4/22/2014 Cancer Survivorship Endometrial Cancer: Quality of Life, Physical Activity and Diet Vivian von Gruenigen, MD Professor and Chair Summa Health System Are Endometrial Cancer Survivors following the same trend? NEOMED NCI website Mortality from Cancer According to Obesity and Mortality from Cancer BMI for U.S. Women. Uterus • Increased body weight was associated with Kidney Cervix increase death rates in cancer patients. Pancreas r • Endometrial cancer patients had the highest e Esophagus c n a C C Gallbladder risk of death risk of death f o Breast Sentinel Event? e p • However, most endometrial cancer patients y NHL T present in Stage I disease and are “cured ” Liver Ovary Calle EE. N Engl J Med 2003 Colorectal » Calle EE. N Engl J Med 2003 MM 0 1 2 3 4 5 6 7 Relative Risk of Death Endometrial cancer patients are getting larger • Prior reviews in the 1970’s found that ~ 30% of patients with endometrial cancer were obese. » Anderson BA et al. Am J Obstet Gynecol 1996 y • Recent research reveals that ~ 70% of women were obese. » von Gruenigen VE et al. J Cancer Integ Med 2005 Ward KK et al. Gynecol Oncol 2012 » Fader AN et al. Gynecol Oncol 2009 1
4/22/2014 GOG #99 Ancillary: Health Obesity QOL , Obesity and Endometrial Cancer Disparities • Obesity is associated with poorer QOL in 100% endometrial cancer survivors 80% • BMI is inversely associated with physical and functional well-being functional well being 60% • Endometrial cancer survivors’ obesity AND 40% inactivity contributes to poorer QOL 20% » Smits A et al., Gynecol Oncol 2012 0% » Basen-Engquist K., Am J Obstet Gynecol 2009 Non-Black Black All Patients Von Gruenigen et al. Cancer 2006 BMI <25 25- 30- 35- 40+ Figure 1. BMI Distribution in Endometrial Patients QOL, BMI, Exercise QOL and OS 160 155 150 • There are correlations between QOL, Obesity, OS FACT-An Scores 145 • There are correlations between QOL, Cancer, OS 140 135 • Do Endometrial Cancer Patients with higher QOL 130 have increased OS? 125 • Or is it about the weight and/or PA (self-efficacy)? 160 120 NW OW MO SO VSO 155 150 FACT-An Scores 145 140 135 Lean et al., Arch Intern Med 1999 130 Quinten C et al., Lancet Oncol 2009 125 Oldenburg CS et al, Gynecol Oncol 2013 120 Regular Exercisers Nonregular Exercisers Courneya et al. Gynecol Oncol 2005 Endometrial Cancer patients are not Line-item analysis of FACT-G healthy Line Item Direction p value • They do not make spontaneously lifestyle of change changes Functional Ability to work <.05 • Only 1% are meeting the 2006 ACS guidelines Fulfillment of work <.05 Able to enjoy life <.05 for cancer survivors ; (150 minutes/week of moderate ; ( / Enjoy things I do for fun j y g <.05 Content with QOL right now <.05 to vigorous PA, 5 servings fruit/vegetables per day, no smoking) Social • Co-morbidity is as important as pathological Closeness to friends <.01 Satisfied with family <.01 features for predicting OS communication » Von Gruenigen et al. Obstet Gynecol 2011 Physical NS » Robbins JR, et al. Gynecol Oncol 2013 Lack of energy <.01 Fader AN et al., Obstet Gynecol Int 2011 2
4/22/2014 Feasibility and effectiveness of a lifestyle intervention Social Cognitive Theory: Self-Efficacy program in obese endometrial cancer patients: A randomized trial • Self-efficacy is a mental factor that plays a role in weight loss and weight management • It is defined as an individual’s belief in his or her ability to perform and succeed in challenging situations i i • Self-efficacy has been connected with positive health related decisions Shin H, Shin J, Liu PY, et al. Nutr Res . 2011 Bandura A. Psych Rev 1977 Byrne, S. J Psychosom Res . 2002 Grembowski D, Patrick D, Diehr P. J Health Soc Behav. 1993 von Gruenigen VE, Gynecol Oncol 2008 Group Sessions Effects of Weight Loss on Eating Assessments Variables Baseline 3 mos 6 mos 12 mos Time Month 1 July 2005 Weight loss goal setting x Grou Physical activity p P* Increase F&V intake Weight self-efficacy <0.01 Month 2 August Increase whole grain & dairy intake Total (0-180) Weight losers 107 (37) 134 (36) 135 (34) 138 (34) Dealing with barriers; negative Weight gainers 114 (36) 127(34) 117(34) 123 (31) thinking Three-factor eating Three factor eating Restraint (0-21) 0.01 Behavior modification Weight losers 10 (5) - - 13 (4) Grocery shopping / Nutrition facts, Weight gainers 10 (5) - - 10 (5) labels Disinhibition (0-16) Weight losers 8 (3) - - 7 (3) 0.05 Month 3 September Relapse prevention Weight gainers 8 (4) - - 8 (4) Month 4 October Eating out;social issues Hunger (0-14) Weight losers 6 (4) - - 5 (3) 0.36 Month 5 Nov Stress Management Weight gainers 5 (3) - - 5 (3) Month 6 Dec Review of topics Data are presented as the mean (standard deviation). * p value for repeated measures ANOVA or independent samples t-test (eating inventory)l Exercise Improvement Weight Loss 45 5 40 4 35 3 ge (kg) 30 ETS) 2 25 25 Weight chang 1 1 LSI (ME Intervention Intervention Intervention Control 0 20 Control -1 15 -2 10 -3.5 kg + 16.4 METS/wk -3 5 +1.4 - 1.3 -4 0 -5 Baseline 3 mos 6 mos 12 mos Baseline 3 mos 6 mos 12 mos 3
4/22/2014 S urvivors of U terine C ancer E mpowered by E xercise and healthy D iet Results • Adherence was 84% • Mean difference in PA minutes between groups at 6 months was 100, p=0.03 and at 12 months was 89, p=0.02. • Mean difference in kilocalories consumed was - 217.8 (p<0.001) at 6 months and -187.2 (p<0.001) at 12 months. • Mean [95% CI] difference in fruit and vegetable servings was 0.91 servings/day at 6 months and 0.92 at 12 months (p<0.001). Von Gruenigen VE et al. Gynecol Oncol 2012 30% achieved 5% weight loss 21 22 Novel exercise, weight-loss, and dietary approaches in overweight endometrial and breast cancer survivors Lifestyle and Mobile Technology (NEWDAY) • During recent years, mobile phones have become the major conduit for communication 4 weeks: ancillary active, healthcare-provider interface and information Encouraging exercise and nutritional guidance • According to PEW, the types of health apps • According to PEW the types of health apps PROVIDER INTERVENTION used on smartphones are dominated by Physician Minimum weekly contact via email, social exercise, diet, and weight-loss apps media, or phone Registered Dietician Nutritional Analysis and Support • More accurate self-logging • Personalized messages Research Assistants Emotional support, technical trouble- shooting 4
4/22/2014 Conclusions • We do not have 5-year lifestyle outcomes in endometrial cancer patients • This population has health disparities • Lifestyle intervention trials in this patient Lif l i i i l i hi i population are feasible and necessary 25 Safety in Teams • Thanks to team at University Hospital of Cleveland and Summa Health System • Special thanks to Heidi Frasure and Dr. Michele McCarroll Michele McCarroll 5
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