1
|
Puklin LS, Ferrucci LM, Harrigan M, McGowan C, Zupa M, Cartmel B, Li FY, Ligibel JA, Spiegelman D, Sharifi M, Sanft T, Irwin ML. Improving lifestyle behaviors during chemotherapy for breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis (LEANer) Trial. Cancer 2024. [PMID: 38470431 DOI: 10.1002/cncr.35280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Little is known about improving physical activity (PA) and diet during and after chemotherapy for breast cancer. This secondary analysis examines changes in PA and diet quality during a yearlong intervention for patients with breast cancer undergoing chemotherapy and evaluates factors associated with these changes. METHODS Newly diagnosed patients with breast cancer (N = 173) undergoing chemotherapy were randomized to a year-long nutrition and exercise intervention (n = 87) or usual care (UC, n = 86). Mixed models compared 1-year changes in PA and diet quality via the Healthy Eating Index (HEI)-2015 by study arm. Among the intervention group, baseline factors associated with change in PA and diet were assessed with multivariable linear and logistic regression. RESULTS At 1 year, compared with UC, the intervention arm increased PA more (mean difference = 136.1 minutes/week; 95% CI, 90.2-182.0), participated in more strength training (56% vs. 15%; p < .001), and had suggestive improvements in HEI-2015 (mean difference = 2.5; 95% CI, -0.3 to 5.3; p = .08). In the intervention arm, lower fatigue was associated with improved PA (p = .04) and higher education was associated with improved HEI-2015 (p = .001) at 1 year. Higher HEI-2015 (p = .04) and married/living with someone (p = .05) were associated with higher odds of participating in strength training at 1 year. CONCLUSIONS This year-long lifestyle intervention for patients with breast cancer undergoing chemotherapy resulted in increases in PA and suggestive improvements in diet quality. Behavior change was associated with baseline fatigue, diet quality, education, and married/living with someone. Addressing these factors in interventions may improve uptake of lifestyle behaviors in trials during and after chemotherapy.
Collapse
Affiliation(s)
- Leah S Puklin
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Leah M Ferrucci
- Yale School of Public Health, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Maura Harrigan
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Courtney McGowan
- Yale School of Public Health, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Michelle Zupa
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Fang-Yong Li
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Donna Spiegelman
- Yale School of Public Health, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Mona Sharifi
- Yale School of Public Health, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melinda L Irwin
- Yale School of Public Health, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| |
Collapse
|
2
|
Cao A, Esserman DA, Cartmel B, Irwin ML, Ferrucci LM. Association between diet quality and ovarian cancer risk and survival. J Natl Cancer Inst 2024:djae040. [PMID: 38400738 DOI: 10.1093/jnci/djae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Research on diet quality and ovarian cancer is limited. We examined the association between diet quality and ovarian cancer risk and survival in a large prospective cohort. METHODS We utilized data from women in the prospective NIH-AARP Diet and Health Study enrolled from 1995-1996 and were 50-71 years old at baseline with follow-up through 12/31/2017. Participants completed a 124-item Food Frequency Questionnaire at baseline and diet quality was assessed via the Healthy Eating Index-2015 (HEI-2015), the alternate Mediterranean diet score (aMED), and the Dietary Approaches to Stop Hypertension score (DASH). Primary outcomes were first primary epithelial ovarian cancer diagnosis from cancer registry data, and among those diagnosed with ovarian cancer all-cause mortality. We used a semi-Markov multi-state model with Cox proportional hazards regression to account for semi-competing events. RESULTS Among 150,643 participants with a median follow-up time of 20.5 years, 1,107 individuals were diagnosed with a first primary epithelial ovarian cancer. There was no evidence of an association between diet quality and ovarian cancer risk. Among those diagnosed with epithelial ovarian cancer, 893 deaths occurred with a median survival of 2.5 years. Better pre-diagnosis diet quality, according to the HEI-2015 (Quintile 5 vs Quintile 1 HR = 0.75 [0.60-0.93]) and aMED (Quintile 5 vs Quintile 1: HR = 0.68, [0.53-0.87]) was associated with lower all-cause mortality. There was no evidence of an association between DASH and all-cause mortality. CONCLUSIONS Better pre-diagnosis diet quality was associated with lower all-cause mortality after ovarian cancer diagnosis, but was not associated with ovarian cancer risk.
Collapse
Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, 06520, CT, USA
| | - Denise A Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, 06520, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, 06520, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, 06520, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| |
Collapse
|
3
|
Banas J, McDowell Cook A, Raygoza-Cortez K, Davila D, Irwin ML, Ferrucci LM, Humphries DL. United States Long-Term Trends in Adult BMI (1959-2018): Unraveling the Roots of the Obesity Epidemic. Int J Environ Res Public Health 2024; 21:73. [PMID: 38248537 PMCID: PMC10815706 DOI: 10.3390/ijerph21010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
The escalating rates of obesity since the 1950s poses a critical public health challenge across all age groups in the United States. While numerous studies have examined cross-sectional disparities across racial, ethnic, and socioeconomic groups, there has been limited research on long-term trends. To address this gap, we analyzed average adult body mass index (BMI) trends from 1959 to 2018, using data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Examination Survey (NHES). Employing time series analysis, we evaluated BMI trends across income, education, and race/ethnicity. The results revealed a consistent upward trajectory in average BMI across all groups over the six-decade period, with no significant differences by income or education levels among high school graduates. However, individuals with less than a high school education displayed a more gradual increase in BMI. Racial disparities were also evident, with Black adults showing higher BMI growth rates compared to White adults, while Hispanic and other racial groups experienced slower increases. These findings underscore the need for systemic interventions to address the ongoing obesity epidemic, emphasizing the importance of research to identify trends over time and a system-thinking approach to inform effective population-level interventions and policy decisions.
Collapse
Affiliation(s)
- Julia Banas
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA
| | | | | | - Daniel Davila
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA
| | - Melinda L Irwin
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Leah M Ferrucci
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA
- Yale Cancer Center, New Haven, CT 06510, USA
| | | |
Collapse
|
4
|
Puklin LS, Li F, Cartmel B, Zhao J, Sanft T, Lisevick A, Winer EP, Lustberg M, Spiegelman D, Sharifi M, Irwin ML, Ferrucci LM. Post-diagnosis weight trajectories and mortality among women with breast cancer. NPJ Breast Cancer 2023; 9:98. [PMID: 38042922 PMCID: PMC10693588 DOI: 10.1038/s41523-023-00603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/16/2023] [Indexed: 12/04/2023] Open
Abstract
Weight gain after breast cancer diagnosis is associated with adverse health outcomes. Yet, few studies have characterized post-diagnosis weight change in the modern treatment era or populations most at risk for weight changes. Among women diagnosed with stages I-III breast cancer in the Smilow Care Network (2013-2019; N = 5441), we abstracted demographic and clinical characteristics from electronic health records and survival data from tumor registries. We assessed if baseline characteristics modified weight trajectories with nonlinear multilevel mixed-effect models. We evaluated body mass index (BMI) at diagnosis and weight change 1-year post-diagnosis in relation to all-cause and breast cancer-specific mortality with Cox proportional hazard models. Women had 34.4 ± 25.5 weight measurements over 3.2 ± 1.8 years of follow-up. Weight gain was associated with ER/PR-, HER2+ tumors, BMI ≤ 18.5 kg/m2, and age ≤ 45 years (+4.90 kg (standard error [SE] = 0.59), +3.24 kg (SE = 0.34), and +1.75 kg (SE = 0.10), respectively). Weight loss was associated with BMI ≥ 35 kg/m2 and age ≥ 70 years (-4.50 kg (SE = 0.08) and -4.34 kg (SE = 0.08), respectively). Large weight loss (≥10%), moderate weight loss (5-10%), and moderate weight gain (5-10%) 1-year after diagnosis were associated with higher all-cause mortality (hazard ratio [HR] = 2.93, 95% confidence interval [CI] = 2.28-3.75, HR = 1.32, 95% CI = 1.02-1.70 and HR = 1.39, 95% CI = 1.04-1.85, respectively). BMI ≥ 35 kg/m2 or BMI ≤ 18.5 kg/m2 at diagnosis were also associated with higher all-cause mortality. Weight change after a breast cancer diagnosis differed by demographic and clinical characteristics highlighting subgroups at-risk for weight change during a 5-year period post-diagnosis. Monitoring and interventions for weight management early in clinical care are important.
Collapse
Affiliation(s)
- Leah S Puklin
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA.
| | - Fangyong Li
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Brenda Cartmel
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| | - Julian Zhao
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Alexa Lisevick
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
- Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Eric P Winer
- Yale Cancer Center, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Maryam Lustberg
- Yale Cancer Center, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Donna Spiegelman
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| | - Mona Sharifi
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Melinda L Irwin
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| | - Leah M Ferrucci
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| |
Collapse
|
5
|
Sanft T, Harrigan M, McGowan C, Cartmel B, Zupa M, Li FY, Ferrucci LM, Puklin L, Cao A, Nguyen TH, Neuhouser ML, Hershman DL, Basen-Engquist K, Jones BA, Knobf T, Chagpar AB, Silber A, Tanasijevic A, Ligibel JA, Irwin ML. Randomized Trial of Exercise and Nutrition on Chemotherapy Completion and Pathologic Complete Response in Women With Breast Cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis Study. J Clin Oncol 2023; 41:5285-5295. [PMID: 37656930 PMCID: PMC10691793 DOI: 10.1200/jco.23.00871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/31/2023] [Accepted: 07/19/2023] [Indexed: 09/03/2023] Open
Abstract
PURPOSE Successful completion of chemotherapy is critical to improve breast cancer outcomes. Relative dose intensity (RDI), defined as the ratio of chemotherapy delivered to prescribed, is a measure of chemotherapy completion and is associated with cancer mortality. The effect of exercise and eating a healthy diet on RDI is unknown. We conducted a randomized trial of an exercise and nutrition intervention on RDI and pathologic complete response (pCR) in women diagnosed with breast cancer initiating chemotherapy. METHODS One hundred seventy-three women with stage I-III breast cancer were randomly assigned to usual care (UC; n = 86) or a home-based exercise and nutrition intervention with counseling sessions delivered by oncology-certified registered dietitians (n = 87). Chemotherapy dose adjustments and delays and pCR were abstracted from electronic medical records. T-tests and chi-square tests were used to examine the effect of the intervention versus UC on RDI and pCR. RESULTS Participants randomly assigned to intervention had greater improvements in exercise and diet quality compared with UC (P < .05). RDI was 92.9% ± 12.1% and 93.6% ± 11.1% for intervention and UC, respectively (P = .69); the proportion of patients in the intervention versus UC who achieved ≥85% RDI was 81% and 85%, respectively (P = .44). The proportion of patients who had at least one dose reduction and/or delay was 38% intervention and 36% UC (P = .80). Among 72 women who received neoadjuvant chemotherapy, women randomly assigned to intervention were more likely to have a pCR than those randomly assigned to UC (53% v 28%; P = .037). CONCLUSION Although a diet and exercise intervention did not affect RDI, the intervention was associated with a higher pCR in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative and triple-negative breast cancer undergoing neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- Tara Sanft
- Yale University School of Medicine, New Haven, CT
- Yale Cancer Center, New Haven, CT
| | | | | | - Brenda Cartmel
- Yale Cancer Center, New Haven, CT
- Yale School of Public Health, New Haven, CT
| | | | | | - Leah M. Ferrucci
- Yale Cancer Center, New Haven, CT
- Yale School of Public Health, New Haven, CT
| | | | - Anlan Cao
- Yale School of Public Health, New Haven, CT
| | | | | | | | | | - Beth A. Jones
- Yale Cancer Center, New Haven, CT
- Yale School of Public Health, New Haven, CT
| | - Tish Knobf
- Yale Cancer Center, New Haven, CT
- Yale School of Nursing, New Haven, CT
| | - Anees B. Chagpar
- Yale University School of Medicine, New Haven, CT
- Yale Cancer Center, New Haven, CT
| | - Andrea Silber
- Yale University School of Medicine, New Haven, CT
- Yale Cancer Center, New Haven, CT
| | | | | | - Melinda L. Irwin
- Yale Cancer Center, New Haven, CT
- Yale School of Public Health, New Haven, CT
| |
Collapse
|
6
|
Pichardo MS, Ferrucci LM, Molina Y, Esserman DA, Irwin ML. Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review. Cancer Epidemiol Biomarkers Prev 2023; 32:1498-1507. [PMID: 37650844 PMCID: PMC10872641 DOI: 10.1158/1055-9965.epi-22-1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/02/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
One in three adults in the United States has obesity; a chronic disease that is implicated in the etiology of at least 14 cancers. Cancer is the leading cause of death among U.S. Hispanic/Latino adults and the second most common cause of death, after cardiovascular disease, for Black adults. Our country's legacy in overt discrimination (e.g., slavery, segregation) generated inequities across all spheres in which people function as defined by the socioecological model-biological, individual, community, structural-and two of the many areas in which it manifests today are the disproportionate burden of obesity and obesity-related cancers in populations of color. Inequities due to environmental, social, and economic factors may predispose individuals to poor lifestyle behaviors by hindering an individual's opportunity to make healthy lifestyles choices. In this review, we examined the evidence on obesity and the lifestyle guidelines for cancer prevention in relation to cancer risk and outcomes for Black and Hispanic/Latino adults. We also discussed the role of structural and societal inequities on the ability of these two communities to adopt and maintain healthful lifestyle behaviors in accordance with the lifestyle guidelines for cancer prevention and control.
