Elsevier

Gynecologic Oncology

Volume 132, Issue 2, February 2014, Pages 397-402
Gynecologic Oncology

Self-efficacy, quality of life, and weight loss in overweight/obese endometrial cancer survivors (SUCCEED): A randomized controlled trial,☆☆

https://doi.org/10.1016/j.ygyno.2013.12.023Get rights and content

Highlights

  • The purpose of this study was to improve self-efficacy and quality of life.

  • The lifestyle intervention showed positive changes in self-efficacy over control.

  • Significant negative correlation between increasing self-efficacy and 1 BMI weight-loss.

Abstract

Objective

More patient-centered programming is essential for endometrial cancer (EC) survivors needing to lose weight to reduce cardiovascular disease risk (CVD). The purpose of this study was to improve self-efficacy (SE) and quality of life (QOL) using a lifestyle intervention program designed for weight loss.

Methods

Overweight and obese early-stage EC survivors, n = 75, were randomized into two groups: 1) Survivors of Uterine Cancer Empowered by Exercise and Healthy Diet (SUCCEED), a six-month lifestyle intervention or 2) a usual care group (UC). Participants completed the Weight Efficacy Lifestyle Questionnaire (WEL) to assess SE and the Functional Assessment of Cancer Therapy—General (FACT-G) to measure QOL, and their body mass index (BMI) was calculated at baseline, 3, 6, and 12 months. Mixed, repeated-measures ANCOVA models with baseline covariates were employed using SPSS 20.0.

Results

Positive effects in every WEL domain, including the total score, were statistically significant in the SUCCEED group versus the UC group. A linear regression model demonstrated that, if BMI decreased by 1 unit, the total WEL score increased by 4.49 points. Significant negative correlations were found in the total WEL score and a change in BMI of R =  0.356 (p = 0.006). Between-group differences in the FACT-G were significant from baseline in the fatigue domain at three months (p = .008) and in the physical domain at six months (p = .048). No other significant differences were found.

Conclusion

Overall, this study shows promise for targeted interventions to help improve SE, thus improving BMI.

Introduction

Obesity is associated with an increased risk of several cancer types [1]. Endometrial cancer (EC) is the most common female gynecologic (GYN) cancer in the United States, and whereas the majority of those diagnosed are obese [2]. Obesity is the most significant risk factor for the development of EC and also plays a role in a patient's survival [3], [4]. Specifically, women with EC exhibit the highest body mass index (BMI) of all cancers most apparent in women with type I tumors, particularly among women with poorly differentiated tumors [5]. Most women with EC are diagnosed with early-stage disease, and over 500,000 women are survivors of EC [6]. Unfortunately, even with early detection, EC survivors suffer life-threatening co-morbidities associated with obesity-related illnesses including hypertension, hyperlipidemia, and pulmonary dysfunction [7]. Furthermore, overweight and obese EC survivors are susceptible to diabetes, coronary heart disease, and premature death. Cardiovascular (CVD) co-morbidities are the leading cause of death among endometrial cancer survivors secondary to obesity [8]. Several studies suggest that obesity assessed by BMI at diagnosis is associated with worse survival among women diagnosed with endometrial cancer, reflecting the strong relationship between obesity and survival in EC survivors [9]. Consequently, survivorship action plans must mobilize patients into lifestyle programs focused on weight loss and go beyond radiation, chemotherapy, and surgery.

The American Association for Cancer Research (AACR) states that obesity can interfere with a survivor's recovery, quality of life (QOL), and self-efficacy (SE) for weight loss. Patient-reported outcomes (PRO) such as QOL and SE are among the patient-centered approaches to healthcare used in an attempt to understand what influences successful survivorship. In particular, the QOL domains of physical, mental, social, and emotional well-being and development/activity measure the multi-factorial components of a survivor's life. Within the past four decades, QOL has become an important end point relating obesity to lower levels of QOL of EC survivors. Conn et al. indicated that supervised exercise was marginally linked to QOL improvement in cancer survivors [10], while in a meta-analysis by Ferrer et al., exercise interventions had a positive and significant effect on QOL among all intervention groups compared to controls [11].

