and survival following a diagnosis of ovarian cancer? Penny Webb, - - PowerPoint PPT Presentation

Does lifestyle influence quality of life and survival following a diagnosis of

• varian cancer?

Penny Webb, Gynaecological Cancers Group 26 June 2014

Things that influence survival

• Age, BRCA mutation status
• Characteristics of the cancer

– Subtype, grade, stage

• Treatment

– Surgery – Chemotherapy

• Other things?

– Genetics – Lifestyle: diet, vitamin supplements, smoking, exercise? – Body-size? But women with similar cancers and identical treatment can have very different outcomes

• Physical activity:

– Many studies suggest exercise  survival

• Diet / body-size:

– Mixed results in trials – Healthy diet  lower inflammatory markers – Soy foods?

• Alcohol:

– Increases risk of developing breast cancer, effects on survival unclear

Hints from other cancers - lifestyle

• Aspirin – anti-inflammatory & blood thinning:

– Aspirin reduces risk of some cancers – Suggestion from CHD trials that it may  cancer mortality

• Metformin – for diabetes:

– Suggestions Metformin  cancer survival in diabetics

• Statins – for cholesterol-lowering:

– Associated with  prostate & breast cancer survival

Hints from other cancers - medications

Lifestyle & survival from ovarian cancer

10.0 8.0 6.0 4.0 2.0 0.0

Survival time (years)

1.0 0.8 0.6 0.4 0.2 0.0

Cumulative Survival

<10 years 10-19 years 20-29 years 30+ years Survi v al ti m e (ye ars) 1 0 8 6 4 2 1 .0 .9 .8 .7 .6 .5 .4 .3 .2 .1 0 .0 h ig h me di u m l ow

Pack-years smoking (Stage III-IV) Vegetable consumption

Nagle et al. CEBP 2006; IJC 2003

Obesity & ovarian cancer survival

Overall (I-squared = 53.5%, p = 0.006) Zhang 2005a Yang 2008 Moysich 2007 Lamkin 2009 Zhou 2011a Kjaerbye-Thygesen 2006 Schlumbrecht 2009 Schlumbrecht 2011 Schlumbrecht 2011 Nagle 2003 Li 2007 Schildkraut 2000 Pavelka 2006 Skirnisdottir 2010 Skirnisdottir 2008 Dolecek 2010

Study, Year 1.17 (1.05, 1.31)

2.33 (1.12, 4.87) 1.22 (0.86, 1.71) 0.99 (0.71, 1.38) 1.05 (1.01, 1.08) 1.30 (0.92, 1.83) 1.83 (1.38, 2.42) 0.95 (0.68, 2.43) 1.02 (0.43, 2.38) 2.53 (1.19, 5.38) 0.96 (0.74, 1.23) 1.03 (0.78, 1.36) HR (95% CI) 1.10 (0.70, 1.70) 1.28 (1.03, 1.59) 0.94 (0.74, 1.21) 1.73 (0.66, 4.52) 1.20 (0.72, 1.98) 2.33 (1.12, 4.87) 1.22 (0.86, 1.71) 0.99 (0.71, 1.38) 1.05 (1.01, 1.08) 1.30 (0.92, 1.83) 1.83 (1.38, 2.42) 0.95 (0.68, 2.43) 1.02 (0.43, 2.38) 2.53 (1.19, 5.38) 0.96 (0.74, 1.23) 1.03 (0.78, 1.36) HR (95% CI) 1.10 (0.70, 1.70) 1.28 (1.03, 1.59) 0.94 (0.74, 1.21) 1.73 (0.66, 4.52) 1.20 (0.72, 1.98) 1 .5 1 5 10 HR (95% CI) (log scale)

Protani, Ca Prev Res 2012

BETTER WORSE

1. Identify whether lifestyle* after completion of primary treatment is associated with:

– progression-free and overall survival – ‘quality of life’ (QoL), insomnia

2. Identify whether lifestyle during chemotherapy is associated with:

– prevalence and severity of side-effects – physical, functional and emotional wellbeing – chemotherapy completion rates *Lifestyle: diet & supplement use, physical activity, sedentary behaviour, smoking, alcohol consumption, medication use

Aims:

• Target: ~1000, recruited through participating centres

– Currently N = 714

• Eligibility:

– Australian residents, age 18-79 – Primary epithelial cancer of ovary, fallopian tube or peritoneum – Less than 9 months from diagnosis

• Data & sample collection:

– Questionnaire at diagnosis, 3, 6, 9, 12, & 24 (+ 36?) months – Blood sample at diagnosis & 12 months (not essential) – Clinical ‘checklist’ every 3 months from 6 months

Participants

• Ancestry and family history
• Reproductive / hormonal history (brief)
• Height & weight
• Medical history / co-morbidities
• Medications:

– Aspirin, NSAIDs, metformin, statins, other meds

• Lifestyle:

– Smoking, physical activity, diet, supplements

• Insomnia
• Self-rated health
• Quality of life, fatigue

Data collection

Baseline Follow-Up

Timeline

2012 2013 2014 2015 2016 Ethics Recruitment 6 Months 12 Months 24 Months

Thank you

• palstudy.qimrberghofer.edu.au