Collapse
Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA 19104
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| | - Yamile Molina
- School of Public Health, University of Illinois Chicago and Cancer Center University of Illinois Chicago, 60607
| | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| |
Collapse
|
7
|
Cao A, Cartmel B, Li FY, Gottlieb LT, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Irwin ML, Ferrucci LM. Effect of exercise on body composition among women with ovarian cancer. J Cancer Surviv 2023; 17:1386-1396. [PMID: 35377104 PMCID: PMC9530065 DOI: 10.1007/s11764-022-01207-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Obesity is associated with a higher risk of mortality in women with ovarian cancer. Exercise has improved body composition among cancer survivors, yet no randomized controlled trial has explored the effect of exercise on body composition in women with ovarian cancer. In this analysis, we examined the effect of a six-month aerobic exercise intervention on body composition among ovarian cancer survivors in the Women's Activity and Lifestyle Study in Connecticut (WALC). METHODS Women with ovarian cancer (N = 144) were randomized in a 1:1 ratio to 6 months of an aerobic exercise intervention or attention-control, and body composition was measured as a secondary outcome at baseline and 6 months via dual-energy X-ray absorptiometry (DEXA). Women with at least one DEXA scan were included in the analysis (N = 103). RESULTS On average, participants were 57.1 (± 8.7) years old and 1.6 (± 0.9) years since diagnosis. Women randomized to exercise maintained weight during the trial (- 0.11 kg, P = 0.82), while women in attention-control gained weight (+ 1.40 kg, P = 0.03); however, the between-group difference did not reach statistical significance (P = 0.09). We found no statistically significant differences by study arm for changes in body fat percentage, bone mineral density, or lean body mass. CONCLUSIONS Weight was maintained as a result of a 6-month aerobic exercise intervention among post-treatment ovarian cancer survivors. Future exercise and healthy eating interventions should consider additional measures (e.g., computer tomography scans, D3-creatinine) to more accurately assess changes in body composition. IMPLICATIONS FOR CANCER SURVIVORS Moderate-intensity aerobic exercise may help ovarian cancer survivors maintain weight.
Collapse
Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA.
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Fang-Yong Li
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Linda T Gottlieb
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Maura Harrigan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | | | | | - Peter E Schwartz
- Geisinger Health System, Danville, PA, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| |
Collapse
|
8
|
Puklin LS, Harrigan M, Cartmel B, Sanft T, Gottlieb L, Zhou B, Ferrucci LM, Li FY, Spiegelman D, Sharifi M, Irwin ML. Randomized Trial Evaluating a Self-Guided Lifestyle Intervention Delivered via Evidence-Based Materials versus a Waitlist Group on Changes in Body Weight, Diet Quality, Physical Activity, and Quality of Life among Breast Cancer Survivors. Cancers (Basel) 2023; 15:4719. [PMID: 37835412 PMCID: PMC10571774 DOI: 10.3390/cancers15194719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Background: Lifestyle interventions for breast cancer survivors have proved effective at stimulating positive behavior change and promoting healthy weight loss, although integrating these programs into clinical practice is challenging. We evaluated the effect of a 6-month, unsupervised, self-guided, lifestyle intervention using printed materials and online videos vs. waitlist group on body weight for breast cancer survivors. Methods: The Lifestyle, Exercise and Nutrition (LEAN) Self-Guided trial randomized breast cancer survivors with a body mass index ≥25 kg/m2 to a 6-month lifestyle intervention (N = 102) or waitlist group (N = 103). Effects of the intervention on self-reported body weight, physical activity (PA), diet quality (via Health Eating Index-2010 (HEI-2010)), and quality of life were assessed using mixed model repeated measures analysis. Results: At 6 months, the intervention arm had significantly greater weight loss compared with the waitlist group (mean difference = -1.3 kg, 95% confidence interval [CI] = -2.5, -0.13). We observed suggestive improvements in PA (mean difference = 18.7 min/week, 95% CI = -24.2, 61.6), diet quality (mean difference in HEI = 3.2 points, 95% CI = -0.20, 6.5), and fatigue (mean difference in Functional Assessment of Chronic Illness Therapy-Fatigue scale = 1.4 points, 95% CI = -1.1, 3.9). Conclusions: The LEAN Self-Guided intervention led to favorable weight changes over 6 months. Low-resource-intensive programs have the potential to be delivered in diverse healthcare settings and may support breast cancer survivors in achieving a healthy body weight.
Collapse
Affiliation(s)
- Leah S. Puklin
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
| | - Maura Harrigan
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
| | - Brenda Cartmel
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT 06510, USA
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Linda Gottlieb
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
| | - Bin Zhou
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Leah M. Ferrucci
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Fang-Yong Li
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Donna Spiegelman
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Mona Sharifi
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Melinda L. Irwin
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| |
Collapse
|
9
|
Cao A, Cartmel B, Li FY, Gottlieb LT, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Esserman DA, Irwin ML, Ferrucci LM. Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Among Patients Treated for Ovarian Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2326463. [PMID: 37526937 PMCID: PMC10394582 DOI: 10.1001/jamanetworkopen.2023.26463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/20/2023] [Indexed: 08/02/2023] Open
Abstract
Importance Chemotherapy-induced peripheral neuropathy (CIPN), one of the most common and severe adverse effects of chemotherapy, is associated with worse quality of life among survivors of ovarian cancer. Currently, there is no effective treatment for CIPN. Objective To evaluate the effect of a 6-month aerobic exercise intervention vs attention-control on CIPN among women treated for ovarian cancer in the Women's Activity and Lifestyle Study in Connecticut (WALC) to provide evidence to inform the guidelines and recommendations for prevention or treatment of CIPN. Design, Setting, and Participants This prespecified secondary analysis evaluated the Women's Activity and Lifestyle Study in Connecticut (WALC), a multicentered, open-label, population-based, phase 3 randomized clinical trial of an aerobic exercise intervention vs attention control for CIPN in patients who were diagnosed with ovarian cancer. Only WALC participants who received chemotherapy were included in this analysis. Participants were randomized 1:1 to either a 6-month aerobic exercise intervention or to attention control. All analyses were conducted between September 2022 and January 2023. Interventions The exercise intervention consisted of home-based moderate-intensity aerobic exercise facilitated by weekly telephone counseling from an American College of Sports Medicine/American Cancer Society-certified cancer exercise trainer. Attention control involved weekly health education telephone calls from a WALC staff member. Main Outcomes and Measure Change in CIPN was the primary outcome in this secondary analysis. This outcome was represented by CIPN severity, which was self-measured by participants at baseline and 6 months using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity scale, with a score range of 0 to 44. A mixed-effects model was used to assess the 6-month change in CIPN between the exercise intervention and attention control arms. Results Of the 134 participants (all females; mean [SD] age, 57.5 [8.3] years) included in the analysis, 69 were in the exercise intervention arm and 65 were in the attention control arm. The mean (SD) time since diagnosis was 1.7 (1.0) years. The mean (SD) baseline CIPN scores were 8.1 (5.6) in the exercise intervention arm and 8.8 (7.9) in the attention control arm (P = .56). At 6 months, the self-reported CIPN score was reduced by 1.3 (95% CI, -2.3 to -0.2) points in the exercise intervention arm compared with an increase of 0.4 (95% CI, -0.8 to 1.5) points in the attention control arm. The between-group difference was -1.6 (95% CI, -3.1 to -0.2) points. The point estimate was larger among the 127 patients with CIPN symptoms at enrollment (-2.0; 95% CI, -3.6 to -0.5 points). Conclusions and Relevance Findings of this secondary analysis of the WALC trial indicate that a 6-month aerobic exercise intervention vs attention control significantly improved self-reported CIPN among patients who were treated for ovarian cancer. While replication of the findings in other studies is warranted, incorporating referrals to exercise programs into standard oncology care could reduce CIPN symptoms and increase quality of life in patients with ovarian cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02107066.
Collapse
Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| | - Fang-Yong Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Linda T. Gottlieb
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Maura Harrigan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | | | | | | | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| |
Collapse
|
10
|
Akingbesote ND, Owusu D, Liu R, Cartmel B, Ferrucci LM, Zupa M, Lustberg MB, Sanft T, Blenman KRM, Irwin ML, Perry RJ. A review of the impact of energy balance on triple-negative breast cancer. J Natl Cancer Inst Monogr 2023; 2023:104-124. [PMID: 37139977 DOI: 10.1093/jncimonographs/lgad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023] Open
Abstract
Cancer cells cannot proliferate without sufficient energy to generate biomass for rapid cell division, as well as to fuel their functions at baseline. For this reason, many recent observational and interventional studies have focused on increasing energy expenditure and/or reducing energy intake during and after cancer treatment. The impact of variance in diet composition and in exercise on cancer outcomes has been detailed extensively elsewhere and is not the primary focus of this review. Instead, in this translational, narrative review we examine studies of how energy balance impacts anticancer immune activation and outcomes in triple-negative breast cancer (TNBC). We discuss preclinical, clinical observational, and the few clinical interventional studies on energy balance in TNBC. We advocate for the implementation of clinical studies to examine how optimizing energy balance-through changes in diet and/or exercise-may optimize the response to immunotherapy in people with TNBC. It is our conviction that by taking a holistic approach that includes energy balance as a key factor to be considered during and after treatment, cancer care may be optimized, and the detrimental effects of cancer treatment and recovery on overall health may be minimized.
Collapse
Affiliation(s)
- Ngozi D Akingbesote
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
| | - Dennis Owusu
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti Region, Ghana
| | - Ryan Liu
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
- Cedar Park High School, Cedar Park, TX, USA
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Leah M Ferrucci
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | | | - Maryam B Lustberg
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Tara Sanft
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Kim R M Blenman
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
- Department of Computer Science, Yale University, New Haven, CT, USA
| | - Melinda L Irwin
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Rachel J Perry
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| |
Collapse
|
11
|
Cao A, Cartmel B, Li FY, Gottlieb LT, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Irwin ML, Ferrucci LM. Exercise adherence in a randomized controlled trial of exercise on quality of life in ovarian cancer survivors. J Cancer Surviv 2023; 17:535-543. [PMID: 36550261 PMCID: PMC10038915 DOI: 10.1007/s11764-022-01325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Factors associated with improving exercise in ovarian cancer survivors remain unknown. We explored characteristics associated with exercise adherence among women treated for ovarian cancer in the Women's Activity and Lifestyle Study in Connecticut (WALC) randomized controlled trial. METHODS We evaluated adherence among women randomized to the WALC exercise intervention (N = 74). Women had to be exercising ≤ 90 min/week and post-treatment. The intervention included 25 telephone-based exercise counseling sessions over 6 months. Adherence was defined as 150 min/week of moderate/vigorous-intensity exercise. We evaluated factors associated with exercise adherence and duration using multivariate logistic and linear regression. The number of sessions sufficient to achieve 150 min/week was modeled with an unadjusted receiver operating characteristic (ROC) curve. RESULTS Women were 57.3 ± 8.8 years old and 1.7 ± 1.0 years since diagnosis. The mean exercise time over 6 months was 166.0 ± 66.1 min/week, and 64.9% of women met the 150 min/week goal. Women attended 22.8 ± 3.6 (92%) counseling sessions. No cancer recurrence during the study (OR = 9.15, 95% CI: 1.09-44.02) and greater session attendance (OR = 1.21, 95% CI: 1.02-1.43) were related to meeting the exercise goal. Greater session attendance (P < 0.01) and higher baseline activity level (P = 0.02) were associated with greater average weekly exercise duration. The ROC curve suggested attending 18 counseling sessions was optimal to meet the exercise goal. CONCLUSIONS Women attending more counseling sessions or with no cancer recurrence during the study were more likely to meet the exercise goal. More research is needed to understand ideal counseling intensity for ovarian cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Eighteen counseling sessions are sufficient for ovarian cancer survivors to achieve 150 min/week exercise.
Collapse
Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA.
