectal cancer (CRC) survivors have an increased risk of developing second primary malignancies (SPMs). The association between diabetes mellitus (DM) and the risk of cancer is well known. However, the role of DM and its therapy in the development of SPMs in CRC patients is not well described. Methods In this single-institutional retrospective analysis we identified 1,174 colorectal carcinoma patients, median follow-up 10.1 years, (median age 63 years, 724 men). All patients over 18 years with histologically confirmed CRC who were admitted in the period 1.1. 2003- 31.12.2013 and followed-up till 31.12. 2018 at the Masaryk Memorial Cancer Institute (MMCI) were screened for eligibility. The exclusion criteria were CRC diagnosed at autopsy, lost to follow-up and high risk of development of SPMs due to hereditary cancer syndrome. Tumours are considered multiple primary malignancies if arising in different sites and/or are of a different histology or morphology group. Comparisons of the basic characteristics between the patients with SPM and the patients without SPM were performed as well as comparison of the occurrence of SPMs by the site of diagnosis between the DM and non-DM cohorts and survival analyses. Results A SPM was diagnosed in 234 (20%) patients, DM in 183 (15%) patients. DM was diagnosed in 22.6% of those with SPM vs. in 13.8% of those without SPM (p=0.001). The most common types of SPMs in DM patients were other CRC, kidney, lung, bladder and nonmelanoma skin cancer, but only carcinoma of the liver and bile duct tracts was significantly more common than in the group without DM. Although breast cancer was the second most common in the group with DM, its incidence was lower than in the group without DM, as well as prostate cancer. A significantly higher incidence of SPMs was found in older CRC patients (≥ 65 years) and in those with lower stage colon cancer and DM. No significant difference in DM treatment between those with and without a SPM was observed including analysis of type of insulin. Conclusion CRC patients with diabetes mellitus, especially those with older age, and early stages of colon cancer, should be screened for second primary malignancies more often than the standard population. Patients without DM have longer survival. According to the occurrence of the most common second malignancies, a clinical examination, blood count, and ultrasound of the abdomen is appropriate, together with standard breast and colorectal cancer screening, and lung cancer screening under certain conditions, and should be recommended in CRC survivors especially in patients with intercurrent DM, however the necessary frequency of screening remains unclear.
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Affiliation(s)
- Jana Halamkova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czechia.,Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Medical Ethics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czechia.,Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Lucie Pehalova
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Roman Gonec
- Department of Pharmacy, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Sarka Kozakova
- Department of Pharmacy, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Lucia Bohovicova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Ondrej Slaby
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czechia.,Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czechia.,Central European Institute of Technology, Molecular Oncology II-Solid Cancer, Masaryk University, Brno, Czechia
| | - Regina Demlova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia.,Clinical Trial Unit, Masaryk Memorial Cancer Institute, Brno, Czechia
| | - Marek Svoboda
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czechia.,Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Igor Kiss
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czechia.,Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czechia
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21
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Sung H, Hyun N, Leach CR, Yabroff KR, Jemal A. Association of First Primary Cancer With Risk of Subsequent Primary Cancer Among Survivors of Adult-Onset Cancers in the United States. JAMA 2020; 324:2521-2535. [PMID: 33351041 PMCID: PMC7756242 DOI: 10.1001/jama.2020.23130] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE The number of cancer survivors who develop new cancers is projected to increase, but comprehensive data on the risk of subsequent primary cancers (SPCs) among survivors of adult-onset cancers are limited. OBJECTIVE To quantify the overall and cancer type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types and sex. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study from 12 Surveillance, Epidemiology, and End Results registries in the United States, that included 1 537 101 persons aged 20 to 84 years diagnosed with FPCs from 1992-2011 (followed up until December 31, 2017) and who survived at least 5 years. EXPOSURES First primary cancer. MAIN OUTCOMES AND MEASURES Incidence and mortality of SPCs per 10 000 person-years; standardized incidence ratio (SIR) and standardized mortality ratio (SMR) compared with those expected in the general population. RESULTS Among 1 537 101 survivors (mean age, 60.4 years; 48.8% women), 156 442 SPC cases and 88 818 SPC deaths occurred during 11 197 890 person-years of follow-up (mean, 7.3 years). Among men, the overall risk of developing any SPCs was statistically significantly higher for 18 of the 30 FPC types, and risk of dying from any SPCs was statistically significantly higher for 27 of 30 FPC types as compared with risks in the general population. Among women, the overall risk of developing any SPCs was statistically significantly higher for 21 of the 31 FPC types, and risk of dying from any SPCs was statistically significantly higher for 28 of 31 FPC types as compared with risks in the general population. The highest overall SIR and SMR were estimated among survivors of laryngeal cancer (SIR, 1.75 [95% CI, 1.68-1.83]; incidence, 373 per 10 000 person-years) and gallbladder cancer (SMR, 3.82 [95% CI, 3.31-4.39]; mortality, 341 per 10 000 person-years) among men, and among survivors of laryngeal cancer (SIR, 2.48 [95% CI, 2.27-2.72]; incidence, 336 per 10 000 person-years; SMR, 4.56 [95% CI, 4.11-5.06]; mortality, 268 per 10 000 person-years) among women. Substantial variation existed in the associations of specific types of FPCs with specific types of SPC risk; however, only a few smoking- or obesity-associated SPCs, such as lung, urinary bladder, oral cavity/pharynx, colorectal, pancreatic, uterine corpus, and liver cancers constituted considerable proportions of the total incidence and mortality, with lung cancer alone accounting for 31% to 33% of mortality from all SPCs. CONCLUSIONS AND RELEVANCE Among survivors of adult-onset cancers in the United States, several types of primary cancer were significantly associated with greater risk of developing and dying from an SPC, compared with the general population. Cancers associated with smoking or obesity comprised substantial proportions of overall SPC incidence and mortality among all survivors and highlight the importance of ongoing surveillance and efforts to prevent new cancers among survivors.
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Affiliation(s)
- Hyuna Sung
- Department of Data Science, American Cancer Society, Atlanta, Georgia
| | - Noorie Hyun
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee
| | - Corinne R. Leach
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - K. Robin Yabroff
- Department of Data Science, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Data Science, American Cancer Society, Atlanta, Georgia
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22
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Neuzillet C, Anota A, Foucaut AM, Védie AL, Antoun S, Barnoud D, Bouleuc C, Chorin F, Cottet V, Fontaine E, Garabige V, Hébuterne X, Huguet F, Lièvre A, Marchal T, Mouillot T, Peschaud F, Quilliot D, Raynard B, Schneider S, Scotté F, Vansteene D, Mariani P, Bouché O, Joly F. Nutrition and physical activity: French intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC, SFP-APA, SFNCM, AFSOS). BMJ Support Palliat Care 2020; 11:381-395. [PMID: 33177113 DOI: 10.1136/bmjspcare-2020-002751] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
This document is a summary of the French intergroup guidelines regarding the nutrition and physical activity (PA) management in digestive oncology. This collaborative work was produced under the auspices of all French medical and surgical societies involved in digestive oncology, nutrition and supportive care. It is based on published guidelines, recent literature review and expert opinions. Recommendations are graded according to the level of evidence. Malnutrition affects more than half of patients with digestive cancers and is often underdiagnosed. It has multiple negative consequences on survival, quality of life and risk of treatment complications. Consequently, in addition to anticancer treatments, supportive care including nutritional support and PA plays a central role in the management of digestive cancers. It is crucial to detect malnutrition (diagnostic criteria updated in 2019) early, to prevent it and to act against it at all stages of the cancer and at all times of the care pathway. In this context, we proposed recommendations for the evaluation and management in nutrition and PA in digestive oncology for each stage of the disease (perioperative setting, during radiation therapy, during systemic treatments, at the palliative phase, after cancer). Guidelines for nutrition and PA management aim at increasing awareness about malnutrition in oncology. They are continuously evolving and need to be regularly updated.
