Examining the Obesity-Cancer Connection

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Although obesity is considered a risk factor for developing cancer, it is also associated with a worse prognosis and an increased risk for recurrence for those that have cancer. This was a topic of discussion at the Oncology Nursing Society's (ONS) 40^th Annual Congress meeting in Orlando, Florida, April 23-26, 2015.

Speaker Adrienne Wald, EdD, MBA, RN, MCHES, CNE, nursing professor at the College of New Rochelle in New Rochelle, New York, discussed the impact that obesity is having on cancer statistics, noting that some are even calling this epidemic, “the new smoking.”

As clinicians, are we properly assessing patients for obesity? Looking closely at an increasing body mass index (BMI), waist circumference, skin fold measurement, or even the amount and depth of intra-abdominal fat on a CT scan can be a good indication of which patients may be at risk for developing cancer or disease recurrence. Obesity is a marker for an unhealthy lifestyle.

Obese patients face a number of challenges, including the inability to receive effective health and/or cancer screenings. For example, the difficulty in reading diagnostic images, the inaccuracy of biomarker results due to hemodilution, or even the embarrassment associated with physical examinations are just some of the barriers and complications practitioners face when screening and caring for these patients.

When it comes to treating obese cancer patients, surgical procedures and medicinal treatment administration can also be challenging. Some obese patients do not receive an effective dose of chemotherapy for their weight. Aside from dose reductions due to pre-existing medical conditions or fixed/maximum dosing limits, the patient should receive a dose based on his/her actual body weight-not ideal body weight.

Obese patients are also at risk for developing serious quality-of-life issues before, during, and after cancer treatment. Fatigue, blood clots, drug-drug interactions (polypharmacy), and infections are just a few that should be on the health care provider’s radar as they follow these patients throughout their cancer treatment.

As oncology nurses are at the forefront of cancer care, this is an opportune time to educate patients on lifestyle changes to help reduce their overall risk: assess for weight gain; make time to discuss weight management with your patients; include other members of the health care team to counsel patients on diet, exercise, etc; set realistic goals for the patient-create an individualized care plan; and help to reduce stigma for obese patients.

Dr. Wald stressed that obesity is a heterogeneous condition and not a single disorder, and it should not be treated as such.