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Fang-Yong Li
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Linda T Gottlieb
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | - Maura Harrigan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
| | | | | | | | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA
- Yale Cancer Center, New Haven, CT, USA
| |
Collapse
|
12
|
Pichardo MS, Sanft T, Ferrucci LM, Romero-Ramos YM, Cartmel B, Harrigan M, Velazquez AI, Fayanju OM, Winer EP, Irwin ML. Diet and physical activity interventions in Black and Latina women with breast cancer: A scoping review. Front Oncol 2023; 13:1079293. [PMID: 36994212 PMCID: PMC10040823 DOI: 10.3389/fonc.2023.1079293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/30/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundA growing number of lifestyle interventions are being developed to promote weight loss and adoption of a healthful lifestyles among breast cancer survivors; yet Black and Latina women remain underrepresented.PurposeWe performed a scoping review of the available peer-reviewed literature to describe and compare the content, design, methods, and primary outcomes of current diet and/or physical activity (PA) interventions after a breast cancer diagnosis among Black and Latina women.MethodsWe queried PubMed, EMBASE, CINAHL, MEDLINE, and Clinicaltrials.gov up to October 1, 2022, to identify all randomized controlled trials of diet and/or PA after diagnosis of breast cancer with a majority (>50%) of Black or Latina participants.ResultsTwenty-two randomized controlled trials were included in this review (five efficacy, twelve pilot, five on-going). Nine trials were among Latinas (two diet, four PA, and three diet/PA), six among Blacks (one PA and five diet/PA) and seven included both populations (five PA and two diet/PA), all of which examined different endpoints. Two of the five efficacy studies achieved their a priori outcome (one diet trial improved short term dietary intake; one PA trial achieved clinically significant improvements in metabolic syndrome score), both in Latinas. Eight pilot trials intervened on both diet and PA and three of them found favorable behavioral changes. Three (two for Latinas and one for Blacks) out of the nine diet and PA trials and three (all for Latinas) efficacy trials incorporated a culturally focused approach (i.e., traditional foods, music, Spanish content, bicultural health coaches, spirituality). Overall, four trials, including one efficacy trial, had one-year follow-up data, with three finding sustained behavior change. Electronic/mobile components were incorporated in five trials and one involved informal care givers. Most of the trials were geographically limited to the Northeast USA (n=8, NY, NC, DC, NJ) and Texas (n=4).ConclusionsMost of the trials we identified were pilot or feasibility studies and of short duration, demonstrating the need for large randomized controlled efficacy lifestyle interventions among Black and Latina breast cancer survivors. Culturally tailored programing was limited but is an important component to incorporate in future trials in these populations.
Collapse
Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Margaret S. Pichardo,
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, United States
- Deparment of Medical Oncology, Yale School of Medicine, New Haven, CT, United States
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
| | | | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
| | | | - Ana I. Velazquez
- Department of Medicine, Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | | | - Eric P. Winer
- Yale Cancer Center, New Haven, CT, United States
- Deparment of Medical Oncology, Yale School of Medicine, New Haven, CT, United States
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
| |
Collapse
|
13
|
Pichardo MS, Irwin ML, Sanft T, Ferrucci LM, Ginader A, Nguyen TH, Esserman D, Cartmel B, Molina Y. A qualitative study identifying challenges resulting from complex evidence on lifestyle factors and cancer: perspectives from Black and Latina cancer survivors and healthcare providers. Support Care Cancer 2023; 31:111. [PMID: 36633678 PMCID: PMC9912693 DOI: 10.1007/s00520-022-07539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/10/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Most breast cancer survivors have challenges with adopting healthy lifestyle behaviors. This may be due to contextual challenges that result from the complex nature of the evidence. To address this gap, we explored the experiences of breast cancer survivors of color and oncology healthcare providers. METHODS Content analysis with inductive and deductive approaches was used for semi-structured interviews with 26 female breast cancer survivors and 10 oncology healthcare providers from Greater New Haven, Connecticut. RESULTS Survivors identified substantial confusion on the evidence regarding lifestyle behaviors and breast cancer, stemming from inadequate healthcare provider counseling and an overreliance on informal sources of information. Providers identified lack of evidence-based knowledge as a barrier to counseling on these topics. There was a mixed perspective regarding the consistency of evidence, stemming from a combination of gaps in the available evidence and accessing evidence-based knowledge from a wide range of professional resources. Some providers perceived the guidelines as consistent; others felt guidelines were constantly changing, impacting how and on what they counseled. Therefore, many healthcare providers in oncology care relied on generic messaging on lifestyle behaviors after a cancer diagnosis. CONCLUSIONS Inconsistent information sources, the rapidly changing evidence, and gaps in the current evidence contribute to generic messaging about lifestyle behaviors and may inhibit a survivor's ability to engage in behavior change. Consistent and uniform healthy lifestyle guidelines for cancer outcomes may address both provider and patient level barriers to knowledge.
Collapse
Affiliation(s)
- Margaret S Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4, PA, 19104, Philadelphia, USA.
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, USA
- Department of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Abigail Ginader
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Thai Hien Nguyen
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Yamile Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, IL, Chicago, USA
- University of Illinois Cancer Center, Chicago, IL, USA
- Mile Square Health Center, Chicago, IL, USA
| |
Collapse
|
14
|
Pichardo MS, Irwin ML, Esserman D, Molina Y, Ferrucci LM. A competing risk analysis of adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention and obesity-related cancer risk in Hispanic/Latino adults in the NIH-AARP Diet and Health Study. Int J Cancer 2022; 151:1902-1912. [PMID: 35802472 PMCID: PMC9588580 DOI: 10.1002/ijc.34200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/06/2022]
Abstract
Incidence of obesity-related cancers (ORCs) is rising among US Hispanic/Latino adults, which may be partly due to inadequate engagement in healthy lifestyle behaviors. Prior research on cancer prevention guideline adherence and cancer risk has not considered competing events that may lead to misinterpreting the magnitude of risk between guideline adherence and cancer incidence. Among Hispanic/Latino adults (N = 9204) in the NIH-AARP Diet and Health Study, we examined the association between adherence to the 2012 American Cancer Society (ACS) guidelines (high, moderate, low) on nutrition and physical activity for cancer prevention and risk of any first observed ORC using Fine and Gray methods for competing risk analysis. Over a median of 10.5 years of follow-up, there were 619 first ORCs. The cumulative risk of ORC over a 15-year period was not significantly different across ACS guideline adherence categories (high cumulative incidence function [CIF]: 2.2%-5.8%; moderate CIF: 2.2%-6.6%; low CIF: 2.3%-6.7%, PGray's log rank = .690). In competing risk analysis, high (compared to low) adherence to the ACS guidelines was associated with reduced probability of ORC (subdistribution hazard [SHR]: 0.76, 95% CI: 0.58-0.996, P = .047), with evidence of a linear trend for increasing adherence (Ptrend = .039). Our findings were consistent with hypothesized inverse associations between ACS guideline adherence and ORC incidence accounting for competing risks. These findings suggest a need for continued public health efforts focused on promoting engagement in healthy lifestyle behaviors to reduce ORC incidence among US Hispanic/Latino adults.
Collapse
Affiliation(s)
- Margaret S Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Yamile Molina
- School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, Illinois, USA
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| |
Collapse
|
15
|
Shen X, Jain A, Aladelokun O, Yan H, Gilbride A, Ferrucci LM, Lu L, Khan SA, Johnson CH. Asparagine, colorectal cancer, and the role of sex, genes, microbes, and diet: A narrative review. Front Mol Biosci 2022; 9:958666. [PMID: 36090030 PMCID: PMC9453556 DOI: 10.3389/fmolb.2022.958666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023] Open
Abstract
Asparagine (Asn) and enzymes that catalyze the metabolism of Asn have been linked to the regulation and propagation of colorectal cancer (CRC). Increased Asn and asparagine synthetase (ASNS) expression, both contribute to CRC progression and metastasis. In contradistinction, L-asparaginase (ASNase) which breaks down Asn, exhibits an anti-tumor effect. Metabolic pathways such as KRAS/PI3K/AKT/mTORC1 signaling and high SOX12 expression can positively regulate endogenous Asn production. Conversely, the tumor suppressor, TP53, negatively impacts ASNS, thus limiting Asn synthesis and reducing tumor burden. Asn abundance can be altered by factors extrinsic to the cancer cell such as diet, the microbiome, and therapeutic use of ASNase. Recent studies have shown that sex-related factors can also influence the regulation of Asn, and high Asn production results in poorer prognosis for female CRC patients but not males. In this narrative review, we critically review studies that have examined endogenous and exogenous modulators of Asn bioavailability and summarize the key metabolic networks that regulate Asn metabolism. We also provide new hypotheses regarding sex-related influences on Asn, including the involvement of the sex-steroid hormone estrogen and estrogen receptors. Further, we hypothesize that sex-specific factors that influence Asn metabolism can influence clinical outcomes in CRC patients.
Collapse
Affiliation(s)
- Xinyi Shen
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States,Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Abhishek Jain
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Oladimeji Aladelokun
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Hong Yan
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Austin Gilbride
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Lingeng Lu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Sajid A. Khan
- Division of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States,*Correspondence: Sajid A. Khan, ; Caroline H. Johnson,
| | - Caroline H. Johnson
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States,*Correspondence: Sajid A. Khan, ; Caroline H. Johnson,
| |
Collapse
|
16
|
Pichardo MS, Esserman D, Ferrucci LM, Molina Y, Chlebowski RT, Pan K, Garcia DO, Lane DS, Shadyab AH, Lopez-Pentecost M, Luo J, Kato I, Springfield S, Rosal MC, Bea JW, Cespedes Feliciano EM, Qi L, Nassir R, Snetselaar L, Manson J, Bird C, Irwin ML. Adherence to the American Cancer Society Guidelines on nutrition and physical activity for cancer prevention and obesity-related cancer risk and mortality in Black and Latina Women's Health Initiative participants. Cancer 2022; 128:3630-3640. [PMID: 35996861 DOI: 10.1002/cncr.34428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/29/2022] [Accepted: 07/14/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although adherence to the American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Prevention associates with lower risk of obesity-related cancer (ORC) incidence and mortality, evidence in Black and Latina women is limited. This association was examined in Black and Latina participants in the Women's Health Initiative (WHI). METHODS Semi-Markov multistate model examined the association between ACS guideline adherence and ORC incidence and mortality in the presence of competing events, combined and separately, for 9301 Black and 4221 Latina postmenopausal women. Additionally, ACS guideline adherence was examined in a subset of less common ORCs and potential effect modification by neighborhood socioeconomic status and smoking. RESULTS Over a median of 11.1, 12.5, and 3.7 years of follow-up for incidence, nonconditional mortality, and conditional mortality, respectively, 1191 ORCs (Black/Latina women: 841/269), 1970 all-cause deaths (Black/Latina women: 1576/394), and 341 ORC-related deaths (Black/Latina women: 259/82) were observed. Higher ACS guideline adherence was associated with lower ORC incidence for both Black (cause-specific hazard ratio [CSHR]highvs.low : 0.72; 95% CI, 0.55-0.94) and Latina (CSHRhighvs.low : 0.58, 95% CI, 0.36-0.93) women; but not conditional all-cause mortality (Black hazard ratio [HR]highvs.low : 0.86; 95% CI, 0.53-1.39; Latina HRhighvs.low : 0.81; 95% CI, 0.32-2.06). Higher adherence was associated with lower incidence of less common ORC (Ptrend = .025), but conditional mortality events were limited. Adherence and ORC-specific deaths were not associated and there was no evidence of effect modification. CONCLUSIONS Adherence to the ACS guidelines was associated with lower risk of ORCs and less common ORCs but was not for conditional ORC-related mortality. LAY SUMMARY Evidence on the association between the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention and cancer remains scarce for women of color. Adherence to the guidelines and risk of developing one of 13 obesity-related cancers among Black and Latina women in the Women's Health Initiative was examined. Women who followed the lifestyle guidelines had 28% to 42% lower risk of obesity-related cancer. These findings support public health interventions to reduce growing racial/ethnic disparities in obesity-related cancers.
Collapse
Affiliation(s)
- Margaret S Pichardo
- Yale School of Public Health, New Haven, Connecticut, USA.,Howard University College of Medicine, Washington, District of Columbia, USA
| | | | | | - Yamile Molina
- University of Illinois Chicago, Chicago, Illinois, USA
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kathy Pan
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | | | | | | | | | - Juhua Luo
- Indiana University, Bloomington, Indiana, USA
| | - Ikuko Kato
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Milagros C Rosal
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | - Lihong Qi
- University of California Davis, Davis, California, USA
| | - Rami Nassir
- Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - JoAnn Manson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chloe Bird
- RAND Corporation, Santa Monica, California, USA
| | | |
Collapse
|
17
|
Sanft TB, Harrigan M, Cartmel B, Li F, Zupa M, McGowan C, Ferrucci LM, Puklin L, Nguyen TH, Tanasijevic A, Neuhouser ML, Hershman DL, Basen-Engquist K, Jones BA, Knobf MT, Chagpar AB, Silber A, Ligibel JA, Irwin ML. Randomized trial of diet and exercise on chemotherapy completion in women with breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis (LEANer) study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12007 Background: In observational studies, 25%-55% of women with breast cancer (BC) do not complete chemotherapy as initially prescribed, primarily due to toxicity. Relative dose intensity (RDI) is an integrated measure of chemotherapy dose delays and reductions and is associated with cancer mortality. Physical activity (PA) and diet may reduce treatment toxicity, but less is known about their effect on RDI. We conducted a randomized trial of a diet and PA intervention on RDI (primary endpoint) in women with newly diagnosed BC initiating chemotherapy. Methods: 173 women with Stage I-III BC were randomized to usual care (UC, n = 86) or a yearlong, 16-session, in-person or telephone-administered diet and PA intervention (n = 87) delivered by registered dietitians. Dates, doses and reason for dose-adjustments/delays of chemotherapy were abstracted from electronic medical records or obtained from treating oncologists. T-tests and Chi-square tests were used to examine the effect of the intervention vs. UC on RDI. Results: Participants were 53±11 years old, had a body mass index of 29.7+6.8 kg/m2, 51% had stage I BC and 22% were under-represented minorities. 27 different chemotherapy regimens were prescribed. Participants randomized to intervention completed 94% of counseling sessions during chemotherapy and had statistically significant improvements in PA and diet compared to UC. Average continuous RDI was unexpectedly high in both groups, with 93%+14% of prescribed chemotherapy completed (p = 0.92). However, 17% and 15% of intervention and UC participants, respectively, had < 85% RDI (p = 0.70) and more than one-third had at least one toxicity-associated dose reduction and/or delay (> 7 days) for at least one chemotherapy drug (39% intervention and 37% UC, p = 0.80). In posthoc analyses, there was a benefit of the intervention on chemotherapy completion compared to UC in the 74 women receiving neoadjuvant chemotherapy (RDI: 95% intervention vs. 90% UC, p = 0.05). Among intervention women, a dose-response effect was seen with participants who achieved more PA and better diet quality via the Healthy Eating Index (above median) experiencing higher RDI vs participants who were below the median for PA and/or diet quality (97% vs 90% RDI, p = 0.05). Conclusions: A primarily telephone-based diet and PA intervention led to improved diet and PA, but did not improve RDI compared to UC. However, a dose-response effect of the intervention was observed with higher PA and diet associated with higher RDI. Future analyses will examine intervention effects on secondary endpoints of endocrine therapy adherence and patient-reported outcomes when all women reach the 1-year timepoint (end of intervention). Further study of diet and PA interventions in patients receiving neoadjuvant chemotherapy are necessary. Clinical trial information: NCT03314688.