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Affiliation(s)
- Cindy Neuzillet
- Department of Medical Oncology, Curie Institute, Versailles Saint-Quentin University (UVSQ) - Paris Saclay University, Saint-Cloud, France
| | - Amélie Anota
- Methodology and Quality of Life Unit in Oncology, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Hospital of Besançon, University Bourgogne Franche-Comté, Inserm, EFS BFC, Besançon, France.,Biostatistics Unit, DRCI, Centre Léon Bérard, Lyon, France
| | - Aude-Marie Foucaut
- Laboratoire Educations et Pratiques de Santé UR 3412, Université Sorbonne Paris Nord, Bobigny, France
| | - Anne-Laure Védie
- Department of Gastroenterology and Pancreatology, Beaujon University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris 7 Diderot University, Clichy La Garenne, France
| | - Sami Antoun
- Nutrition and Readaptation Unit, Gustave Roussy Institute - Cancer Campus, Villejuif and Chevilly-Larue, France
| | - Didier Barnoud
- Department of Intensive Clinical Nutrition, Hospices Civils de Lyon (CHU Lyon), Lyon, France
| | - Carole Bouleuc
- Department of Supportive Care, Curie Institute, Paris, France
| | - Frédéric Chorin
- Plateforme Fragilité, Université Côte d'Azur, CHU Nice, LAMHESS, Nice, France
| | - Vanessa Cottet
- INSERM UMR1231 CIC 1432, CHU Dijon, NACRe National Network, University of Burgundy Franche-Comté, Dijon, France
| | - Eric Fontaine
- University of Grenoble Alpes, INSERM, LBFA, Grenoble, France
| | | | - Xavier Hébuterne
- Gastroenterology and Clinical Nutrition, CHU of Nice and University Côte d'Azur, Nice, France
| | - Florence Huguet
- Service d'Oncologie Radiothérapie, CHU Tenon, IUC, AP-HP, Sorbonne Université, Paris, France
| | - Astrid Lièvre
- Department of Gastroenterology, INSERM U1242 "Chemistry Oncogenesis Stress Signaling", University Hospital Pontchaillou, Rennes 1 University, Rennes, France
| | | | - Thomas Mouillot
- Service d'Hépato-gastro-entérologie, CHU F. Mitterrand, Dijon, France
| | - Frédérique Peschaud
- Department of Surgical Oncology, CHU Ambroise Paré, APHP, UVSQ - Paris Saclay University, Boulogne-Billancourt, France
| | - Didier Quilliot
- Nutritional Assistance Department and Transversal Nutrition Unit, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Bruno Raynard
- Nutrition and Readaptation Unit, Gustave Roussy Institute - Cancer Campus, Villejuif and Chevilly-Larue, France
| | - Stéphane Schneider
- Plateforme Fragilité, Université Côte d'Azur, CHU Nice, LAMHESS, Nice, France
| | - Florian Scotté
- Department of Supportive Care (Département Interdisciplinaire d'Organisation des Parcours Patients - DIOPP), Gustave Roussy Institute - Cancer Campus, Villejuif, France
| | - Damien Vansteene
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Pascale Mariani
- Department of Digestive Surgery, Curie Institute, Paris, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
| | - Francisca Joly
- Department of Gastroenterology, IBD and Nutrition Support, CHU Beaujon, AP-HP, Paris 7 Diderot University, Clichy La Garenne, France
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23
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Denlinger CS, Sanft T, Moslehi JJ, Overholser L, Armenian S, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Henry NL, Hill-Kayser C, Hudson M, Khakpour N, Koura D, McDonough AL, Melisko M, Mooney K, Moore HCF, Moryl N, O'Connor T, Paskett ED, Patel C, Peterson L, Pirl W, Rodriguez MA, Ruddy KJ, Shockney L, Smith S, Syrjala KL, Tevaarwerk A, Zee P, McMillian NR, Freedman-Cass DA. NCCN Guidelines Insights: Survivorship, Version 2.2020. J Natl Compr Canc Netw 2020; 18:1016-1023. [PMID: 32755975 DOI: 10.6004/jnccn.2020.0037] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment, with the goal of helping healthcare professionals who work with survivors, including those in primary care. The guidelines also provide recommendations to help clinicians promote physical activity, weight management, and proper immunizations in survivors and facilitate care coordination to ensure that all of the survivors' needs are addressed. These NCCN Guidelines Insights summarize additions and changes made to the guidelines in 2020 regarding cardiovascular disease risk assessment and screening for subsequent primary malignancies.
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Affiliation(s)
| | - Tara Sanft
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Mindy Goldman
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | - Melissa Hudson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | - Kathi Mooney
- Huntsman Cancer Institute at the University of Utah
| | - Halle C F Moore
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Lindsay Peterson
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Lillie Shockney
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Phyllis Zee
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University; and
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24
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Abstract
The Nutrition Society's 1st Annual Nutrition and Cancer Networking Conference brought together scientists from the fields of Nutrition, Epidemiology, Public Health, Medical Oncology and Surgery with representatives of the public, cancer survivors and cancer charities. Speakers representing these different groups presented the challenges to collaboration, how the needs of patients and the public can be met, and the most promising routes for future research. The conference programme promoted debate on these issues to highlight current gaps in understanding and barriers to generating and implementing evidence-based nutrition advice. The main conclusions were that the fundamental biology of how nutrition influences the complex cancer risk profiles of diverse populations needs to be better understood. Individual and population level genetics interact with the environment over a lifespan to dictate cancer risk. Large charities and government have a role to play in diminishing our current potently obesogenic environment and exploiting nutrition to reduce cancer deaths. Understanding how best to communicate, advise and support individuals wishing to make dietary and lifestyle changes, can reduce cancer risk, enhance recovery and improve the lives of those living with and beyond cancer.
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25
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Silva A, Faria G, Araújo A, Monteiro MP. Impact of adiposity on staging and prognosis of colorectal cancer. Crit Rev Oncol Hematol 2019; 145:102857. [PMID: 31881452 DOI: 10.1016/j.critrevonc.2019.102857] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/18/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023] Open
Abstract
Abdominal visceral fat is a well-recognized a risk for colorectal cancer (CRC). In contrast to the risk for CRC, the impact of adiposity in disease staging and patient survival is less well-established. Our aim was to critically review the literature on the influence of adiposity assessed by different methods routinely used in clinical settings, on CRC staging and prognosis. In the 32 studies reviewed, overweight was initially identified as a survival advantage, an evidence that was later challenged by studies suggesting that body adiposity is likely to have a deleterious effect in CRC outcomes, particularly in males. Hence, whether obesity has a negative impact in CRC staging or prognosis remains controversial. In sum, addressing the impact of body fat in CRC biological behavior is still an unmet need. Understanding how adiposity influences CRC staging and prognosis could allow further patient risk stratification for devising targeted interventions and improve clinical outcomes.
