Endometrial cancer patients don’t implement lifestyle changes to reduce comorbidities

ABSTRACT: Physicians must engage and educate patients about significant risk for cardiovascular disease.

Although they have survived their cancer, endometrial carcinoma patients face an increased risk of mortality because of an issue unrelated to their disease: complications from obesity. A new study on early-stage endometrial cancer survivors documented that these women are eschewing the activities-exercise, proper nutrition, and not smoking-that could help protect them against comorbidities.

"The study really points to the importance of encouraging lifestyle changes in endometrial cancer survivors," said lead author Vivian von Gruenigen, MD, chair of obstetrics and gynecology for Summa Health System in Akron, Ohio. "Physicians should take advantage of an endometrial cancer diagnosis [as] a teachable moment, engage patients in healthy lifestyle behaviors, and educate them about the significant risk for cardiovascular disease in this patient population."

"We found that not engaging in healthy lifestyle behaviors also resulted in compromised quality of life." - VIVIAN VON GRUENIGEN, MD

Dr. von Gruenigen and colleagues examined the lifestyle activities and health of 120 early-stage endometrial cancer survivors, administering questionnaires that assessed behaviors, morbidities, global health, and quality of life. Forty percent of the patients had hypertension, 39% osteoarthritis, 33% metabolic syndrome, and 24% type II diabetes. Ninety-four percent of the patients were abdominally obese, and 90% met criteria for being at high risk for type II diabetes, hypertension, and cardiovascular disease (2010 American College of Obstetricians and Gynecologists meeting).

According to the results, less than 1% of those surveyed practiced all three of the healthy behaviors recommended by the American Cancer Society (ACS): 150 minutes of moderate to strenuous physical activity per week, five servings of fruits and vegetables per day, and not smoking.

Eighty percent of participants reported no strenuous exercise, the median fruit/vegetable serving per day was 2.6, and more than 20% were smokers.

"Unlike breast and colon cancer patients, endometrial cancer patients do not make spontaneous lifestyle changes after their diagnosis that could decrease comorbidities. In our study, we found that not engaging in healthy lifestyle behaviors also resulted in compromised quality of life," Dr. von Gruenigen said. She noted that those who did not exercise or who smoked experienced decreased emotional well-being and an increased risk of fatigue.

FACTEndometrial ca recurrence and obesityIn a previous study, Dr. von Gruenigen and colleagues examined rates of disease recurrence, treatment-related adverse effects, and survival between obese or morbidly obese and nonobese patients (

Cancer

107:2786-2791, 2006).

Although the study points to problematic morbidities and lifestyle behaviors in endometrial cancer survivors, Dr. von Gruenigen believes that physicians can make a difference in this population. To that end, she and fellow researchers are studying the effects of teaching healthy behaviors to endometrial cancer survivors in a clinical trial funded by the ACS in which participants will be randomized to healthy behavior interventions or observation.

In the study, a multidisciplinary team of clinicians, including a physician, a psychologist, a physical therapist, and a nutritionist, will coach endometrial cancer survivors on healthy behaviors in sequential small group meetings, she said. The study will follow the survivors for at least one year after the intervention, and results should be available in less than two years.

"The majority of endometrial cancer patients should be surviving; however, a significant number of these patients are not. We suspect that it has to do with risk factors for cardiovascular disease, particularly their generosity of weight," she said.