Collapse
Affiliation(s)
| | | | | | - Fangyong Li
- Yale Center for Analytical Sciences, New Haven, CT
| | - Michelle Zupa
- Yale University School of Public Health, New Haven, CT
| | | | | | | | | | | | | | - Dawn L. Hershman
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Cao A, Ferrucci LM, Caan BJ, Irwin ML. Effect of Exercise on Sarcopenia among Cancer Survivors: A Systematic Review. Cancers (Basel) 2022; 14:cancers14030786. [PMID: 35159052 PMCID: PMC8833677 DOI: 10.3390/cancers14030786] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Sarcopenia is a condition characterized by loss of skeletal muscle mass and low muscle strength or physical performance. Cancer survivors are likely to be impacted by sarcopenia and suffer from a worse prognosis. Exercise has been suggested to be a promising tool to attenuate sarcopenia, but its effect among cancer survivors has not been systematically tested yet. We conducted a systematic review of seven interventional studies examining the effects of exercise on sarcopenia among cancer survivors. Results suggested that exercise improved muscle quantity and potentially reversed sarcopenia among breast, gastric, prostate and liver cancer survivors. If the relationship is further supported by larger trials, we could potentially identify cancer survivors at higher risk of adverse health outcomes by screening for sarcopenia and improve their prognosis and quality of life through exercise interventions. Abstract Sarcopenia is related to adverse health outcomes in cancer survivors. Previous reviews reported exercise improved muscle mass or function in cancer survivors, but thus far a systematic review examining the effect of exercise on sarcopenia in this population has not been conducted. Therefore, we systematically searched PubMed, CENTRAL (Cochrane Central Register of Controlled Trials) and ClinicalTrials.gov for publications and ongoing trials (through November 2021) that reported exercise interventions and diagnosed sarcopenia among cancer survivors. Seven exercise trials were eligible for this review. Six of seven studies showed exercise increased skeletal muscle post intervention (1.6% to 5.4% increase within intervention groups compared to baseline, p ≤ 0.07; 2.1% to 12.8% greater increase for intervention than control groups, p ≤ 0.02) and in the three studies that reported sarcopenia reversal, an improvement (18.2% to 42.9% decrease in sarcopenia in exercise groups, 5.2% increase to 16.7% decrease in sarcopenia in control groups, p = 0.04) was observed. Existing research indicates the potential for exercise to improve health outcomes for cancer survivors through building muscle and attenuating sarcopenia. More high-quality, long-term, large randomized controlled trials examining effects of different exercise types and doses to improve sarcopenia should be conducted to further explore this important topic.
Collapse
Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; (L.M.F.); (M.L.I.)
- Correspondence: ; Tel.: +1-475-837-8503
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; (L.M.F.); (M.L.I.)
- Yale Cancer Center, New Haven, CT 06520-8034, USA
| | - Bette J. Caan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA;
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; (L.M.F.); (M.L.I.)
- Yale Cancer Center, New Haven, CT 06520-8034, USA
| |
Collapse
|
19
|
Puklin L, Irwin ML, Sanft T, Ferrucci LM. Letter to the Editor: Differentiating Between Intentional Versus Unintentional Weight Loss. J Natl Compr Canc Netw 2022; 20:xliv. [PMID: 34991074 DOI: 10.6004/jnccn.2021.7052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Tara Sanft
- bYale Cancer Center, and.,cYale School of Medicine, Yale University, New Haven, Connecticut
| | | |
Collapse
|
20
|
Ton M, Ferrucci LM, Weinstein SJ, Hashemian M, Albanes D, Huang J. Nut and peanut butter consumption and risk of prostate cancer in the NIH-AARP diet and health study. Cancer Commun (Lond) 2021; 42:65-69. [PMID: 34661979 PMCID: PMC8753310 DOI: 10.1002/cac2.12230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/15/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mimi Ton
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, United States.,Yale School of Public Health, Yale University, New Haven, CT, 06520, United States
| | - Leah M Ferrucci
- Yale School of Public Health, Yale University, New Haven, CT, 06520, United States.,Yale Cancer Center, Yale University, New Haven, CT, 06520, United States
| | - Stephanie J Weinstein
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, United States
| | - Maryam Hashemian
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, United States.,Department of Biology, School of Arts and Sciences, Utica College, Utica, NY, 13502, United States
| | - Demetrius Albanes
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, United States
| | - Jiaqi Huang
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, United States.,National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| |
Collapse
|
21
|
Sanft T, Harrigan M, Cartmel B, Ferrucci LM, Li FY, McGowan C, Zupa M, Nguyen TH, Ligibel J, Neuhouser ML, Hershman DL, Basen-Engquist K, Jones B, Knobf T, Chagpar A, Silber A, Irwin ML. Effect of healthy diet and exercise on chemotherapy completion rate in women with breast cancer: The Lifestyle, Exercise and Nutrition Early after Diagnosis (LEANer) study: Study protocol for a randomized clinical trial. Contemp Clin Trials 2021; 109:106508. [PMID: 34274495 PMCID: PMC10424280 DOI: 10.1016/j.cct.2021.106508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The World Cancer Research Fund and the American Cancer Society provide nutrition and physical activity guidelines for cancer survivors. Many women with breast cancer do not follow these guidelines and delay efforts toward following them until active treatment is complete. However, adoption of these recommended lifestyle behaviors soon after diagnosis may prevent adverse treatment-related side effects and may improve adherence to treatment, resulting in improved breast cancer prognosis. The Lifestyle, Exercise, and Nutrition Early after Diagnosis (LEANer) study is testing the effect of a nutrition and physical activity intervention on chemotherapy completion rates. METHODS 172 women with stage I-III breast cancer undergoing chemotherapy will be randomized 1:1 to a yearlong, 16 session, nutrition and exercise intervention or usual care control group. The intervention is delivered by registered dietitians specializing in oncology nutrition and exercise training. The intervention includes goal setting to meet nutrition and physical activity guidelines for cancer survivors. After each chemotherapy session, date and dose of each drug administered, and reason for dose-adjustments and/or dose-delays are abstracted from the electronic medical record or obtained from the treating oncologist. Chemotherapy completion rate is assessed as the average relative dose-intensity (RDI) for the originally planned regimen based on standard formulas. Secondary endpoints of endocrine therapy adherence, treatment-related side effects, and changes in inflammatory and metabolic biomarkers, body composition, and patient reported outcomes are assessed at four timepoints. DISCUSSION If successful, this study has the potential to make healthy lifestyle interventions a standard component of breast cancer treatment.
Collapse
Affiliation(s)
- Tara Sanft
- Yale University School of Medicine, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America.
| | - Maura Harrigan
- Yale University School of Public Health, New Haven, CT, United States of America.
| | - Brenda Cartmel
- Yale University School of Public Health, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America.
| | - Leah M Ferrucci
- Yale University School of Public Health, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America.
| | - Fang-Yong Li
- Yale University School of Public Health, New Haven, CT, United States of America.
| | - Courtney McGowan
- Yale University School of Public Health, New Haven, CT, United States of America.
| | - Michelle Zupa
- Yale University School of Public Health, New Haven, CT, United States of America.
| | - Thai Hien Nguyen
- Yale University School of Public Health, New Haven, CT, United States of America.
| | - Jennifer Ligibel
- Dana-Farber Cancer Institute, Boston, MA, United States of America.
| | - Marian L Neuhouser
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America.
| | - Dawn L Hershman
- Columbia University Medical Center, New York, NY, United States of America.
| | - Karen Basen-Engquist
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Beth Jones
- Yale University School of Public Health, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America.
| | - Tish Knobf
- Yale Cancer Center, New Haven, CT, United States of America; Yale School of Nursing, New Haven, CT, United States of America.
| | - Anees Chagpar
- Yale University School of Medicine, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America.
| | - Andrea Silber
- Yale University School of Medicine, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America.
| | - Melinda L Irwin
- Yale University School of Public Health, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America.
| |
Collapse
|
22
|
Xiao C, Miller AH, Peng G, Levine ME, Conneely KN, Zhao H, Eldridge RC, Wommack EC, Jeon S, Higgins KA, Shin DM, Saba NF, Smith AK, Burtness B, Park HS, Irwin ML, Ferrucci LM, Ulrich B, Qian DC, Beitler JJ, Bruner DW. Association of Epigenetic Age Acceleration With Risk Factors, Survival, and Quality of Life in Patients With Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2021; 111:157-167. [PMID: 33882281 DOI: 10.1016/j.ijrobp.2021.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Epigenetic age acceleration (EAA) is robustly linked with mortality and morbidity. This study examined risk factors of EAA and its association with overall survival (OS), progression-free survival (PFS), and quality of life (QOL) in patients with head and neck cancer (HNC) receiving radiation therapy. METHODS AND MATERIALS Patients without distant metastasis were enrolled and followed before and at the end of radiation therapy and at 6 and 12 months after radiation therapy. EAA was calculated with DNAmPhenoAge at all 4 time points. Risk factors included demographic characteristics, lifestyle, clinical characteristics, treatment-related symptoms, and blood biomarkers. Survival data were collected until August 2020, and QOL was measured using Functional Assessment of Cancer Therapy-HNC. RESULTS Increased comorbidity, symptoms unrelated to human papilloma virus, and more severe treatment-related symptoms were associated with higher EAA (P = .03 to P < .001). A nonlinear association (quadratic) between body mass index (BMI) and EAA was observed: decreased BMI (<35 kg/m2; P = .04) and increased BMI (≥35 kg/m2; P = .01) were linked to higher EAA. Increased EAA (per year) was associated with worse OS (hazard ratio [HR], 1.11 [95% confidence interval {CI}, 1.03-1.18; P = .004]; HR, 1.10 [95% CI, 1.01-1.19; P = .02] for EAA at 6 and 12 months after treatment, respectively) and PFS (HR, 1.10 [95% CI, 1.02-1.19; P = .02]; HR, 1.14 [95% CI, 1.06-1.23; P < .001]; and HR, 1.08 [95% CI, 1.02-1.14; P = .01]) for EAA before, immediately after, and 6 months after radiation therapy, respectively) and QOL over time (β = -0.61; P = .001). An average of 3.25 to 3.33 years of age acceleration across time, which was responsible for 33% to 44% higher HRs of OS and PFS, was observed in those who died or developed recurrence compared with those who did not (all P < .001). CONCLUSIONS Compared with demographic and lifestyle factors, clinical characteristics were more likely to contribute to faster biological aging in patients with HNC. Acceleration in epigenetic age resulted in more aggressive adverse events, including OS and PFS. EAA could be considered as a marker for cancer outcomes, and decelerating aging could improve survival and QOL.