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Affiliation(s)
- Ana Silva
- Pharmacy Department, Centro Hospitalar do Porto, 4099-001 Porto, Portugal; School of Health, Polytechnic Institute of Porto, Polytechnic of Porto, 4200 - 072, Porto, Portugal
| | - Gil Faria
- CINTESIS-Center for Research in Health Technologies and Information Systems, 4200-450, Porto, Portugal; General Surgery, Hospital de Pedro Hispano - Unidade Local de Saúde de Matosinhos, 4464-513, Senhora da Hora, Portugal
| | - António Araújo
- Unit of Oncobiology Research, Unit for Multidisciplinary Biomedical Research (UMIB) of Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, 4050-313, Porto, Portugal; Medical Oncology Department, Centro Hospitalar do Porto, 4099-001 Porto, Portugal
| | - Mariana P Monteiro
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Biomedical Research (UMIB) of Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, 4050-313, Porto, Portugal; Centre for Obesity Research, University College London, London, WC1E 6JF, United Kingdom.
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Gu Q, Dummer TBJ, Spinelli JJ, Murphy RA. Diet Quality among Cancer Survivors and Participants without Cancer: A Population-Based, Cross-Sectional Study in the Atlantic Partnership for Tomorrow's Health Project. Nutrients 2019; 11:nu11123027. [PMID: 31835839 PMCID: PMC6950144 DOI: 10.3390/nu11123027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/09/2019] [Indexed: 02/08/2023] Open
Abstract
Cancer survivors are encouraged to have a healthy lifestyle to reduce health risks and improve survival. An understanding of health behaviors, such as diet, is also important for informing post-diagnosis support. We investigated the diet quality of cancer survivors relative to participants without cancer, overall and by cancer site and time from diagnosis. A cross-sectional study design within the Atlantic PATH study was used which included 19,973 participants aged 35 to 69 years from Atlantic Canada, of whom 1,930 were cancer survivors. A diet quality score was derived from a food frequency questionnaire. Comparisons of diet quality between cancer survivors and non-cancer controls, cancer site and years since diagnosis were examined in multivariable multi-level models. Cancer survivors had a mean diet quality of 39.1 out of 60 (SD: 8.82) and a higher diet quality than participants without cancer (mean difference: 0.45, 95% CI: 0.07, 0.84) after adjustment for confounders. Odds of high diet quality was greater in breast cancer survivors than participants without cancer (OR = 1.42, 95% CI: 1.06, 1.90), and higher among survivors diagnosed ≤2 years versus >10 years (OR = 1.71, 95% CI: 1.05, 2.80). No other differences by cancer site and years since diagnosis were observed. The difference in diet quality, although statistically significant, is unlikely to be meaningful, suggesting that cancer survivors have similar diet quality as participants without cancer. There was considerable room for dietary improvement regardless of cancer status, highlighting the need for dietary interventions, especially among cancer survivors, who are at higher risk for secondary health problems.
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Affiliation(s)
- Qianqian Gu
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (Q.G.); (T.B.J.D.); (J.J.S.)
| | - Trevor B. J. Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (Q.G.); (T.B.J.D.); (J.J.S.)
| | - John J. Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (Q.G.); (T.B.J.D.); (J.J.S.)
- Population Oncology, BC Cancer Agency, Vancouver, BC V5Z 1G1, Canada
| | - Rachel A. Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (Q.G.); (T.B.J.D.); (J.J.S.)
- Cancer Control Research, BC Cancer Agency, 675 W 10th Ave, Vancouver, BC V5Z 1L3, Canada
- Correspondence: ; Tel.: +1-604-822-1397
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Park Y, Peterson LL, Colditz GA. The Plausibility of Obesity Paradox in Cancer-Point. Cancer Res 2019; 78:1898-1903. [PMID: 29654151 DOI: 10.1158/0008-5472.can-17-3043] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/25/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
In contrast to the convincing evidence that obesity (measured by body mass index, BMI) increases the risk of many different types of cancer, there is an ambiguity in the role of obesity in survival among cancer patients. Some studies suggested that higher BMI decreased mortality risk in cancer patients, a phenomenon called the obesity paradox. The spurious positive association between BMI and cancer survival is likely to be explained by several methodologic limitations including confounding, reverse causation, and collider stratification bias. Also, the inadequacy of BMI as a measure of body fatness in cancer patients commonly experiencing changes in body weight and body composition may have resulted in the paradox. Other factors contributing to the divergent results in literature are significant heterogeneity in study design and method (e.g., study population, follow-up length); time of BMI assessment (pre-, peri-, or post-diagnosis); and lack of consideration for variability in the strength and directions of associations by age, sex, race/ethnicity, and cancer subtype. Robust but practical methods to accurately assess body fatness and body compositions and weight trajectories in cancer survivors are needed to advance this emerging field and to develop weight guidelines to improve both the length and the quality of cancer survival. Cancer Res; 78(8); 1898-903. ©2018 AACR.
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Affiliation(s)
- Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Lindsay L Peterson
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Simard J, Kamath S, Kircher S. Survivorship Guidance for Patients with Colorectal Cancer. Curr Treat Options Oncol 2019; 20:38. [DOI: 10.1007/s11864-019-0635-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Jung SY, Kim YA, Jo M, Park SM, Won YJ, Ghang H, Kong SY, Jung KW, Lee ES. Prediagnosis obesity and secondary primary cancer risk in female cancer survivors: A national cohort study. Cancer Med 2019; 8:824-838. [PMID: 30652416 PMCID: PMC6382718 DOI: 10.1002/cam4.1959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/05/2018] [Accepted: 12/16/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study evaluated the effects of body mass index (BMI) before the diagnosis of the first primary cancer on the development of secondary primary cancers (SPCs) in female cancer survivors. METHODS This study population included 146 377 Korean female cancer survivors whose first primary cancer was diagnosed between 2002 and 2010. The incidence of SPCs was evaluated throughout follow-up until December 2011. We used Cox proportional hazards models to calculate the hazard ratios of SPCs with prediagnosis BMI and compared it to those of first cancers in the general population. RESULTS After 565 877 person-years of follow-up, 2222 patients with SPC were observed. The higher BMI was more in female cancer survivors than in general population. The age-standardized incidence rate of cancer in cancer survivors was 2.02 times higher than that of the general population. There were positive linear trends between prediagnosis BMI and risk of overall, colorectal, ovary, thyroid, and obesity-related SPCs. In addition, the BMI-SPC risk association was statistically significant in female cancer survivors without smoking history (Ptrend = 0.001) and with a localized first primary cancer (Ptrend = 0.014). However, the magnitude of the BMI-SPC risk association was similar to that for first cancers in the general population (Pheterogeneity = 0.403 in BMI ≥ 30.0 kg/m2 ). CONCLUSIONS In female cancer survivors, prediagnosis obesity was a risk factor for overall, individual, and obesity-related SPCs. However, the magnitude of the BMI-SPC risk association was similar to that for first cancers in the general population.
