Self-efficacy, quality of life, and weight loss in overweight/obese endometrial cancer survivors (SUCCEED): A randomized controlled trial☆,☆☆
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)
- et al.
Body mass index, physical activity, and survival after endometrial cancer diagnosis: results from the Women's Health Initiative
Gynecol Oncol
(Feb 2013) - et al.
Cardiovascular disease is the leading cause of death among endometrial cancer patients
Gynecol Oncol
(2012 Aug) - et al.
Survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED): a randomized controlled trial
Gynecol Oncol
(June 2012) - et al.
Meta-analysis provides evidence-based effect sizes for a cancer-specific quality-of-life questionnaire, the FACT-G
J Clin Epidemiol
(Mar 2010) - et al.
The relationship of body mass index with quality of life among endometrial cancer survivors: a study from the population-based PROFILES registry
Gynecol Oncol
(Apr 2013) National cancer institute fact sheets
United States Cancer Statistics: 1999–2009 incidence and mortality web-based report
- et al.
Million women study collaboration. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study
BMJ
(2007) - et al.
Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults
N Engl J Med
(2003) Endometrial (uterine) cancer [American cancer society web site]
Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma
Cancer
Obesity and endometrial cancer survival: a systematic review
Int J Obes (Lond)
A meta-analysis of exercise interventions among people treated for cancer
Support Care Cancer
Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes
Ann Behav Med
Weight loss and self-regulatory eating efficacy in older adults: the cooperative lifestyle intervention program
J Gerontol B Psychol Sci Soc Sci
Cancer prevention after cancer: changing the paradigm: a report from the American society of preventive oncology
Cancer Epidemiol Biomarkers Prev
Better health and you
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Funding support: American Cancer Society.
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Presentation at meeting: Oral Plenary Presentation Society of Gynecologic Oncology, Los Angeles, CA, March 10, 2013.