Collapse
Affiliation(s)
- Canhua Xiao
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
| | | | - Gang Peng
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Hongyu Zhao
- Yale University School of Medicine, New Haven, Connecticut
| | - Ronald C Eldridge
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | | | | | - Dong M Shin
- Emory University School of Medicine, Atlanta, Georgia
| | - Nabil F Saba
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Henry S Park
- Yale University School of Medicine, New Haven, Connecticut
| | - Melinda L Irwin
- Yale University School of Public Health and Yale Cancer Center, New Haven, Connecticut
| | - Leah M Ferrucci
- Yale University School of Public Health and Yale Cancer Center, New Haven, Connecticut
| | - Bryan Ulrich
- Emory University School of Medicine, Atlanta, Georgia
| | - David C Qian
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| |
Collapse
|
23
|
Cartmel B, Anderson C, Irwin ML, Harrigan M, Sanft T, Li F, Gellermann W, Ermakov IV, Ferrucci LM. Skin carotenoids are inversely associated with adiposity in breast cancer survivors. Nutr Res 2020; 79:77-86. [PMID: 32650223 DOI: 10.1016/j.nutres.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 05/07/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Abstract
Carotenoids are antioxidants which may mitigate some of the adverse effects of obesity, a condition associated with poor outcomes in breast cancer patients. We hypothesized that baseline skin carotenoids would be inversely associated with adiposity in breast cancer survivors and would increase with weight loss. Skin carotenoid score (SCS) was assessed by resonance Raman spectroscopy in breast cancer survivors (body mass index ≥25 kg/m2) enrolled in a 6-month randomized controlled weight loss trial (n = 47). Measurements included total body fat using dual-energy X-ray absorptiometry, height, weight, waist and hip circumference, dietary intake, and serum biomarkers. Associations between SCS, adiposity measures, and serum biomarkers were assessed at baseline, as was the change in SCS from baseline to 6 months, in the intervention and usual care groups. At baseline, SCS was inversely correlated with all adiposity measures (P ≤ .05). In multivariate analyses, baseline percent body fat had the strongest association with baseline SCS (partial R2= 0.20). Baseline SCS was significantly inversely associated with log C-reactive protein levels (regression coefficient β ± SE: -0.051± 0.019; P = .011) and log leptin (β ± SE: -0.019± 0.009; P = .046), but the associations were no longer significant after adjustment for adiposity. Over the 6-month study, the intervention group had a 17.6% increase in SCS compared to a 1.5% decrease in the usual care group (P = .28). In our study of overweight and obese breast cancer survivors, dual-energy X-ray absorptiometry-measured body fat explained a large portion of the variation in skin carotenoids at baseline, suggesting a stronger association than that previously seen in studies using less accurate measures of adiposity.
Collapse
Affiliation(s)
- Brenda Cartmel
- Yale School of Public Health, 60 College St, New Haven, CT 06511; Yale Cancer Center, PO Box 208028, New Haven, CT 06519.
| | - Chelsea Anderson
- Yale School of Public Health, 60 College St, New Haven, CT 06511.
| | - Melinda L Irwin
- Yale School of Public Health, 60 College St, New Haven, CT 06511; Yale Cancer Center, PO Box 208028, New Haven, CT 06519.
| | - Maura Harrigan
- Yale School of Public Health, 60 College St, New Haven, CT 06511.
| | - Tara Sanft
- Yale Cancer Center, PO Box 208028, New Haven, CT 06519; Yale School of Medicine, 333 Cedar St, New Haven, CT 06511.
| | - Fangyong Li
- Yale School of Public Health, 60 College St, New Haven, CT 06511.
| | - Werner Gellermann
- Longevity Link Corporation, 391 Chipeta Way, Suite E, Salt Lake City, UT 84108.
| | - Igor V Ermakov
- Longevity Link Corporation, 391 Chipeta Way, Suite E, Salt Lake City, UT 84108.
| | - Leah M Ferrucci
- Yale School of Public Health, 60 College St, New Haven, CT 06511; Yale Cancer Center, PO Box 208028, New Haven, CT 06519.
| |
Collapse
|
24
|
Sanft TB, Harrigan M, Cartmel B, Ferrucci LM, Basen-Engquist K, Hershman DL, Ligibel JA, Neuhouser M, Chagpar AB, Jones BA, Knobf MT, Silber A, Li F, Irwin ML. A randomized trial of a healthy lifestyle intervention versus usual care on chemotherapy and endocrine therapy adherence rate in women with breast cancer: The Lifestyle Exercise and Nutrition Early After Diagnosis (LEANER) Study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps11633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS11633 Background: The World Cancer Research Fund and the American Cancer Society provide diet and exercise guidelines for cancer survivors. Many women with breast cancer do not follow these guidelines. Adoption of recommended lifestyle behaviors soon after diagnosis may prevent adverse changes in body composition, breast cancer biomarkers, and may improve adherence to treatment thereby improving breast cancer prognosis. The Lifestyle, Exercise, and Nutrition Early after Diagnosis (LEANER) study is testing the impact of a healthy lifestyle intervention on chemotherapy completion and endocrine therapy adherence. Secondary endpoints include changes in inflammatory and metabolic biomarkers, body composition, and patient reported outcomes. Methods: Eligible participants are women with stage I-III breast cancer undergoing chemotherapy. 250 participants are being recruited and randomized 1:1 to a yearlong, 16 session, healthy diet and exercise counseling intervention or usual care group. The intervention is delivered in person and/or via telephone by registered dietitians with training in exercise science. Materials include workbooks, videos, cookbooks, fit bits, and home-based exercise equipment. Intervention is focused on graduated goal setting to meet the recommended diet and exercise guidelines for cancer survivors. The primary endpoint, chemotherapy completion rate, is gathered from the Electronic Medical Record and the average Relative Dose Intensity for the originally planned regimen is calculated based on standard formulas. Assessments are completed at baseline, post chemotherapy, 1- and 2- year time points (to assess adherence to endocrine therapy). Body composition is measured using dual energy X-ray absorptiometry, blood samples and patient reported outcomes are collected. At time of submission, 39 women have been randomized. Discussion: If successful, this study has the potential to make healthy lifestyle interventions initiated shortly after diagnosis a standard component of breast cancer treatment. Clinical trial information: NCT03314688.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Fangyong Li
- Yale Center for Analytical Sciences, New Haven, CT
| | | |
Collapse
|
25
|
Baglia ML, Lin IH, Cartmel B, Sanft T, Ligibel J, Hershman DL, Harrigan M, Ferrucci LM, Li FY, Irwin ML. Endocrine-related quality of life in a randomized trial of exercise on aromatase inhibitor-induced arthralgias in breast cancer survivors. Cancer 2019; 125:2262-2271. [PMID: 30840336 DOI: 10.1002/cncr.32051] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the role of a 12-month exercise intervention on endocrine-related quality of life (QOL) and overall QOL among breast cancer survivors with aromatase inhibitor (AI)-induced arthralgia in the Hormones and Physical Exercise (HOPE) Study. METHODS This was a randomized controlled trial of 121 breast cancer survivors who were currently receiving AIs and experiencing at least mild arthralgia. QOL was assessed using the Functional Assessment of Cancer Therapy (FACT) questionnaires and the 36-Item Short Form Survey (SF-36) at baseline, 6 months, and 12 months. Participants were randomized to either a 1-year gym-based, supervised exercise intervention group (150 minutes of aerobic exercise and 2 strength-training sessions each week) or a usual care group. Effects of the intervention on QOL were assessed using mixed-model, repeated-measures analysis. RESULTS At 12 months, the exercise group had greater improvement in the overall QOL measures as well as the breast cancer-specific (scores, 2.2 vs 0.7; P = .02), endocrine-specific (scores, 5.6 vs 1.6; P < .001), and fatigue-specific (score, 5.8 vs 0.5; P < .001) subscales compared with the usual care group. The results indicated a stronger effect at 12 months versus 6 months after the intervention. CONCLUSIONS Combined aerobic and resistance exercise, such as treadmill walking and strength training, improved endocrine-related and overall QOL among breast cancer survivors who were experiencing adverse side effects from AIs. Because adverse side effects associated with AI use are quite common and this is the main reason for treatment discontinuation, this nonpharmacologic intervention could benefit many breast cancer survivors and increase successful adherence to AIs in breast cancer treatment.
Collapse
Affiliation(s)
| | - I-Hsin Lin
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Tara Sanft
- Yale Cancer Center, New Haven, Connecticut
| | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Leah M Ferrucci
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Fang-Yong Li
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Melinda L Irwin
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| |
Collapse
|
26
|
Ferrucci LM, Cartmel B, Clare RA, Choy CC, Kershaw T, Leffell DJ, Mayne ST. Cross-sectional assessment of ultraviolet radiation-related behaviors among young people after a diagnosis of melanoma or basal cell carcinoma. J Am Acad Dermatol 2018; 79:149-152. [PMID: 29291957 PMCID: PMC6004335 DOI: 10.1016/j.jaad.2017.12.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 12/05/2017] [Accepted: 12/10/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Leah M Ferrucci
- Yale School of Public Health, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut.
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut
| | | | | | - Trace Kershaw
- Yale School of Public Health, New Haven, Connecticut
| | - David J Leffell
- Yale Cancer Center, New Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Susan T Mayne
- Yale School of Public Health, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland
| |
Collapse
|
27
|
Abstract
Indoor tanning is a known risk factor for skin cancer and is especially dangerous for adolescents. Some states have passed indoor tanning bans for minors, but business compliance with the bans is not well understood. Thus far, studies have assessed ban compliance in one or two states at a time. This study aimed to assess compliance with indoor tanning bans for minors and knowledge of dangers and benefits of tanning among indoor tanning businesses. Female research assistants posing as minors telephoned a convenience sample of 412 businesses in 14 states with tanning bans for minors under age 17 or 18. We evaluated differences in compliance by census region and years since ban was implemented and differences in reported dangers and benefits by compliance. Most (80.1%) businesses told the "minor" caller she could not use the tanning facilities. Businesses in the south and in states with more recent bans were less compliant. Among those (n = 368) that completed the full interview, 52.2% identified burning and 20.1% mentioned skin cancer as potential dangers. However, 21.7% said dangers were no worse than the sun and 10.3% denied any dangers. Stated benefits included vitamin D (27.7%), social/cosmetic (27.2%), and treats skin diseases (26.4%), with only 4.9% reporting no benefits. While most businesses followed the indoor tanning ban when a minor called, one-fifth did not. Many stated inaccurate health claims. Additional enforcement or education might increase compliance with indoor tanning bans and action is needed to prevent businesses from stating false health information.
Collapse
Affiliation(s)
- Courtney C Choy
- Yale School of Public Health, 55 Church Street, Suite 801, New Haven, CT, 06510, USA
| | - Brenda Cartmel
- Yale School of Public Health, 55 Church Street, Suite 801, New Haven, CT, 06510, USA.,Yale Cancer Center, New Haven, CT, 06520, USA
| | - Rachel A Clare
- Yale School of Public Health, 55 Church Street, Suite 801, New Haven, CT, 06510, USA
| | - Leah M Ferrucci
- Yale School of Public Health, 55 Church Street, Suite 801, New Haven, CT, 06510, USA. .,Yale Cancer Center, New Haven, CT, 06520, USA.
| |
Collapse
|
28
|
Ferrucci LM, Cartmel B, Harrigan M, Sanft T, Playdon M, Jia W, Yu H, Johnson CH, Pusztai L, Chagpar AB, Irwin ML. Abstract 5321: Metabolomics and body mass index among breast cancer survivors in The Lifestyle, Exercise, and Nutrition (LEAN) Study. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: While there is a growing body of literature on metabolomics and body mass index (BMI), there are limited studies in relation to weight change in overweight and obese individuals, and to our knowledge, no such studies in breast cancer survivors.
Methods: The Lifestyle, Exercise and Nutrition (LEAN) randomized diet- and exercise-induced weight loss trial in breast cancer survivors enrolled overweight or obese breast cancer survivors (Stage 0-III) identified via the Yale-New Haven Hospital tumor registry or self-referral. Participants were randomized to either usual care group (n=33) or the 6-month lifestyle intervention (11 sessions with a registered dietitian) (n=67). Height and weight were measured by study staff at baseline and 6 months, and a fasting (≥ 12 hours) blood draw was also performed at these time points. Paired (baseline and 6-month) serum metabolomics data were available for 83 women. Only those metabolites consistently detected in >80% of quality control samples with a coefficient of variation <30% were included in data analysis. We evaluated partial Pearson correlations between the ratio of metabolites at baseline versus 6-months and change in BMI adjusted for age and intervention group. We also assessed mean changes in metabolites from baseline to 6-months by randomization group using the general estimating equation in linear regression. Adjustment for multiple comparisons was based on the False Discovery Rate (FDR) with a threshold of 0.1.
Results: Overall, a total of 307 metabolites were analyzed; 168 were quantitated by LC-MS and 139 were semi-quantitated by GC-TOF/MS. For BMI change from baseline to 6-months, we observed correlations with 16 metabolites (isocitric acid, 3-hydroxybutyric acid, serine, L-cysteine, petroselinic acid, aminomalonic acid, palmitoleic acid, linoleic acid, 2-hydroxybutyric acid, and seven unidentified metabolites, p <0.05), however FDR correction for multiple comparisons yielded no statistically significant results. We also observed differences by randomization group for L-alanine, dopamine, serotonin, PCaaC36:1, 3-hydroxyoleoylcarnitine, and PCaeC36:1 in bivariate analyses, but in models adjusted for age and BMI only L-alanine remained significant (p<0.05). After correction for FDR, there were no significant differences by randomization group.
Conclusions: There were no clear associations between metabolites and change in BMI or randomization group among overweight and obese breast cancer survivors enrolled in a weight loss trial. Larger sample sizes would help to clarify if any of the potential signals observed in this population may be associated with BMI or other lifestyle changes, such as diet quality.