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Affiliation(s)
- So-Youn Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Young Ae Kim
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Minkyung Jo
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Haryeom Ghang
- Health Insurance Policy Research Institute, National Health Insurance Service, Gangwon-do, Korea
| | - Sun-Young Kong
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,Department of Laboratory Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Translational Cancer Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyu-Won Jung
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Obi K, Ramsey M, Hinton A, Stanich P, Gray DM, Krishna SG, El-Dika S, Hussan H. Insights into insulin resistance, lifestyle, and anthropometric measures of patients with prior colorectal cancer compared to controls: A National Health and Nutrition Examination Survey (NHANES) Study. Curr Probl Cancer 2018; 42:276-285. [PMID: 29395416 DOI: 10.1016/j.currproblcancer.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/18/2017] [Accepted: 12/10/2017] [Indexed: 01/05/2023]
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Tarasiuk A, Mosińska P, Fichna J. The mechanisms linking obesity to colon cancer: An overview. Obes Res Clin Pract 2018; 12:251-259. [PMID: 29428365 DOI: 10.1016/j.orcp.2018.01.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/19/2018] [Accepted: 01/26/2018] [Indexed: 12/16/2022]
Abstract
Obesity, characterised as a chronic low-grade inflammation is a crucial risk factor for colon cancer. The expansion of the adipose tissue is related to elevated triglyceride and low-density lipoprotein (LDL) levels and hyperinsulinemia, which all are presumed mediators of the tumour development. Obesity is also believed to support carcinogenesis by activating the insulin/IGF-1 pathway. Moreover, obesity increases the level of proinflammatory cytokines (e.g. TNF-α, IL-1, and IL-6) and has a significant impact on selected adipokines. This paper briefly outlines the latest evidence of the linkage between the obesity and colon cancer and discusses its possible implication for the improvement of anticancer prevention and treatment strategies connected with nutrition.
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Affiliation(s)
- Aleksandra Tarasiuk
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Poland
| | - Paula Mosińska
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Poland
| | - Jakub Fichna
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Poland.
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Lin X, Lu L, Liu L, Wei S, He Y, Chang J, Lian X. Blood lipids profile and lung cancer risk in a meta-analysis of prospective cohort studies. J Clin Lipidol 2017; 11:1073-1081. [PMID: 28669687 DOI: 10.1016/j.jacl.2017.05.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/16/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Emerging evidence has connected lipid metabolism disturbance with lung diseases, but the relationship between blood lipid profile and lung cancer risk is controversial and inconclusive. OBJECTIVE We conducted a meta-analysis of prospective cohort studies to evaluate the relationship between blood lipids profile and lung cancer incidence. METHODS Relevant studies were identified by searching PubMed, Cochrane Library, Web of Science, EBSCO, Ovid, CNKI, VIP, and WANGFANG MED through August 2016. Nine prospective cohort studies were included in the meta-analysis, and fixed or random effects model was used to calculate pooled relative risk (RRs). The RR was calculated using either highest vs lowest categories, or upper quantile vs lowest quantile. The thresholds were determined by the authors of each original publication, based on either predefined cut-offs or the distributions within their study population. RESULTS Analysis of 18,111 lung cancer cases among 1,832,880 participants showed that serum total cholesterol levels were inverse associated with lung cancer risk (RR = 0.93, 95% confidence interval [CI]: 0.85-1.03). Further analysis considered the lag time and excluded the effects of preclinical cancer, with totally 1,239,948 participants and 14,052 lung cancer cases, found a significantly inverse association between total cholesterol and lung cancer risk (RR = 0.89, 95% CI: 0.83-0.94). Analysis of 3067 lung cancer cases among 59,242 participants found that the high-density lipoprotein cholesterol levels (RR = 0.76, 95% CI: 0.59-0.97) was negatively associated with lung cancer risk and 4673 lung cancer cases among 685,852 participants showed that the total triglyceride (RR = 1.68, 95% CI: 1.44-1.96) was positively associated with lung cancer risk. CONCLUSION Cholesterol and fatty acid metabolism might present different and specific mechanism on lung cancer etiology and needs further elucidation.
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Affiliation(s)
- Xiaojing Lin
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, P.R. China; Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Center for Lipid Research, Chongqing, China
| | - Lei Lu
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, P.R. China; Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Center for Lipid Research, Chongqing, China
| | - Lingli Liu
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, P.R. China
| | - Siyu Wei
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, P.R. China
| | - Yunyun He
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, P.R. China
| | - Jing Chang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Lian
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, P.R. China; Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Center for Lipid Research, Chongqing, China.
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Park SM, Li T, Wu S, Li WQ, Qureshi AA, Stampfer M, Cho E. Risk of second primary cancer associated with pre-diagnostic smoking, alcohol, and obesity in women with keratinocyte carcinoma. Cancer Epidemiol 2017; 47:106-113. [PMID: 28242577 DOI: 10.1016/j.canep.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 11/19/2022]
Abstract
Keratinocyte carcinoma (KC), which includes basal-cell carcinoma (BCC) and squamous-cell cancer (SCC), has been associated with an increased risk of second primary cancers (SPCs), although the reason for this increase is unknown. We assessed the effects of smoking, alcohol, and obesity prior to the diagnosis of KC on the development of SPCs, as these are well-established risk factors for multiple cancers and may also contribute to the increased risk of SPCs among those with KC. A total of 15,628 women with self-reported KC were identified in the Nurses' Health Study. Incident SPCs were assessed throughout the follow-up until June 2012. Cox proportional hazards models were used to calculate the hazard ratios (HRs) of SPC associated with pre-diagnostic smoking, alcohol and body mass index (BMI). We also compared these risk estimates to those for first cancers in all cohort participants. During 193,695 person-years of follow-up, we recorded 2839 SPC cases. Compared with never smokers, current smokers had a significantly elevated risk for SPC overall and specifically for lung, colorectal, and bladder cancers. We also found a positive association between higher BMI and risk for SPC overall as well as for endometrial and bladder SPCs. Women with KC who consumed alcohol ≥30g/day had a marginally higher risk of SPC compared to non-drinkers. The associations between incident SPC risk among KC cases and smoking, alcohol, and obesity appeared similar to the associations between these risk factors and the incident first primary cancers in the whole cohort. Only in the heavy smoking (≥25 cigarettes/day) category was the HR for SPC after KC (2.34; 95% CI 1.98-2.76) slightly higher than that for the first cancer in the overall cohort (HR 1.86; 95% CI 1.75-1.98, Pheterogeneity=0.01). In conclusion, pre-diagnostic smoking, alcohol and obesity prior to KC diagnosis were associated with risk of SPCs.
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Affiliation(s)
- Sang Min Park
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Family Medicine & Department of Biomedical Sciences, Seoul National University College of Medicine, Republic of Korea
| | - Tricia Li
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Shaowei Wu
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Wen-Qing Li
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Abrar A Qureshi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Meir Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Eunyoung Cho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA.