Often, QOL and SE are mentioned hand in hand, yet they represent two separate aspects of a patient's approach to survivorship. Self-efficacy may actually influence weight loss and the QOL of cancer survivors, as demonstrated by Rejeski et al. [12]. Today, the increasing population of women diagnosed with obesity-driven female cancers underscores the need for weight loss/patient-centered interventions to improve short-term and long-term survivorship [13]. What is unknown is the effect that QOL and SE have on a patient's potential to lose weight in survivorship.

We previously published results of the Survivors of Uterine Cancer Empowered by Exercise and Healthy Diet (SUCCEED) intervention for obese and overweight EC survivors [14]. This study demonstrated that after lifestyle interventions were implemented using the SUCCEED methodology, weight loss and positive dietary and physical activity behaviors occurred and were sustained over a one-year period. Our current inquiry expands upon the previously published results to determine whether the SUCCEED intervention has positive effects on self-efficacy and QOL that subsequently leads to weight loss. In this study, we report the changes in QOL and self-efficacy scores that accompanied changes in body weight observed over a one-year period. We hypothesized that SUCCEED participants will have increased self-efficacy and QOL compared to EC survivor controls.

Section snippets

Study design and patient recruitment

This study was a two-group randomized trial (n = 75) in Stage I or II EC patients categorized as having an obese or overweight BMI. Patients were randomized to either: 1) a lifestyle intervention (SUCCEED) group that received nutrition, exercise, and behavioral modification counseling and 2) a usual care (UC) group. The SUCCEED group received six months of comprehensive lifestyle modification intervention from physicians and qualified allied health professionals in nutrition, exercise, and mental

Results

Seventy-five patients were enrolled and randomized to either the SUCCEED group (n = 41) or the UC group (n = 34). There was a statistically significant BMI loss for the SUCCEED group versus the UC group at the 6- and 12-month post-baseline time points (Table 1). The SUCCEED group exceeded the UC group in BMI reduction at each post-baseline time point; however, the BMI of the SUCCEED group significantly (p = 0.041) increased at six months to 12 months post-baseline by 0.28 kg/m  m. Positive effects in

Discussion

Our study demonstrated that positive changes in SE were statistically significant in the SUCCEED group over the UC group. The study results revealed a negative correlation between increasing all WEL domains and a loss of 1 BMI, aside from the negative emotions domain. Specifically, if BMI decreased by 1 unit, then the SE of the EC survivor increased. The FACT-G QOL scores demonstrated no correlation to weight loss.

Using QOL questionnaires in lifestyle interventions is widely accepted as an

Conflict of interest statement

The authors declare that there are no conflicts of interest.

References (35)

  • V.E. von Gruenigen et al.

    Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma

    Cancer

    (2006)
  • H. Arem et al.

    Obesity and endometrial cancer survival: a systematic review

    Int J Obes (Lond)

    (May 2013)
  • V.S. Conn et al.

    A meta-analysis of exercise interventions among people treated for cancer

    Support Care Cancer

    (2006)
  • R.A. Ferrer et al.

    Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes

    Ann Behav Med

    (2011 Feb)
  • W.J. Rejeski et al.

    Weight loss and self-regulatory eating efficacy in older adults: the cooperative lifestyle intervention program

    J Gerontol B Psychol Sci Soc Sci

    (2011)
  • R.A. Campo et al.

    Cancer prevention after cancer: changing the paradigm: a report from the American society of preventive oncology

    Cancer Epidemiol Biomarkers Prev

    (2011)
  • Weight Control Information Network

    Better health and you

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    Funding support: American Cancer Society.

    ☆☆

    Presentation at meeting: Oral Plenary Presentation Society of Gynecologic Oncology, Los Angeles, CA, March 10, 2013.

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