Citation Format: Leah M. Ferrucci, Brenda Cartmel, Maura Harrigan, Tara Sanft, Mary Playdon, Wei Jia, Herbert Yu, Caroline H. Johnson, Lajos Pusztai, Anees B. Chagpar, Melinda L. Irwin. Metabolomics and body mass index among breast cancer survivors in The Lifestyle, Exercise, and Nutrition (LEAN) Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5321. doi:10.1158/1538-7445.AM2017-5321
Collapse
Affiliation(s)
| | | | | | | | | | - Wei Jia
- 4University of Hawaii Cancer Center, Honolulu, HI
| | - Herbert Yu
- 4University of Hawaii Cancer Center, Honolulu, HI
| | | | | | | | | |
Collapse
|
29
|
Playdon MC, Nagle CM, Ibiebele TI, Ferrucci LM, Protani MM, Carter J, Hyde SE, Neesham D, Nicklin JL, Mayne ST, Webb PM. Pre-diagnosis diet and survival after a diagnosis of ovarian cancer. Br J Cancer 2017; 116:1627-1637. [PMID: 28463959 PMCID: PMC5518850 DOI: 10.1038/bjc.2017.120] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/12/2022] Open
Abstract
Background: The relationship between diet and survival after ovarian cancer diagnosis is unclear as a result of a limited number of studies and inconsistent findings. Methods: We examined the association between pre-diagnostic diet and overall survival in a population-based cohort (n=811) of Australian women diagnosed with invasive epithelial ovarian cancer between 2002 and 2005. Diet was measured by validated food frequency questionnaire. Deaths were ascertained up to 31 August 2014 via medical record review and Australian National Death Index linkage. We conducted Cox proportional hazards regression analysis, controlling for diagnosis age, tumour stage, grade and subtype, residual disease, smoking status, body mass index, physical activity, marital status, and energy intake. Results: We observed improved survival with highest compared with lowest quartile of fibre intake (hazard ratio (HR)=0.69, 95% CI: 0.53–0.90, P-trend=0.002). There was a suggestion of better survival for women with highest compared with lowest intake category of green leafy vegetables (HR=0.79, 95% CI: 0.62–0.99), fish (HR=0.74, 95% CI: 0.57–0.95), poly- to mono-unsaturated fat ratio (HR=0.76, 95% CI: 0.59–0.98), and worse survival with higher glycaemic index (HR=1.28, 95% CI: 1.01–1.65, P-trend=0.03). Conclusions: The associations we observed between healthy components of diet pre-diagnosis and ovarian cancer survival raise the possibility that dietary choices after diagnosis may improve survival.
Collapse
Affiliation(s)
- Mary C Playdon
- Yale School of Public Health, Department of Chronic Disease Epidemiology, Yale University, 60 College Street, New Haven, CT 06520, USA
| | - Christina M Nagle
- Gynaecological Cancers Group, QIMR Berghofer Institute of Medical Research, 300 Herston Road, Herston, Queensland 4006, Australia
| | - Torukiri I Ibiebele
- Gynaecological Cancers Group, QIMR Berghofer Institute of Medical Research, 300 Herston Road, Herston, Queensland 4006, Australia
| | - Leah M Ferrucci
- Yale School of Public Health, Department of Chronic Disease Epidemiology, Yale University, 60 College Street, New Haven, CT 06520, USA
| | - Melinda M Protani
- Gynaecological Cancers Group, QIMR Berghofer Institute of Medical Research, 300 Herston Road, Herston, Queensland 4006, Australia.,School of Public Health, University of Queensland Public Health Building, Herston Road, Queensland 4006, Australia
| | - Jonathan Carter
- Department of Gynaecological Oncology, The University of Sydney, Sydney, New South Wales 2006, Australia.,Lifehouse Gynaecologic Oncology Group, Lifehouse, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia
| | - Simon E Hyde
- Mercy Hospital for Women, Department of Gynaecological Oncology, Studley Road, Heidelberg, Victoria 3084, Australia
| | - Deborah Neesham
- Oncology/Dysplasia Unit, The Royal Women's Hospital, Flemington Road, Parkville, Victoria 3052, Australia
| | - James L Nicklin
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia.,School of Medicine, Department of Obstetrics and Gynaecology, The University of Queensland, Herston, Queensland 4006, Australia
| | - Susan T Mayne
- Yale School of Public Health, Department of Chronic Disease Epidemiology, Yale University, 60 College Street, New Haven, CT 06520, USA.,Yale Cancer Center, New Haven, CT 06520, USA.,U.S. Food and Drug Administration, College Park, MD, USA
| | - Penelope M Webb
- Gynaecological Cancers Group, QIMR Berghofer Institute of Medical Research, 300 Herston Road, Herston, Queensland 4006, Australia.,School of Public Health, University of Queensland Public Health Building, Herston Road, Queensland 4006, Australia
| |
Collapse
|
30
|
Cartmel B, Bale AE, Mayne ST, Gelernter JE, DeWan AT, Spain P, Leffell DJ, Pagoto S, Ferrucci LM. Predictors of tanning dependence in white non-Hispanic females and males. J Eur Acad Dermatol Venereol 2017; 31:1223-1228. [PMID: 28129487 DOI: 10.1111/jdv.14138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/10/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Growing evidence suggests that some individuals may exhibit symptoms of dependence on ultraviolet (UV) light, a known carcinogen, in the context of tanning; however, few studies have investigated predictors of tanning dependence (TD). OBJECTIVE To identify predictors of TD. METHODS Non-Hispanics of European ancestry who had previously participated in a case-control study of early-onset basal cell carcinoma completed an online survey to ascertain TD and other behaviours (alcohol dependence, nicotine dependence, seasonal affective disorder (SAD), exercise 'addiction' and depression). Information on host factors, such as skin and eye colour and history of sunbathing and indoor tanning, was obtained from a study in which the participants were previously enrolled. Lifetime TD was assessed using the modified Cut down, Annoyed, Guilty, Eye-opener (mCAGE) and the modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (mDSM-IV-TR) questionnaires. Participants were classified as 'TD' if positive on both questionnaires and not TD if negative on both questionnaires. RESULTS In total, 499 individuals completed the online survey (81.9% participation rate), and 24.4% were classified as 'TD'. In the multivariate model, women were more likely to be TD [odds ratio (OR) 6.93; 95% confidence intervals (95% CI) (3.36-14.27)] than men. Alcohol dependence (OR 6.55: 95% CI 3.19-13.42), SAD (OR 2.77; 95% CI 1.26-6.09) and exercise 'addiction' (OR 5.47; 95% CI 1.15-26.06) were all significant predictors for TD. CONCLUSION Increased knowledge of those at risk for TD will allow appropriate interventions to be designed.
Collapse
Affiliation(s)
- B Cartmel
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - A E Bale
- Yale Cancer Center, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - S T Mayne
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | | | - A T DeWan
- Yale School of Public Health, New Haven, CT, USA
| | - P Spain
- Yale School of Public Health, New Haven, CT, USA
| | - D J Leffell
- Yale Cancer Center, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - S Pagoto
- University of Massachusetts Medical School, Worcester, MA, USA
| | - L M Ferrucci
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| |
Collapse
|
31
|
Zhang Y, Cartmel B, Choy CC, Molinaro AM, Leffell DJ, Bale AE, Mayne ST, Ferrucci LM. Body mass index, height and early-onset basal cell carcinoma in a case-control study. Cancer Epidemiol 2016; 46:66-72. [PMID: 28039770 DOI: 10.1016/j.canep.2016.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/30/2016] [Accepted: 12/14/2016] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common malignancy in the US. Body mass index (BMI) and height have been associated with a variety of cancer types, yet the evidence regarding BCC is limited. Therefore, we evaluated BMI and height in relation to early-onset BCC (under age 40) and explored the potential role of ultraviolet (UV) radiation exposure and estrogen-related exposures in the BMI-BCC relationship. METHODS BCC cases (n=377) were identified through a central dermatopathology facility in Connecticut. Control subjects (n=389) with benign skin conditions were randomly sampled from the same database and frequency matched to cases on age (median=36, interquartile range 33-39), gender, and biopsy site. Participants reported weight (usual adult and at age 18), adult height, sociodemographic, phenotypic, and medical characteristics, and prior UV exposures. We calculated multivariate odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression models. RESULTS Adult BMI was inversely associated with early-onset BCC (obese vs. normal OR=0.43, 95% CI=0.26-0.71). A similar inverse association was present for BMI at age 18 (OR=0.54, 95% CI=0.34-0.85). Excluding UV exposures from the BMI models and including estrogen-related exposures among women only did not alter the association between BMI and BCC, indicating limited mediation or confounding. We did not observe an association between adult height and BCC (OR per cm=1.00, 95% CI=0.98-1.02). CONCLUSIONS We found a significant inverse association between BMI and early-onset BCC, but no association between height and BCC. This association was not explained by UV exposures or estrogen-related exposures in women.
Collapse
Affiliation(s)
- Yanchang Zhang
- Yale School of Public Health, New Haven, CT, 06520, United States
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, CT, 06520, United States; Yale Cancer Center, New Haven, CT, 06520, United States
| | - Courtney C Choy
- Yale School of Public Health, New Haven, CT, 06520, United States
| | - Annette M Molinaro
- UCSF Departments of Neurological Surgery and Epidemiology and Biostatistics, San Francisco, CA 94143, United States
| | - David J Leffell
- Yale Cancer Center, New Haven, CT, 06520, United States; Yale University School of Medicine, New Haven, CT 06520, United States
| | - Allen E Bale
- Yale Cancer Center, New Haven, CT, 06520, United States; Yale University School of Medicine, New Haven, CT 06520, United States
| | - Susan T Mayne
- Yale School of Public Health, New Haven, CT, 06520, United States; Yale Cancer Center, New Haven, CT, 06520, United States
| | - Leah M Ferrucci
- Yale School of Public Health, New Haven, CT, 06520, United States; Yale Cancer Center, New Haven, CT, 06520, United States.
| |
Collapse
|
32
|
Cartmel B, Dewan A, Ferrucci LM, Gelernter J, Stapleton J, Leffell DJ, Mayne ST, Bale AE. Novel gene identified in an exome-wide association study of tanning dependence. Exp Dermatol 2016; 23:757-9. [PMID: 25041255 DOI: 10.1111/exd.12503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 01/01/2023]
Abstract
Growing evidence suggests that some individuals may exhibit symptoms of dependence to ultraviolet light, a known carcinogen, in the context of tanning. Genetic associations with tanning dependence (TD) have not yet been explored. We conducted an exome-wide association study in 79 individuals who exhibited symptoms of TD and 213 individuals with volitional exposure to ultraviolet light, but who were not TD based on three TD scales. A total of 300 000 mostly exomic single nucleotide polymorphisms primarily in coding regions were assessed using an Affymetrix Axiom array. We performed a gene burden test with Bonferroni correction for the number of genes examined (P < 0.05/14 904 = 3.36 × 10(-6) ). One gene, patched domain containing 2 (PTCHD2), yielded a statistically significant P-value of 2.5 × 10(-6) (OR = 0.27) with fewer individuals classified as TD having a minor allele at this locus. These results require replication, but are the first to support a specific genetic association with TD.
Collapse
Affiliation(s)
- Brenda Cartmel
- Yale School of Public Health, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Playdon M, Ferrucci LM, McCorkle R, Stein KD, Cannady R, Sanft T, Cartmel B. Health information needs and preferences in relation to survivorship care plans of long-term cancer survivors in the American Cancer Society's Study of Cancer Survivors-I. J Cancer Surviv 2016; 10:674-85. [PMID: 26744339 DOI: 10.1007/s11764-015-0513-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/25/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Survivorship care plans (SCPs) provide cancer patients and health care providers with a treatment summary and outline of recommended medical follow-up. Few studies have investigated the information needs and preferred sources among long-term cancer survivors. METHODS Cancer survivors of the ten most common cancers enrolled in the longitudinal Study of Cancer Survivors-I (SCS-I) completed a survey 9 years post-diagnosis (n = 3138); at time of diagnosis of the SCS-I cohort, SCPs were not considered usual care. We assessed participants' current desire and preferred sources for information across ten SCP items and evaluated factors associated with information need 9 years after diagnosis. RESULTS The proportion of long-term cancer survivors endorsing a need for cancer and health information 9 years post-diagnosis ranged from 43 % (cancer screening) to 9 % (consequences of cancer on ability to work). Print media and personalized reading materials were the most preferred information sources. Younger age, higher education, race other than non-Hispanic white, later cancer stage, having breast cancer, having ≥2 comorbidities, and self-reporting poor health were associated with greater informational need (p < 0.05). CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS Long-term cancer survivors continue to report health information needs for most SCP items and would prefer a print format; however, level of need differs by socio-demographic and cancer characteristics. Cancer survivors who did not previously receive a SCP may still benefit from receiving SCP content, and strategies for enabling dissemination to long-term survivors warrant further investigation.