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Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017. [DOI: 10.1016/j.clnu.2016.07.015 10.1016/j.clnu.2016.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Krishna SG, Hussan H, Cruz-Monserrate Z, Conteh LF, Mumtaz K, Conwell DL. A review of the impact of obesity on common gastrointestinal malignancies. ACTA ACUST UNITED AC 2017; 4. [PMID: 28819564 PMCID: PMC5557628 DOI: 10.15761/icst.1000223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Obesity is a global pandemic and is a well-recognized risk factor for various gastrointestinal diseases. The prevalence of obesity is increasing across all age groups. There is an emergent need for focused guidelines aimed at reducing the incidence, prevalence, and associated risks of obesity. The impact of obesity on gastrointestinal cancers being multifactorial adversely influences the associated risk, disease course, prognosis, and overall survival. We have summarized the current literature highlighting the association between obesity and common gastrointestinal cancers, with specific focus on esophageal adenocarcinoma, colon cancer, hepatocellular cancer, cholangiocarcinoma, and pancreatic malignancies.
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Affiliation(s)
- Somashekar G Krishna
- Sections of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, USA
| | - Hisham Hussan
- Sections of Intestinal Neoplasia and Hereditary Polyposis, and Obesity and Bariatric Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Comprehensive Cancer Center, The Ohio State University, USA
| | - Zobeida Cruz-Monserrate
- Section of Molecular and Cellular Biology, Division of Gastroenterology, Hepatology and Nutrition, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, USA
| | - Lanla F Conteh
- Section of Hepatology & Comprehensive Transplant Center, Division of Gastroenterology, Hepatology and Nutrition, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, USA
| | - Khalid Mumtaz
- Section of Hepatology & Comprehensive Transplant Center, Division of Gastroenterology, Hepatology and Nutrition, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, USA
| | - Darwin L Conwell
- Section of Pancreatic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, USA
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Abstract
PURPOSE OF REVIEW The gastroenterology literature emphasizes factors that increase colorectal cancer (CRC) incidence but presents little about management after initial CRC treatments. The purpose of this review is to describe the remarkably increasing numbers of CRC survivors in whom surveillance guidelines are often not followed and patient care is fragmented. The gastroenterologist can play an important role in this care to improve prognosis and overall health. RECENT FINDINGS Existing surveillance recommendations by specialty societies for CRC survivors are fairly consistent but implementation occurs in less than half. The gastroenterologist can help to coordinate care to ensure appropriate surveillance and also can help to diagnose and treat chemotherapy and radiotherapy complications in survivors which can affect the quality of life long after the initial treatment. The gastroenterologist also can focus on host factors, including management of obesity, exercise programs, and the diet and can introduce potential chemopreventive agents such as nonsteroidal anti-inflammatory drugs when positive prospective studies are forthcoming. Interested gastroenterologists also have a role in participating in such prospective studies. SUMMARY The gastroenterologist should enhance her/his role for coordinated management of CRC survivors to improve patient surveillance care, to treat posttherapy complications and encourage preventive measures to improve prognosis and quality of life.
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Park SM, Yun YH, Kim YA, Jo M, Won YJ, Back JH, Lee ES. Prediagnosis Body Mass Index and Risk of Secondary Primary Cancer in Male Cancer Survivors: A Large Cohort Study. J Clin Oncol 2016; 34:4116-4124. [PMID: 27863195 PMCID: PMC5477820 DOI: 10.1200/jco.2016.66.4920] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose Male cancer survivors have a higher risk of cancer than the general population, which might be caused by an increased prevalence of obesity or susceptibility to obesity-related carcinogenesis. We assessed the effects of obesity before the diagnosis of a first cancer on the development of secondary primary cancers (SPCs). Methods The study population consisted of 239,615 Korean male cancer survivors between January 2003 and December 2010. Incident SPCs were assessed throughout follow-up until December 2011. Cox proportional hazards models were used to calculate the hazard ratios of SPCs associated with prediagnosis body mass index (BMI), which were compared with those of first cancers in all cohort participants. Results After 1,614,583 person-years of follow-up, we observed 4,799 patients with SPC. The age-standardized incidence rate of cancer in cancer survivors was 1.1 times higher than that of the general population. We found positive linear trends between prediagnosis BMI and risk of all-combined, colorectal, liver, lymphoma, biliary tract, kidney, and obesity-related SPCs. The magnitude of the BMI-SPC risk association in male cancer survivors was stronger than that for first cancers in the general population, whereas the mean BMI was similar in both groups. In the severely obese category (BMI ≥ 30 kg/m2), the adjusted hazard ratios for SPCs among cancer survivors (1.41; 95% CI, 1.15 to 1.74) were significantly higher than those for first cancers among all cohort participants (1.12; 95% CI, 1.09 to 1.16; Pheterogeneity < .01). Conclusion Prediagnosis obesity is a risk factor for overall and individual SPCs, and the strength of the BMI-cancer association is slightly stronger in male cancer survivors than in the general population.
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Affiliation(s)
- Sang Min Park
- Sang Min Park and Young Ho Yun, Seoul National University College of Medicine; Joung Hwan Back, National Health Insurance Service, Seoul; Young Ae Kim, Minkyung Jo, Young-Joo Won, and Eun-Sook Lee, National Cancer Center, Goyang, Republic of Korea
| | - Young Ho Yun
- Sang Min Park and Young Ho Yun, Seoul National University College of Medicine; Joung Hwan Back, National Health Insurance Service, Seoul; Young Ae Kim, Minkyung Jo, Young-Joo Won, and Eun-Sook Lee, National Cancer Center, Goyang, Republic of Korea
| | - Young Ae Kim
- Sang Min Park and Young Ho Yun, Seoul National University College of Medicine; Joung Hwan Back, National Health Insurance Service, Seoul; Young Ae Kim, Minkyung Jo, Young-Joo Won, and Eun-Sook Lee, National Cancer Center, Goyang, Republic of Korea
| | - Minkyung Jo
- Sang Min Park and Young Ho Yun, Seoul National University College of Medicine; Joung Hwan Back, National Health Insurance Service, Seoul; Young Ae Kim, Minkyung Jo, Young-Joo Won, and Eun-Sook Lee, National Cancer Center, Goyang, Republic of Korea
| | - Young-Joo Won
- Sang Min Park and Young Ho Yun, Seoul National University College of Medicine; Joung Hwan Back, National Health Insurance Service, Seoul; Young Ae Kim, Minkyung Jo, Young-Joo Won, and Eun-Sook Lee, National Cancer Center, Goyang, Republic of Korea
| | - Joung Hwan Back
- Sang Min Park and Young Ho Yun, Seoul National University College of Medicine; Joung Hwan Back, National Health Insurance Service, Seoul; Young Ae Kim, Minkyung Jo, Young-Joo Won, and Eun-Sook Lee, National Cancer Center, Goyang, Republic of Korea
| | - Eun-Sook Lee
- Sang Min Park and Young Ho Yun, Seoul National University College of Medicine; Joung Hwan Back, National Health Insurance Service, Seoul; Young Ae Kim, Minkyung Jo, Young-Joo Won, and Eun-Sook Lee, National Cancer Center, Goyang, Republic of Korea
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Abstract
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.
