The relationship of body mass index with quality of life among endometrial cancer survivors: A study from the population-based PROFILES registry

doi:10.1016/j.ygyno.2012.12.041

Gynecologic Oncology

Volume 129, Issue 1, April 2013, Pages 216-221

https://doi.org/10.1016/j.ygyno.2012.12.041 Get rights and content

Abstract

Objective

The aim of the study was to assess the association of body mass index (BMI) and Health-Related Quality of Life (HRQoL), and the relative importance of BMI in explaining variation in QoL among stage I or II endometrial cancer (EC), independent of comorbidities, socio-demographic and clinical characteristics.

Methods

A population-based, cross-sectional survey was conducted in 2008 among endometrial cancer survivors diagnosed between 1999 and 2007 sampled from the Eindhoven Cancer Registry. The HRQoL (SF-36), EC specific HRQoL (EORTC-QLQ-EN24), comorbidities (SCQ) and fatigue (FAS) questionnaire were completed by 666 endometrioid EC survivors. Multivariate regression analyses were used to assess the associations of HRQoL with BMI reported at time of questionnaire completion and to assess the percentage of variance in HRQoL outcomes explained by BMI (R²), (controlled for socio-demographic and clinical characteristics and comorbidity).

Results

Of all women, 432 (67.6%) were pre-obese (BMI 25–30) or obese (BMI > 30). Increased BMI was associated with decreased physical function, decreased vitality, more lymphoedema symptoms, decreased sexual/vaginal problems, less taste change and more fatigue symptoms. BMI added significantly to the explained variance of physical function (4.3%), physical limitations in daily life (role physical; 0.7%), bodily pain (1.5%), vitality (1.6%), emotional limitations in daily life (role emotional; 0.9%), lymphoedema symptoms (5.2%), sexual/vaginal problems (3.2%), urologic problems (0.7%), and fatigue (1.4%).

Conclusion

BMI was related to several HRQoL outcomes. Therefore BMI needs to be taken into account in HRQoL studies. Moreover, future research should assess if interventions to decrease BMI in obese EC survivors might improve HRQoL.

Highlights

► BMI has an important contribution to the health-related and endometrial-specific quality of life of endometrial cancer survivors. ► Survivors with a higher BMI had a worse physical functioning, with more lymphoedema and fatigue symptoms, but less sexual/vaginal problems. ► BMI needs to be taken into account in health-related quality of life studies and should be targeted in interventions.

Introduction

Endometrial cancer (EC) is the most common gynecologic malignancy with approximately 142,200 new cases diagnosed per year in developed countries [1]. The incidence of EC is still rising, among others due to an aging population and an increase in body mass index (BMI). Currently, 39% of all EC cases is attributed to obesity in industrialized countries [2]. Overall, 85% of EC cases is discovered in an early stage. These early-stage EC patients have a good prognosis since the 5-year survival rate of stage I is approximately 75–90% [3]. The rising incidence, combined with the good prognosis of EC survivors will lead to a considerable group of long-term EC survivors whereby HRQoL and the factors which influence the HRQoL become very important.

Health-Related Quality of Life (HRQoL) of EC survivors is negatively affected by BMI, both in the general population and in EC survivors [4], [5], [6]. Overweight or obese EC survivors report a poorer general health, more fatigue symptoms, lower physical functioning, more bodily pain, and more problems with work or daily activities [7], [8]. HRQoL is also affected by the presence of comorbidities. Comorbidities are highly prevalent in EC survivors. About 70% of EC survivors report at least one comorbidity [9], while on average EC patients report 2.4 comorbidities [10]. The studies about the association between HRQoL and BMI do not include specific items for QoL in patients with endometrial cancer and need replication in a larger sample. Better understanding of the impact of BMI on HRQoL is needed to develop interventions to improve the HRQoL of the growing group endometrial cancer survivors. Because of the important association between comorbidities and HRQoL, comorbidities need to be taken into account in such a study.

Therefore, the aim of this study was (1) to assess the association between BMI and HRQoL and (2) to evaluate the amount of variance of HRQoL explained by BMI in addition to comorbidities and socio-demographic and clinical characteristics in stage I or II EC survivors. We hypothesize that BMI is associated with and adds to the explained variance of specific HRQoL outcomes in EC survivors independent of comorbidities and socio-demographic and clinical characteristics.

Section snippets

Setting and participants

A population-based cross-sectional survey was conducted in 2008. In total 1478 patients who were newly diagnosed with FIGO stage I or II EC in the south of the Netherlands between 1998 and 2007, were registered by the Eindhoven Cancer Registry (ECR) of the Comprehensive Cancer Center South (CCCS) that covers about 10 community hospitals. Of these patients, 198 were deceased, 81 were 85 years old or older and excluded, 108 were from a hospital that declined participation and 126 addresses could

Socio-demographic and clinical characteristics

Table 1 represents the socio-demographic and clinical characteristics of respondents, non-respondents and patients with unverifiable addresses. Respondents were younger than non-respondents (66.8 vs. 69.2 years) and were more likely to have a high socio-economic status (33% vs. 28%). Almost all women (92%) were aged above 55 years. The mean time since diagnosis was 4.3 years (range 0.6–9.1) and was shorter for respondents than for non-respondents. Most patients (92%) had stage I endometrial cancer

Discussion

This population-based study showed that women with a higher BMI reported lower physical function, lower vitality, more lymphoedema symptoms, less sexual/vaginal problems and more fatigue symptoms after adjustment for socio-demographic and clinical characteristics and comorbidities. Furthermore, BMI added significantly to the explained variance of several domains of HRQoL in EC survivors i.e. physical health, role physical (problems with work or other daily activities as a result of physical

Conflict of interest statement

None.

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The relationship of body mass index with quality of life among endometrial cancer survivors: A study from the population-based PROFILES registry

Abstract

Objective

Methods

Results

Conclusion

Highlights

Introduction

Section snippets

Setting and participants

Socio-demographic and clinical characteristics

Discussion

Conflict of interest statement

Gynecol Oncol

Am J Obstet Gynecol

Eur J Cancer

Eur J Cancer

Patient Educ Couns

Gynecol Oncol

J Clin Epidemiol

Eur J Cancer

Respir Med

Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths

CA Cancer J Clin

Obesity and cancer risk: recent review and evidence

Curr Oncol Rep

Incidence and survival trends of uncommon corpus uteri malignancies in the Netherlands, 1989–2008

Int J Gynecol Cancer