Collapse
Affiliation(s)
- Mary Playdon
- Yale School of Public Health, Yale University, 55 Church Street, Suite 801, New Haven, CT, 06510, USA.
| | - Leah M Ferrucci
- Yale School of Public Health, Yale University, 55 Church Street, Suite 801, New Haven, CT, 06510, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Ruth McCorkle
- Yale Cancer Center, New Haven, CT, USA.,Yale School of Nursing, Yale University, New Haven, CT, USA.,Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Kevin D Stein
- Behavioral Research Center, American Cancer Society, Atlanta, GA, USA
| | - Rachel Cannady
- Behavioral Research Center, American Cancer Society, Atlanta, GA, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, USA.,Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Brenda Cartmel
- Yale School of Public Health, Yale University, 55 Church Street, Suite 801, New Haven, CT, 06510, USA.,Yale Cancer Center, New Haven, CT, USA
| |
Collapse
|
34
|
Cartmel B, Mayne ST, Bale AE, Gelernter J, DeWan A, Leffell DJ, Pagoto S, Spain P, Ferrucci LM. Predictors of tanning dependence in white non-hispanic females and males. Dermatol Online J 2016. [DOI: 10.5070/d3229032556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
35
|
Anderson C, Cartmel B, Mayne ST, Ferrucci LM. Attitudes and predictors of sunless tanning in a sample of young adults. Dermatol Online J 2016. [DOI: 10.5070/d3229032520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
36
|
Choy C, Cartmel B, Clare R, Ferrucci LM. Compliance with indoor tanning laws for minors among salons and business in the United States. Dermatol Online J 2016. [DOI: 10.5070/d3229032531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
37
|
Molinaro AM, Ferrucci LM, Cartmel B, Loftfield E, Leffell DJ, Bale AE, Mayne ST. Abstract A50: Impact of indoor tanning and MC1R genotype on basal cell carcinoma risk in young people. Cancer Prev Res (Phila) 2015. [DOI: 10.1158/1940-6215.prev-14-a50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The incidence of basal cell carcinoma (BCC), which accounts for the majority of non-melanoma skin cancer (NMSC), is increasing, particularly in young people. While BCC is treatable, it can be associated with significant morbidity and health care costs. The ability to identify individuals at the highest risk of early-onset BCC could help focus public health efforts and mitigate the increasing incidence. However, to date, few risk prediction models exist for BCC. To identify individuals at risk of BCC at young ages, we assessed the utility of existing skin cancer risk prediction models (for melanoma or overall skin cancer) in the setting of early-onset BCC and built a novel risk prediction model, with a focus on indoor tanning and melanocortin 1 receptor (MC1R) genotype.
Methods: We evaluated unconditional multivariate logistic regression models among 759 (376 cases, 383 controls) non-Hispanic whites from the Yale Study of Skin Health, a case-control study of early-onset BCC conducted in Connecticut among individuals under age 40. BCC cases and randomly sampled controls with minor benign skin conditions diagnosed between July 2006 and September 2010 were identified through Yale University's Dermatopathology database. Participants completed a structured in-person interview, self-administered questionnaires, and provided a saliva sample. We gathered self-reported eye color, skin color (inner upper arm), hair color (natural color), freckling on the arms (based on images), number of moles on the back ≥ 5 mm (clear acetate size template), mole removal, skin reaction to sunlight for the first time in the summer for one hour without sunscreen, skin reaction after repeated and prolonged exposure to sunlight, family history of melanoma and NMSC, and indoor and outdoor ultraviolet (UV) radiation exposure.
We assessed the predictive performance of our novel risk prediction model and two models in the literature via summary measures of calibration, misclassification, and discrimination. We employed bootstrapping to better reflect the area under the receiver operating characteristic curve (AUC) expected when the model is tested on an independent, but similar set of patients. To investigate if indoor tanning and MC1R improved prediction performance over our early-onset BCC base model, we evaluated the regression coefficients for the markers in the expanded risk model and the corresponding likelihood ratio test statistic. All statistical tests were two-sided and analyses were performed in the statistical software R (Version 3.0.2).
Results: An existing model by Han et al. (2006) included seven MC1R variants and in our data the bootstrapped AUC for this model was 0.72 (95% CI, 0.66-0.78). Another existing model by Smith et al. (2012) with MC1R and indoor tanning resulted in a bootstrapped AUC of 0.69 (95% CI 0.63-0.75) in our population. Our base model, which included hair color, skin color, skin reaction with prolonged sun exposure, education, freckles on arm, family history of NMSC, and outdoor sun exposure in warm months, had greater predictive ability (bootstrapped AUC=0.75, 95% CI=0.72-0.79) than the existing models we evaluated. We also found that our model was significantly improved when we added ever indoor tanning, burns from indoor tanning, and the R151C MC1R variant (bootstrapped AUC=0.77, 95% CI, 0.74-0.81).
Conclusions: Our risk prediction model incorporating both MC1R and indoor tanning in the risk of early-onset BCC, validates and extends the work of other skin cancer risk prediction models and emphasizes the value of considering both genotype and indoor tanning in skin cancer risk prediction in young people. Therefore, in addition to the typical skin cancer characteristics clinicians rely on, assessing and counseling young people to reduce both indoor and outdoor UV exposure is needed to reduce BCC risk.
Citation Format: Annette M. Molinaro, Leah M. Ferrucci, Brenda Cartmel, Erikka Loftfield, David J. Leffell, Allen E. Bale, Susan T. Mayne. Impact of indoor tanning and MC1R genotype on basal cell carcinoma risk in young people. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A50.
Collapse
|
38
|
Berlin NL, Ferrucci LM, Cartmel B, Wang SY, Leffell DJ, McNiff JM, Mayne ST. Subsequent skin cancer in patients with early-onset basal cell carcinoma. Australas J Dermatol 2015. [PMID: 26201376 DOI: 10.1111/ajd.12338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Leah M Ferrucci
- Yale School of Public Health, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Shi-Yi Wang
- Yale School of Public Health, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - David J Leffell
- Yale Cancer Center, New Haven, Connecticut, USA.,Yale University School of Medicine, New Haven, Connecticut, USA.,Center for Food Safety and Applied Nutrition, Food and Drug Administration
| | - Jennifer M McNiff
- Yale University School of Medicine, New Haven, Connecticut, USA.,Center for Food Safety and Applied Nutrition, Food and Drug Administration
| | - Susan T Mayne
- Yale School of Public Health, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| |
Collapse
|
39
|
Molinaro AM, Ferrucci LM, Cartmel B, Loftfield E, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and the MC1R genotype: risk prediction for basal cell carcinoma risk in young people. Am J Epidemiol 2015; 181:908-16. [PMID: 25858289 PMCID: PMC4445390 DOI: 10.1093/aje/kwu356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/01/2014] [Indexed: 12/25/2022] Open
Abstract
Basal cell carcinoma (BCC) incidence is increasing, particularly in young people, and can be associated with significant morbidity and treatment costs. To identify young individuals at risk of BCC, we assessed existing melanoma or overall skin cancer risk prediction models and built a novel risk prediction model, with a focus on indoor tanning and the melanocortin 1 receptor gene, MC1R. We evaluated logistic regression models among 759 non-Hispanic whites from a case-control study of patients seen between 2006 and 2010 in New Haven, Connecticut. In our data, the adjusted area under the receiver operating characteristic curve (AUC) for a model by Han et al. (Int J Cancer. 2006;119(8):1976-1984) with 7 MC1R variants was 0.72 (95% confidence interval (CI): 0.66, 0.78), while that by Smith et al. (J Clin Oncol. 2012;30(15 suppl):8574) with MC1R and indoor tanning had an AUC of 0.69 (95% CI: 0.63, 0.75). Our base model had greater predictive ability than existing models and was significantly improved when we added ever-indoor tanning, burns from indoor tanning, and MC1R (AUC = 0.77, 95% CI: 0.74, 0.81). Our early-onset BCC risk prediction model incorporating MC1R and indoor tanning extends the work of other skin cancer risk prediction models, emphasizes the value of both genotype and indoor tanning in skin cancer risk prediction in young people, and should be validated with an independent cohort.
Collapse
Affiliation(s)
- Annette M. Molinaro
- Correspondence to Dr. Annette M. Molinaro, Department of Neurosurgery, University of California, San Francisco, 400 Parnassus Avenue, Room A 808, San Francisco, CA 94143-0372 (e-mail: )
| | | | | | | | | | | | | |
Collapse
|
40
|
Zhang Y, Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Alcohol intake and early-onset basal cell carcinoma in a case-control study. Br J Dermatol 2014; 171:1451-7. [PMID: 25059635 DOI: 10.1111/bjd.13291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous epidemiological studies of overall alcohol intake and basal cell carcinoma (BCC) are inconsistent, with some evidence for differences by type of alcoholic beverage. While alcohol may enhance the carcinogenicity of ultraviolet (UV) radiation, this has not been evaluated in existing epidemiological studies. OBJECTIVES To evaluate alcohol intake in relation to early-onset BCC, and explore potential interactions with UV exposure. METHODS Basal cell carcinoma cases (n = 380) and controls with benign skin conditions (n = 390) under 40 years of age were identified through Yale Dermatopathology. Participants provided information on lifetime alcohol intake, including type of beverage, during an in-person interview. Self-reported data on indoor tanning and outdoor sunbathing were used to categorize UV exposure. We calculated odds ratios (OR) and 95% confidence intervals (CIs) using unconditional multivariate logistic regression in the full sample and in women only. RESULTS There was no statistically significant association between lifetime alcohol intake and early-onset BCC overall [above median intake vs. no regular alcohol intake (OR 1·10, 95% CI 0·69-1·73)] or in women only (OR 1·21, 95% CI 0·73-2·01). Similarly, intake of red wine, white wine, beer or spirits and mixed drinks was not associated with early-onset BCC. In exploratory analyses, we saw limited evidence for an interaction (P(interaction) = 0·003), with highest risk for high alcohol and high UV exposures, especially in women, but subgroup risk estimates had wide and overlapping CIs. CONCLUSIONS Overall, we did not observe any clear association between lifetime alcohol intake and early-onset BCC.
Collapse
Affiliation(s)
- Y Zhang
- Yale School of Public Health, New Haven, CT 06520, U.S.A
| | | | | | | | | | | | | |
Collapse
|
41
|
Ferrucci LM, Vogel RI, Cartmel B, Lazovich D, Mayne ST. Indoor tanning in businesses and homes and risk of melanoma and nonmelanoma skin cancer in 2 US case-control studies. J Am Acad Dermatol 2014; 71:882-7. [PMID: 25062934 DOI: 10.1016/j.jaad.2014.06.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/27/2014] [Accepted: 06/28/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Indoor tanning increases skin cancer risk. Beyond early research describing melanoma and sun lamps, few recent reports describe where individuals indoor tan and whether skin cancer risk varies by location (business, home-based). OBJECTIVE We sought to assess where individuals tanned indoors and skin cancer risk by tanning device location. METHODS Multivariate logistic regression was conducted in 2 US case-control studies of melanoma (1161 cases, 1083 controls, ages 25-59 years) and early-onset basal cell carcinoma (375 cases, 382 controls, age<40 years) conducted between 2004 and 2010. RESULTS Most indoor tanners (86.4%-95.1%), especially younger individuals, tanned exclusively in businesses. Persons who used indoor tanning exclusively in businesses were at increased risk of melanoma (odds ratio 1.82, 95% confidence interval 1.47-2.26) and basal cell carcinoma (odds ratio 1.69, 95% confidence interval 1.15-2.48) compared with non-users. Melanoma risk was also increased in the small number who reported tanning indoors only at home relative to non-users (odds ratio 4.14, 95% confidence interval 1.75-9.78); 67.6% used sun lamps. LIMITATIONS Self-reported tanning and potential recall bias are limitations. CONCLUSION Business-only tanning, despite claims of "safe" tanning, was positively associated with a significant risk of melanoma and basal cell carcinoma. Home tanning was uncommon and mostly from sun lamps, which were rarely used by younger participants. Regardless of location, indoor tanning was associated with increased risk of skin cancer.