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Winkels RM, van Lee L, Beijer S, Bours MJ, van Duijnhoven FJB, Geelen A, Hoedjes M, Mols F, de Vries J, Weijenberg MP, Kampman E. Adherence to the World Cancer Research Fund/American Institute for Cancer Research lifestyle recommendations in colorectal cancer survivors: results of the PROFILES registry. Cancer Med 2016; 5:2587-95. [PMID: 27418442 PMCID: PMC5055169 DOI: 10.1002/cam4.791] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/12/2016] [Accepted: 05/13/2016] [Indexed: 12/31/2022] Open
Abstract
We examined adherence to the eight The World Cancer Research Foundation/American Institute for Cancer Research (WCRF/AICR) recommendations on diet, physical activity, and body weight among colorectal cancer survivors, and whether adherence was associated with intention to eat healthy and with the need for dietary advice. Adherence to these recommendations may putatively reduce the risk of recurrence and death. Studies on adherence to these recommendations in colorectal cancer (CRC) survivors are lacking. Adherence was assessed in a cross-sectional study among 1196 CRC survivors and could range between 0 (no adherence) and 8 points (complete adherence). Participants completed questionnaires on dietary intake, physical activity, and body weight. Prevalence Ratios were calculated to assess whether adherence to recommendations were associated with dietary intentions and needs. Twelve percentage of the survivors adhered to 6 or more recommendations; 65% had a score between >4 and 6 points; 23% scored no more than 4 points. The recommendation for to be modest with consumption of meat showed lowest adherence: 8% adhered; whereas the recommendation not to use dietary supplements showed highest adherence (75%). 18% reported a need for dietary advice, but this was not associated with adherence to recommendations. Survivors with higher adherence reported less often that they had received dietary advice, were less likely to have the intention to eat healthier, but reported more often that they had changed their diet since diagnosis. There is ample room for improvement of lifestyle recommendations in virtually all CRC survivors. A minor part of CRC survivors expressed a need for dietary advice which was not associated with adherence to the recommendations.
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Affiliation(s)
- Renate M Winkels
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
| | - Linde van Lee
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Martijn J Bours
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | | | - Anouk Geelen
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Meeke Hoedjes
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Floortje Mols
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jeanne de Vries
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Imaoka T, Nishimura M, Daino K, Morioka T, Nishimura Y, Uemura H, Akimoto K, Furukawa Y, Fukushi M, Wakabayashi K, Mutoh M, Shimada Y. A Rat Model to Study the Effects of Diet-Induced Obesity on Radiation-Induced Mammary Carcinogenesis. Radiat Res 2016; 185:505-15. [PMID: 27135968 DOI: 10.1667/rr14309.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A detailed understanding of the relationship between radiation-induced breast cancer and obesity is needed for appropriate risk management and to prevent the development of a secondary cancer in patients who have been treated with radiation. Our goal was to develop an animal model to study the relationship by combining two existing Sprague-Dawley rat models of radiation-induced mammary carcinogenesis and diet-induced obesity. Female rats were fed a high-fat diet for 4 weeks and categorized as obesity prone or obesity resistant based on their body weight at 7 weeks of age, at which time the rats were irradiated with 4 Gy. Control rats were fed a standard diet and irradiated at the same time and in the same manner. All rats were maintained on their initial diets and assessed for palpable mammary cancers once a week for the next 30 weeks. The obesity-prone rats were heavier than those in the other groups. The obesity-prone rats were also younger than the other animals at the first detection of mammary carcinomas and their carcinoma weights were greater. A tendency toward higher insulin and leptin blood levels were observed in the obesity-prone rats compared to the other two groups. Blood angiotensin II levels were elevated in the obesity-prone and obesity-resistant rats. Genes related to translation and oxidative phosphorylation were upregulated in the carcinomas of obesity-prone rats. Expression profiles from human breast cancers were used to validate this animal model. As angiotensin is potentially an important factor in obesity-related morbidities and breast cancer, a second set of rats was fed in a similar manner, irradiated and then treated with an angiotensin-receptor blocker, losartan and candesartan. Neither blocker altered mammary carcinogenesis; analyses of losartan-treated animals indicated that expression of renin in the renal cortex and of Agtr1a (angiotensin II receptor, type 1) in cancer tissue was significantly upregulated, suggesting the presence of compensating mechanisms for blocking angiotensin-receptor signaling. Thus, obesity-related elevation of insulin and leptin blood levels and an increase in available energy may facilitate sustained protein synthesis in cancer cells, which is required for rapid cancer development.
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Affiliation(s)
- Tatsuhiko Imaoka
- a Radiobiology for Children's Health Program, Research Center for Radiation Protection, National Institute of Radiological Sciences (NIRS) Chiba, Japan;,b Radiation Effect Accumulation and Prevention Project, Fukushima Project Headquarters, NIRS, Chiba, Japan
| | - Mayumi Nishimura
- a Radiobiology for Children's Health Program, Research Center for Radiation Protection, National Institute of Radiological Sciences (NIRS) Chiba, Japan;,b Radiation Effect Accumulation and Prevention Project, Fukushima Project Headquarters, NIRS, Chiba, Japan
| | - Kazuhiro Daino
- a Radiobiology for Children's Health Program, Research Center for Radiation Protection, National Institute of Radiological Sciences (NIRS) Chiba, Japan;,b Radiation Effect Accumulation and Prevention Project, Fukushima Project Headquarters, NIRS, Chiba, Japan
| | - Takamitsu Morioka
- a Radiobiology for Children's Health Program, Research Center for Radiation Protection, National Institute of Radiological Sciences (NIRS) Chiba, Japan;,b Radiation Effect Accumulation and Prevention Project, Fukushima Project Headquarters, NIRS, Chiba, Japan
| | - Yukiko Nishimura
- a Radiobiology for Children's Health Program, Research Center for Radiation Protection, National Institute of Radiological Sciences (NIRS) Chiba, Japan
| | - Hiroji Uemura
- c Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Kenta Akimoto
- a Radiobiology for Children's Health Program, Research Center for Radiation Protection, National Institute of Radiological Sciences (NIRS) Chiba, Japan;,d Division of Radiological Sciences, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuki Furukawa
- a Radiobiology for Children's Health Program, Research Center for Radiation Protection, National Institute of Radiological Sciences (NIRS) Chiba, Japan;,d Division of Radiological Sciences, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Masahiro Fukushi
- d Division of Radiological Sciences, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Keiji Wakabayashi
- e Graduate Division of Nutritional and Environmental Sciences, University of Shizuoka, Shizuoka, Japan; and
| | - Michihiro Mutoh
- f Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Yoshiya Shimada
- a Radiobiology for Children's Health Program, Research Center for Radiation Protection, National Institute of Radiological Sciences (NIRS) Chiba, Japan;,b Radiation Effect Accumulation and Prevention Project, Fukushima Project Headquarters, NIRS, Chiba, Japan
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Kang HT, Bahk HJ, Shim JY, Kim NK. Management of long-term colorectal cancer survivors in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.4.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyun Jung Bahk
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Yong Shim
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Daniel CR, Shu X, Ye Y, Gu J, Raju GS, Kopetz S, Wu X. Severe obesity prior to diagnosis limits survival in colorectal cancer patients evaluated at a large cancer centre. Br J Cancer 2015; 114:103-9. [PMID: 26679375 PMCID: PMC4716542 DOI: 10.1038/bjc.2015.424] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/04/2015] [Accepted: 11/12/2015] [Indexed: 12/17/2022] Open
Abstract
Background: In contrast to the consistent evidence for obesity and colorectal cancer (CRC) risk, the impact of obesity in CRC patients is less clear. In a well-characterised cohort of CRC patients, we prospectively evaluated class I and class II obesity with survival outcomes. Methods: The CRC patients (N=634) were followed from the date of diagnosis until disease progression/first recurrence (progression-free survival (PFS)) or death (overall survival (OS)). Body mass index (BMI) was calculated from reported usual weight prior to diagnosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated in models adjusted for clinicopathologic, treatment, and lifestyle factors. Results: Over a median follow-up of 4 years, 208 (33%) patients died and 235 (37%) recurred or progressed. Class II obesity, as compared with either overweight or normal weight, was associated with an increased risk of death (HR and 95% CI: 1.55 (0.97–2.48) and 1.65 (1.02–2.68), respectively), but no clear association was observed with PFS. In analyses restricted to patients who presented as stages I–III, who reported stable weight, or who were aged <50 years, obesity was associated with a significant two- to five-fold increased risk of death. Conclusions: In CRC patients evaluated at a large cancer centre, severely obese patients experienced worse survival outcomes independent of many other factors.
