Survivorship in gynecologic cancer: enduring the treatment toward a new normal

Eliminating Digestive Irregularities Caused by Late Effects: A Pilot Study of an Innovative Culinary Nutrition Intervention for Reducing Gastrointestinal Toxicity in Gynecologic Cancer Patients Who Have Undergone Pelvic Radiotherapy

BACKGROUND/OBJECTIVES

Pelvic radiotherapy (RT) improves survival in gynecologic cancer patients but often results in gastrointestinal (GI) toxicity, affecting quality of life. Standard nutrition guidance lacks specificity for these survivors, complicating dietary choices. To address this gap, the EDIBLE intervention was developed to offer structured dietary self-management skills to alleviate RT-induced GI toxicity.

METHODS

We conducted a single-arm mixed-methods pilot of the EDIBLE intervention among post-treatment gynecologic cancer survivors to assess its feasibility, acceptability, and preliminary effects on GI symptoms, knowledge, and self-efficacy, with measures at baseline (T1), post-intervention (T2), and after 3 months (T3).

RESULTS

Qualitative interviews supported strong perceptions of intervention feasibility; however, the recruitment (32%) and retention (72%) rates were modest, indicating that alternate formats for program delivery may be needed to make it more accessible. The acceptability of the EDIBLE intervention garnered especially high ratings on measures of satisfaction and utility, with program improvements largely rallying around a desire for increased in-class sessions and program expansion. Statistically significant improvements were observed at the three-month mark (T3), such as enhanced confidence in culinary practices, increased knowledge and skills with regard to managing GI side effects, and improvements in bowel and GI symptoms.

CONCLUSIONS

The results suggest EDIBLE is acceptable, improving GI symptoms and self-efficacy; however, moderate recruitment rates indicate refinement is needed. A randomized control trial and cost-effectiveness analysis is needed to confirm effectiveness and scalability.

Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70)

BACKGROUND

Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)-defined as having biological children with more than one partner, with obesity at midlife.

METHOD

The sample consisted of 2940 fathers and 3369 mothers in the 1970 British Cohort Study. The outcome was obesity (BMI 30 or over) at age 46. Fertility and partnership histories ascertained the number of live biological children and MPF status by age 42. The associations were tested using logistic regression adjusting for confounders at birth, age 10 and age 16. Adult factors recorded at age 42 including age at first birth, smoking status, alcohol dependency, educational attainment and housing tenure were considered as mediators.

RESULTS

For fathers, obesity odds did not differ according to number of children or MPF. In unadjusted models, mothers with one child (OR 1.24 95%CI 1.01-1.51), mothers who had two children with two partners (OR 1.45 95%CI 1.05-1.99), and mothers who had three or more children with two or more partners (OR 1.51 95%CI 1.18-1.93) had higher odds of obesity. In adjusted models, there remained an association between mothers with one child and odds of obesity (OR 1.30 95%CI 1.05-1.60). All other associations were attenuated when confounders were included.

CONCLUSIONS

Mothers who had children with multiple partners had higher odds of obesity. However this association was completely attenuated when parental and child confounders were accounted for; suggesting that this association may be explained by confounding. Mothers who had one child only may be at increased odds of obesity, however this could be due to multiple factors including age at first birth.

Obesity and gynecological cancers: A toxic relationship

Despite the evidence supporting the relevance of obesity and obesity‐associated disorders in the development, management, and prognosis of various cancers, obesity rates continue to increase worldwide. Growing evidence supports the involvement of obesity in the development of gynecologic malignancies. This article explores the molecular basis governing the alteration of hallmarks of cancer in the development of obesity‐related gynecologic malignancies encompassing cervical, endometrial, and ovarian cancers. We highlight specific examples of how development, management, and prognosis are affected for each cancer, incorporate current knowledge on complementary approaches including lifestyle interventions to improve patient outcomes, and highlight how new technologies are helping us better understand the biology underlying this neglected pandemic.

This review focuses on how obesity impacts cancer hallmarks in gynecologic malignancies, thus affecting the diagnosis, management, treatment, and prognosis of these diseases.

Clinical Behavior and Treatment of Endometrial Cancer

Endometrial cancer is the most common gynecologic malignancy diagnosed in women in the developed nations. It affects a disproportionate number of reproductive-aged women. While the overall prognosis is good compared to other cancers affecting women, the pathogenesis and clinical behavior of endometrial cancer are heterogeneous. The risk factors associated with the type I and type II endometrial cancers and their pathogenesis will be discussed, as well as the evaluation and primary treatment of women with endometrial cancer. The chapter will also focus on risk stratification for recurrence after surgery and role of adjuvant treatments. Finally, the treatment of recurrent endometrial cancer will be presented.