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Original research
Body mass index and attitudes towards health behaviors among women with endometrial cancer before and after treatment
  1. Ross Harrison1,
  2. Hui Zhao2,
  3. Charlotte C Sun1,
  4. Shuangshuang Fu2,
  5. Shannon D Armbruster3,
  6. Shannon Neville Westin1,
  7. Jose Alejandro Rauh-Hain1,
  8. Karen H Lu1,
  9. Sharon H Giordano2 and
  10. Larissa A Meyer1
  1. 1 Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
  1. Correspondence to Dr Larissa A Meyer; lmeyer{at}mdanderson.org

Abstract

Introduction Some experts have argued that obesity-related malignancies such as endometrial cancer are a “teachable moment” that lead to meaningful changes in health behaviors. It is unclear if endometrial cancer survivors lose weight following treatment. Our goal with this investigation was to evaluate post-treatment changes in body mass index (BMI) and attitudes towards health behaviors in endometrial cancer survivors.

Methods Incident endometrial cancer cases undergoing surgery between 2009–2015 were identified in the Marketscan Commercial database and linked with BMI data and health behavior questionnaires from the Marketscan Health Risk Assessment database. Patients were excluded for insufficient BMI data. Standard statistical methods, including the two-sample Wilcoxon rank sum test, χ2 test, and McNemar’s test, were used.

Results 655 patients with a median age of 54 (IQR 49-58) were identified and analyzed. Median duration of follow-up was 595 days (IQR 360–1091). Mean pre- and post-treatment BMI was 35.5 kg/m2 (median 35.0; IQR 27.0–42.3) and 35.6 kg/m2 (median 34.3; IQR 28.0–42.0), respectively. Median BMI change in the entire cohort was 0 kg/m2 (IQR −1.0 to 2.0). Weight gain (n=302; 46.1%) or no change in weight (n=106; 16.2%) was seen in most patients. Among the 302 patients who gained weight, the mean pre-treatment BMI was 34.0 kg/m2 and mean increase was 2.8 kg/m2 (median 2.0; IQR 1.0–3.4). Among the 247 cases who lost weight, the mean pre-treatment BMI was 38.6 kg/m2 and mean decrease was 3.2 kg/m2 (median 2.0; IQR 1.0–4.0). No pre- to post-treatment differences were observed in health behavior questionnaires regarding intention to better manage their diet, exercise more, or lose weight.

Discussion Most endometrial cancer survivors gain weight or maintain the same weight following treatment. No post-treatment changes in attitudes regarding weight-related behaviors were observed. The systematic delivery of evidence-based weight loss interventions should be a priority for survivors of endometrial cancer.

  • uterine cancer
  • obesity, morbid
  • genital neoplasms, female
  • endometrium
  • uterine neoplasms

https://doi.org/10.1136/ijgc-2019-000999

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    Footnotes

    • Twitter @rossfh, @Shannon.Westin

    • Contributors All authors made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. All authors were involved in drafting the work or revising it critically for important intellectual content. All authors agree to be held accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding Financial support for this research investigation was provided in part by grant funding to the following individuals and organizations: Ross Harrison: National Institutes of Health T32 grant (#5T32 CA101642). Shannon Armbruster: National Institutes of Health T32 grant (#5T32 CA101642). Shannon Westin: National Cancer Institute SPORE for Uterine Cancer (2P50 CA098258-13); Andrew Sabin Family Fellowship. Sharon Giordano: CPRIT RP160674; Susan Komen SAC150061. Larissa Meyer: National Cancer Institute K award (#K07 CA201013). MD Anderson Cancer Center: National Cancer Institute Cancer Center Support Grant (P30 CA016672).

    • Competing interests Outside the scope of the current work, Dr Sun reports research support from AstraZeneca. Outside the scope of the current work, Dr Westin reports research support from ArQule, AstraZeneca, Bayer, Clovis Oncology, Cotinga Pharmaceuticals, Novartis, Roche/Genentech, and Tesaro. Outside of the scope of the current work, SNW reports consulting fees from AstraZeneca, Clovis Oncology, MediVation, Merck, Ovation, Pfizer, Roche/Genentech, Takeda, and Tesaro. Outside the scope of the current work, Dr Meyer reports research support from AstraZeneca.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.