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Affiliation(s)
- C R Daniel
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Unit 1340, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - X Shu
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Unit 1340, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Y Ye
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Unit 1340, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - J Gu
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Unit 1340, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - G S Raju
- Department of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Kopetz
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - X Wu
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Unit 1340, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Hawkins NA, Berkowitz Z, Rodriguez JL. Awareness of Dietary and Alcohol Guidelines Among Colorectal Cancer Survivors. Am J Prev Med 2015; 49:S509-17. [PMID: 26590646 PMCID: PMC5833984 DOI: 10.1016/j.amepre.2015.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/04/2015] [Accepted: 08/19/2015] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Although dietary habits can affect colorectal cancer (CRC) survivors' health, it is unclear how familiar survivors are with dietary guidelines, what they believe about healthy eating and alcohol consumption, and what hinders healthy dietary habits after cancer. This study assessed CRC survivors' familiarity with dietary guidelines, their eating and drinking habits, and perceived facilitators and barriers to healthy eating after cancer, including social support and self-efficacy for maintaining a healthy diet and limiting alcohol. METHODS A total of 593 individuals (50% female; mean age, 74 years) diagnosed with CRC approximately 6 years prior to study entry in early 2010 were identified through California Cancer Registry records and participated in a cross-sectional mailed survey assessing health behavior after cancer (46% adjusted response rate). Analyses were conducted in 2014-2015. RESULTS Survivors were most familiar with-and most likely to follow-recommendations to choose low-fat foods; 15% had never heard of recommendations to limit alcohol. Survivors were more aware of recommendations involving messages to limit/avoid versus approach/choose certain foods. The most common barrier to a healthy diet involved the effort required (26%). Survivors received more family/friend support and provider recommendations for healthy eating than limiting alcohol. CONCLUSIONS Results provide an overview of awareness of and adherence to dietary recommendations among CRC survivors, highlighting the need for increasing awareness of recommendations that are especially relevant for survivors. Suggestions are made for modifying diet-related messages to facilitate comprehension and recall among CRC survivors, and increasing awareness among groups with the lowest awareness levels.
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Affiliation(s)
- Nikki A Hawkins
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Zahava Berkowitz
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Diedrich J, Gusky HC, Podgorski I. Adipose tissue dysfunction and its effects on tumor metabolism. Horm Mol Biol Clin Investig 2015; 21:17-41. [PMID: 25781550 DOI: 10.1515/hmbci-2014-0045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/14/2015] [Indexed: 12/12/2022]
Abstract
Growing by an alarming rate in the Western world, obesity has become a condition associated with a multitude of diseases such as diabetes, metabolic syndrome and various cancers. Generally viewed as an abnormal accumulation of hypertrophied adipocytes, obesity is also a poor prognostic factor for recurrence and chemoresistance in cancer patients. With more than two-thirds of the adult population in the United States considered clinically overweight or obese, it is critical that the relationship between obesity and cancer is further emphasized and elucidated. Adipocytes are highly metabolically active cells, which, through release of adipokines and cytokines and activation of endocrine and paracrine pathways, affect processes in neighboring and distant cells, altering their normal homeostasis. This work will examine specifically how adipocyte-derived factors regulate the cellular metabolism of malignant cells within the tumor niche. Briefly, tumor cells undergo metabolic pressure towards a more glycolytic and hypoxic state through a variety of metabolic regulators and signaling pathways, i.e., phosphoinositol-3 kinase (PI3K), hypoxia-inducible factor-1 alpha (HIF-1α), and c-MYC signaling. Enhanced glycolysis and high lactate production are hallmarks of tumor progression largely because of a process known as the Warburg effect. Herein, we review the latest literature pertaining to the body of work on the interactions between adipose and tumor cells, and underlining the changes in cancer cell metabolism that have been targeted by the currently available treatments.
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El-Shami K, Oeffinger KC, Erb NL, Willis A, Bretsch JK, Pratt-Chapman ML, Cannady RS, Wong SL, Rose J, Barbour AL, Stein KD, Sharpe KB, Brooks DD, Cowens-Alvarado RL. American Cancer Society Colorectal Cancer Survivorship Care Guidelines. CA Cancer J Clin 2015; 65:428-55. [PMID: 26348643 PMCID: PMC5385892 DOI: 10.3322/caac.21286] [Citation(s) in RCA: 292] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short-term and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.
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Affiliation(s)
- Khaled El-Shami
- Assistant Professor of Medicine, The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Kevin C Oeffinger
- Director, Cancer Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicole L Erb
- Program Manager, National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | - Anne Willis
- Director, Patient-Centered Programs, The George Washington University Cancer Institute, Washington, DC
| | - Jennifer K Bretsch
- Director, Performance Improvement, American Society of Clinical Oncology, Alexandria, VA
| | | | - Rachel S Cannady
- Behavioral Scientist, Behavioral Research Center/National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | - Sandra L Wong
- Associate Professor of Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Johnie Rose
- Assistant Professor, Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine/Case Comprehensive Cancer Center, Cleveland, OH
| | - April L Barbour
- Associate Professor of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kevin D Stein
- Vice President, Behavioral Research, Director, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Katherine B Sharpe
- Senior Vice President, Patient and Caregiver Support, American Cancer Society, Atlanta, GA
| | - Durado D Brooks
- Director, Cancer Control Intervention, American Cancer Society, Atlanta, GA
| | - Rebecca L Cowens-Alvarado
- Vice President, Behavioral Research, South Atlantic Health Systems, American Cancer Society, Atlanta, GA
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Woo J, Cohen SA, Grim JE. Targeted therapy in gastroesophageal cancers: past, present and future. Gastroenterol Rep (Oxf) 2015; 3:316-29. [PMID: 26510453 PMCID: PMC4650980 DOI: 10.1093/gastro/gov052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 12/12/2022] Open
Abstract
Gastroesophageal cancer is a significant global problem that frequently presents at an incurable stage and has very poor survival with standard chemotherapy approaches. This review will examine the epidemiology and molecular biology of gastroesophageal cancer and will focus on the key deregulated signaling pathways that have been targeted in the clinic. A comprehensive overview of clinical data highlighting successes and failures with targeted agents will be presented. Most notably, HER2-targeted therapy with the monoclonal antibody trastuzumab has proven beneficial in first-line therapy and has been incorporated into standard practice. Targeting the VEGF pathway has also proven beneficial, and the VEGFR-targeted monoclonal antibody ramucirumab is now approved for second-line therapy. In contrast to these positive results, agents targeting the EGFR and MET pathways have been evaluated extensively in gastroesophageal cancer but have repeatedly failed to show benefit. An increased understanding of the molecular predictors of response to targeted therapies is sorely needed. In the future, improved molecular pathology approaches should subdivide this heterogeneous disease entity to allow individualization of cancer therapy based on integrated and global identification of deregulated signaling pathways. Better patient selection, rational combinations of targeted therapies and incorporation of emerging immunotherapeutic approaches should further improve the treatment of this deadly disease.