Collapse
Affiliation(s)
- Leah M Ferrucci
- Yale School of Public Health, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut.
| | | | - Brenda Cartmel
- Yale School of Public Health, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Susan T Mayne
- Yale School of Public Health, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut
| |
Collapse
|
42
|
Troche JR, Ferrucci LM, Cartmel B, Leffell DJ, Bale AE, Mayne ST. Systemic glucocorticoid use and early-onset basal cell carcinoma. Ann Epidemiol 2014; 24:625-7. [PMID: 24958637 DOI: 10.1016/j.annepidem.2014.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/30/2014] [Accepted: 05/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Jose Ramon Troche
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Leah M Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT; Yale Cancer Center, New Haven, CT
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT; Yale Cancer Center, New Haven, CT
| | - David J Leffell
- Yale Cancer Center, New Haven, CT; Departments of Dermatology and Surgery, Yale University School of Medicine, New Haven, CT
| | - Allen E Bale
- Yale Cancer Center, New Haven, CT; Department of Genetics, Yale University School of Medicine, New Haven, CT
| | - Susan T Mayne
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT; Yale Cancer Center, New Haven, CT.
| |
Collapse
|
43
|
Ruder EH, Berndt SI, Gilsing AMJ, Graubard BI, Burdett L, Hayes RB, Weissfeld JL, Ferrucci LM, Sinha R, Cross AJ. Dietary iron, iron homeostatic gene polymorphisms and the risk of advanced colorectal adenoma and cancer. Carcinogenesis 2014; 35:1276-83. [PMID: 24536049 DOI: 10.1093/carcin/bgu028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Dietary iron intake and variation in iron homeostasis genes may affect colorectal neoplasia risk. We conducted two nested case-control studies within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial: one of advanced colorectal adenoma (1205 cases; 1387 controls) and one of colorectal cancer (370 cases; 401 controls). Iron intake was estimated with a food frequency questionnaire and genotyping was performed for 21 genes. Unconditional logistic regression was used to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) for colorectal neoplasia risk within quartiles of intake. Several single nucleotide polymorphisms (SNPs) modified the association between iron intake and the risk of adenoma or cancer. Dietary iron was positively associated with colorectal adenoma among three SNPs of HEPHL1, including carriers of the AA genotype at rs7946162 (ORQ4-Q1 = 2.22, 95% CI 1.15-4.27, Ptrend = 0.03; Pinteraction = 0.10), the TT genotype at rs2460063 (ORQ4-Q1 = 2.39, 95% CI 1.26-4.54, Ptrend = 0.02; Pinteraction = 0.04) and the GG genotype at rs7127348 (ORQ4-Q1 = 2.40, 95% CI 1.23-4.67, Ptrend = 0.02; Pinteraction = 0.09). Heme iron was positively associated with colorectal cancer among those with GG genotypes for ACO1 rs10970985 (ORQ4-Q 1 = 2.45, 95% CI 3.40-8.06, Ptrend = 0.004; Pinteraction = 0.05). However, none of the associations were statistically significant after adjustment for multiple comparisons. Future studies should target the specific genes and SNPs for which the association was significant prior to multiple comparison correction.
Collapse
Affiliation(s)
- Elizabeth H Ruder
- School of Health and Rehabilitation Sciences, University of Pittsburgh, 4051 Forbes Tower, Pittsburgh, PA 15260, USA,
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Anne M J Gilsing
- Department of Epidemiology, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Laurie Burdett
- Core Genotyping Facility, National Cancer Institute, SAIC-Frederick, Inc., Gaithersburg, MD 20892, USA
| | - Richard B Hayes
- Division of Epidemiology, Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Joel L Weissfeld
- University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA 15232, USA and
| | | | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Amanda J Cross
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
| |
Collapse
|
44
|
Cartmel B, Ferrucci LM, Spain P, Bale AE, Pagoto SL, Leffell DJ, Gelernter J, Mayne ST. Indoor tanning and tanning dependence in young people after a diagnosis of basal cell carcinoma. JAMA Dermatol 2013; 149:1110-1. [PMID: 23824273 DOI: 10.1001/jamadermatol.2013.5104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut2Yale Cancer Center, New Haven, Connecticut
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Wiznia L, Ferrucci LM, Mayne ST, Chagpar AB. Do nonmelanoma skin cancer survivors use tanning beds more often than the general public? J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e20017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20017 Background: Tanning bed use increases the incidence of nonmelanoma skin cancer (NMSC), however utilization of indoor tanning after diagnosis in this population is not well-studied. We sought to determine if tanning bed use among NMSC survivors differed from the general population. Methods: The National Health Interview Survey is an annual population-based survey that is representative of the civilian US population. We utilized the 2010 cancer supplement to evaluate self-reported tanning bed use in the previous 12 months in self-reported NMSC survivors compared to individuals without a history of skin cancer. Results: In 2010, 24,941 people were surveyed, 1.85% of whom had a self-reported history of NMSC. On univariate analysis, NMSC survivors were significantly less likely to use tanning beds in the previous 12 months (2.16 vs. 5.61%, p < 0.001). On multivariate analysis, however, NMSC survivors were equally likely to use tanning beds as those who had never had skin cancer (see Table). Conclusions: When controlling for other sociodemographic factors, NMSC survivors were no less likely to use tanning beds than the general population. These findings suggest a need to better educate NMSC survivors about the increased risk of future skin cancers with ongoing tanning bed use. [Table: see text]
Collapse
Affiliation(s)
| | | | - Susan T Mayne
- Yale University School of Public Health, New Haven, CT
| | | |
Collapse
|
46
|
Gilsing AMJ, Berndt SI, Ruder EH, Graubard BI, Ferrucci LM, Burdett L, Weissfeld JL, Cross AJ, Sinha R. Meat-related mutagen exposure, xenobiotic metabolizing gene polymorphisms and the risk of advanced colorectal adenoma and cancer. Carcinogenesis 2012; 33:1332-9. [PMID: 22552404 DOI: 10.1093/carcin/bgs158] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Meat mutagens, including heterocyclic amines (HCAs), polycyclic aromatic hydrocarbons (PAHs) and N-nitroso compounds (NOCs), may be involved in colorectal carcinogenesis depending on their activation or detoxification by phase I and II xenobiotic metabolizing enzymes (XME). Using unconditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), we examined the intake of five meat mutagens and >300 single nucleotide polymorphisms (SNPs) in 18 XME genes in relation to advanced colorectal adenoma (1205 cases and 1387 controls) and colorectal cancer (370 cases and 401 controls) within the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Dietary intake of meat mutagens was assessed using a food frequency questionnaire with a detailed meat-cooking module. An interaction was observed between 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) intake and the NAT1 polymorphism rs6586714 in the adenoma study (P(interaction) = 0.001). Among individuals carrying a GG genotype, high MeIQx intake was associated with a 43% increased risk of adenoma (95% CI 1.11-1.85, P(trend) = 0.07), whereas the reverse was observed among carriers of the A variant (OR = 0.50, 95% CI 0.30-0.84, P(trend) = 0.01). In addition, we observed some suggestive (P < 0.05) modifying effects for SNPs in other XME genes (UGT1A, CYP2E1, EPHX1, AHR and GSTM3), but these were not significant after adjustment for multiple testing. This large and comprehensive study of XME genes, meat mutagens and the risk of colorectal tumours found that a NAT1 polymorphism modified the association between MeIQx intake and colorectal adenoma risk.
Collapse
Affiliation(s)
- Anne M J Gilsing
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services Bethesda, MD, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
This review discusses the results of randomized clinical trials of supplemental micronutrients for cancer prevention completed over the past 20 years, including trials of beta-carotene and retinol, vitamins C and E, selenium, folic acid, and vitamin D. Some trials observed significant reductions in risk, whereas others observed significant increases in risk of the primary cancer endpoint. In considering these trials, it appears that supplementation targeted to populations with low status of the nutrient of interest may prevent cancer, whereas supplementation in populations with higher status or to achieve pharmacological exposures may promote cancer. Observational epidemiologic evidence coupled with these trial results supports the concept of a U-shaped curve for micronutrients in relation to cancer prevention. Based on these data, nutrient supplements are not currently recommended for cancer prevention in the general population. The hypothesis that groups with low nutrient status may benefit from supplementation has yet to be formally tested.
Collapse
Affiliation(s)
- Susan T Mayne
- Yale School of Public Health, Yale University, New Haven, Connecticut 06520, USA.
| | | | | |
Collapse
|
48
|
Lostritto K, Ferrucci LM, Cartmel B, Leffell DJ, Molinaro AM, Bale AE, Mayne ST. Lifetime history of indoor tanning in young people: a retrospective assessment of initiation, persistence, and correlates. BMC Public Health 2012; 12:118. [PMID: 22324969 PMCID: PMC3340300 DOI: 10.1186/1471-2458-12-118] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 02/10/2012] [Indexed: 11/19/2022] Open
Abstract
Background Despite educational and public health campaigns to convey the risks of indoor tanning, many individuals around the world continue to engage in this behavior. Few descriptive studies of indoor tanning have collected information pertaining to the lifetime history of indoor tanning, thereby limiting our ability to understand indoor tanning patterns and potentially target interventions for individuals who not only initiate, but continue to persistently engage in indoor tanning. Methods In-person interviews elicited detailed retrospective information on lifetime history of indoor tanning among white individuals (n = 401) under age 40 seen by a dermatologist for a minor benign skin condition. These individuals were controls in a case-control study of early-onset basal cell carcinoma. Outcomes of interest included ever indoor tanning in both males and females, as well as persistent indoor tanning in females - defined as females over age 31 who tanned indoors at least once in the last three or all four of four specified age periods (ages 11-15, 16-20, 21-30 and 31 or older). Multivariate logistic regression was used to identify sociodemographic and lifestyle correlates of ever and persistent indoor tanning in females. Results Approximately three-quarters (73.3%) of females and 38.3% of males ever tanned indoors, with a median age of initiation of 17.0 and 21.5, respectively. Among indoor tanners, 39.3% of females and 21.7% of males reported being burned while indoor tanning. Female ever indoor tanners were younger, had darker color eyes, and sunbathed more frequently than females who never tanned indoors. Using unique lifetime exposure data, 24.7% of female indoor tanners 31 and older persistently tanned indoors starting as teenagers. Female persistent indoor tanners drank significantly more alcohol, were less educated, had skin that tanned with prolonged sun exposure, and sunbathed outdoors more frequently than non-persistent tanners. Conclusions Indoor tanning was strikingly common in this population, especially among females. Persistent indoor tanners had other high-risk behaviors (alcohol, sunbathing), suggesting that multi-faceted behavioral interventions aimed at health promotion/disease prevention may be needed in this population.
Collapse
|
49
|
Cross AJ, Harnly JM, Ferrucci LM, Risch A, Mayne ST, Sinha R. Developing a heme iron database for meats according to meat type, cooking method and doneness level. ACTA ACUST UNITED AC 2012; 3:905-913. [PMID: 23459329 DOI: 10.4236/fns.2012.37120] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Animal studies have demonstrated that iron may be related to carcinogenesis, and human studies found that heme iron can increase the formation of N-nitroso compounds, which are known carcinogens. OBJECTIVES One of the postulated mechanisms linking red meat intake to cancer risk involves iron. Epidemiologic studies attempt to investigate the association between heme iron intake and cancer by applying a standard factor to total iron from meat. However, laboratory studies suggest that heme iron levels in meat vary according to cooking method and doneness level. We measured heme iron in meats cooked by different cooking methods to a range of doneness levels to use in conjunction with a food frequency questionnaire to estimate heme iron intake. METHODS Composite meat samples were made to represent each meat type, cooking method and doneness level. Heme iron was measured using atomic absorption spectrometry and inductively coupled plasma-atomic emission spectrometry. RESULTS Steak and hamburgers contained the highest levels of heme iron, pork and chicken thigh meat had slightly lower levels, and chicken breast meat had the lowest. CONCLUSIONS Although heme iron levels varied, there was no clear effect of cooking method or doneness level. We outline the methods used to create a heme iron database to be used in conjunction with food frequency questionnaires to estimate heme iron intake in relation to disease outcome.
Collapse
Affiliation(s)
- Amanda J Cross
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Rockville, MD, 20852
| | | | | | | | | | | |
Collapse
|
50
|
Ferrucci LM, Sinha R, Huang WY, Berndt SI, Katki HA, Schoen RE, Hayes RB, Cross AJ. Meat consumption and the risk of incident distal colon and rectal adenoma. Br J Cancer 2011; 106:608-16. [PMID: 22166801 PMCID: PMC3281548 DOI: 10.1038/bjc.2011.549] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Most studies of meat and colorectal adenoma have investigated prevalent events from a single screening, thus limiting our understanding of the role of meat and meat-related exposures in early colorectal carcinogenesis. Methods: Among participants in the screening arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who underwent baseline and follow-up sigmoidoscopy (n=17 072), we identified 1008 individuals with incident distal colorectal adenoma. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations between meat and meat-related components and incident distal colorectal adenoma using multivariate logistic regression. Results: We observed suggestive positive associations for red meat, processed meat, haeme iron, and nitrate/nitrite with distal colorectal adenoma. Grilled meat (OR=1.56, 95% CI=1.04–2.36), well or very well-done meat (OR=1.59, 95% CI=1.05–2.43), 2-amino-1-methyl-6-phenyl-imidazo[4,5-b]pyridine (PhIP) (OR=1.75, 95% CI=1.17–2.64), benzo[a]pyrene (OR=1.53, 95% CI=1.06–2.20), and total mutagenic activity (OR=1.57, 95% CI=1.03–2.40) were positively associated with rectal adenoma. Total iron (diet and supplements) (OR=0.69, 95% CI=0.56–0.86) and iron from supplements (OR=0.65, 95% CI=0.44–0.97) were inversely associated with any distal colorectal adenoma. Conclusion: Our findings indicate that several meat-related components may be most relevant to early neoplasia in the rectum. In contrast, total iron and iron from supplements were inversely associated with any distal colorectal adenoma.
Collapse
Affiliation(s)
- L M Ferrucci
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | | | | | | | | | | | | | | |
Collapse
|