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Affiliation(s)
- Janghee Woo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, Division of Medical Oncology, University of Washington, Seattle, WA, USA and
| | - Stacey A Cohen
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, Division of Medical Oncology, University of Washington, Seattle, WA, USA and
| | - Jonathan E Grim
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, Division of Medical Oncology, University of Washington, Seattle, WA, USA and Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, WA, USA
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Blogowski W, Dolegowska K, Deskur A, Dolegowska B, Starzyńska T. An Attempt to Evaluate Selected Aspects of "Bone-Fat Axis" Function in Healthy Individuals and Patients With Pancreatic Cancer. Medicine (Baltimore) 2015; 94:e1303. [PMID: 26266370 PMCID: PMC4616689 DOI: 10.1097/md.0000000000001303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Recently, much attention has been paid to a potential biochemical cross-talk between the metabolism of the adipose tissue (AT) and bone (marrow), termed "bone-fat axis." We hypothesized that selected substances, participating in this "dialog," are associated with body mass and peripheral trafficking of bone marrow-derived stem cells (BMSCs) in both healthy individuals and patients with obesity-associated malignancies such as pancreatic adenocarcinoma.We performed an analysis of the systemic levels of selected substances involved in the regulation of bone (marrow) homeostasis (parathormone, calcitonin, osteopontin, osteonectin, stem cell factor [SCF], and fibroblast growth factor-23) in 35 generally healthy volunteers and 35 patients with pancreatic cancer. Results were correlated with the absolute number of circulating BMSCs and body mass values. Additionally, subcutaneous and visceral/omental AT levels of the aforementioned molecules were analyzed in lean and overweight/obese individuals.Intensified steady-state trafficking of only Lin-CD45 + CD133 + hematopoietic stem/progenitor cells was observed in overweight/obese individuals and this was associated with BMI values and elevated levels of both osteonectin and SCF, which also correlated with BMI. In comparison to healthy individuals, patients with cancer had significantly higher osteopontin levels and lower values of both osteonectin and osteonectin/osteopontin ratio. While no significant correlation was observed between BMI and the number of circulating BMSCs in patients with cancer, peripheral trafficking of CD34 + KDR + CD31 + CD45-endothelial progenitor cells and CD105 + STRO-1 + CD45-mesenchymal stem cells was associated with the osteonectin/osteopontin ratio, which also correlated with BMI (r = 0.52; P < 0.05). AT levels of the examined substances were similar to those measured in the plasma, except for osteonectin, which was about 10 times lower.Our study highlights the potential role of osteonectin, osteopontin, and SCF as communication signals between the bone (marrow) and AT in both healthy individuals and patients with pancreatic cancer. We postulate that these molecules may be overlooked biochemical players linking body mass and BMSCs with obesity-associated cancer development and/or progression in humans.
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Affiliation(s)
- Wojciech Blogowski
- From the Department of Internal Medicine, University of Zielona Góra, Zielona Góra, Poland (WB); Department of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Szczecin, Poland (KD); Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland (AD); Department of Microbiology and Immunological Diagnostics, Pomeranian Medical University in Szczecin, Szczecin, Poland (BD); and Department of Gastroenterology and Internal Medicine, Warsaw Medical University, Warsaw, Poland (TS)
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50
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Lee YT, Liu CJ, Hu YW, Teng CJ, Tzeng CH, Yeh CM, Chen TJ, Lin JK, Lin CC, Lan YT, Wang HS, Yang SH, Jiang JK, Chen WS, Lin TC, Chang SC, Chen MH, Teng HW, Liu JH, Yen CC. Incidence of Second Primary Malignancies Following Colorectal Cancer: A Distinct Pattern of Occurrence Between Colon and Rectal Cancers and Association of Co-Morbidity with Second Primary Malignancies in a Population-Based Cohort of 98,876 Patients in Taiwan. Medicine (Baltimore) 2015; 94:e1079. [PMID: 26131831 PMCID: PMC4504576 DOI: 10.1097/md.0000000000001079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The purpose of this study is to determine the features of second primary malignancies (SPMs) among patients with prior colorectal cancer (CRC) using a nationwide population-based dataset.Patients with CRC newly diagnosed between 1996 and 2011, and >1 year of follow-up were recruited from the Taiwan National Health Insurance database. Standardized incidence ratios (SIRs) of SPMs in patients with CRC were calculated.During the 16-year study period, 4259 SPMs developed among 98,876 CRC patients. The median duration of follow-up was 4.03 years. The SIR for all SPMs was 1.13 (95% confidence interval = 1.10-1.17). Compared with the general population, a higher incidence of thyroid, prostate, ovarian, and hematologic malignancies developed among patients with colon cancer, whereas the risk for bone and soft tissue cancers increased among patients with rectal cancer. The risk for breast, bladder, kidney, lung, and uterine cancers was significantly higher in patients with colon and rectal cancers than the general population. The risk for liver and biliary tract cancers declined in patients with rectal cancer. Based on multivariate analysis among patients with CRC, age ≥70 years, men, chronic obstructive pulmonary disease (COPD), cirrhosis, and dyslipidemia were independent predictors of an SPM.In conclusion, patients with CRC were at increased risk for a second cancer. The pattern of SPMs was distinct between patients with colon and rectal cancer. Age, men, COPD, cirrhosis, and dyslipidemia were independent risk factors for SPMs. Surveillance and education should be provided for survivors with respect to risk for SPMs.
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Affiliation(s)
- Yu-Ting Lee
- From the Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (Y-TL, C-JL, C-HT, M-HC, H-WT, C-CY); National Yang-Ming University School of Medicine, Taipei, Taiwan (Y-TL, C-JL, , Y-WH, C-JT, C-HT, T-JC, J-KL, C-CL, Y-TL, H-SW, S-HY, J-KJ, W-SC, T-CL, S-CC, M-HC, H-WT, J-HL, C-CY); Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan (Y-WH, J-HL); Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan (C-JT); Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (C-MY, T-JC); and Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan (J-KL, C-CL, Y-TL, H-SW, S-HY, J-KJ, W-SC, T-CL, S-CC)
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