Associations among exercise, body weight, and quality of life in a population-based sample of endometrial cancer survivors

https://doi.org/10.1016/j.ygyno.2005.01.007Get rights and content

Abstract

Objectives

Lack of exercise and excess body weight may exacerbate treatment-related declines in quality of life (QoL) in endometrial cancer survivors. The primary purpose of this study was to examine the associations among exercise, body weight, and QoL in a population-based sample of endometrial cancer survivors.

Methods

Participants were 386 endometrial cancer survivors residing in Alberta, Canada who completed a mailed survey that assessed self-reported exercise, height, and weight to calculate body mass index (BMI) and QoL using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale.

Results

Descriptive data indicated that 70% of the sample were not meeting public health exercise guidelines and 72% were overweight or obese. Multivariate analyses of variance demonstrated that endometrial cancer survivors meeting public health guidelines for exercise and body weight reported significantly better QoL than survivors not meeting guidelines. The differences in QoL between the groups were clinically meaningful and were not altered when controlling for important demographic and medical variables. There were no interactions between exercise, BMI, age, or time since diagnosis. Lastly, multiple regression analysis identified that both exercise (β = .21; P < .001) and BMI (β = −.17; P < .001) were independently associated with QoL.

Conclusions

These results suggest that exercise and body weight are important independent correlates of QoL in endometrial cancer survivors. Randomized controlled trials designed to test the causal effects of exercise and/or weight loss on QoL in endometrial cancer survivors are warranted.

Introduction

Endometrial cancer is the fourth most common cancer in American women with over 40,000 new cases expected in 2004 [1]. Incidence rates for endometrial cancer peaked in the 1970s with the widespread use of unopposed exogenous postmenopausal estrogen replacement, followed by a decline in the 1980s, and have remained relatively stable since 1988 [1]. Although over 7000 women are expected to die from endometrial cancer in 2004, the clinical course of the disease is usually favorable. The most recent estimate of the 5-year relative survival rate is 84% [1]. Although the majority of women survive early stage endometrial cancer, it almost always requires some medical intervention. The most common treatment protocol is surgery followed by adjuvant radiation therapy. Less commonly, chemotherapy and/or hormone therapy may be offered in the adjuvant setting. These treatments can lead to acute and chronic side effects that may undermine QoL. The most common side effects include diarrhea, nausea, constipation, painful urination, genitourinary infection, fatigue, depression, poor body image, and sexual dysfunction [2], [3], [4], [5], [6], [7], [8]. Moreover, longer term limitations may result from the disease and its treatments including restrictions in activities of daily living, functional limitations, and psychological disability [9].

The QoL difficulties experienced by some endometrial cancer survivors may be exacerbated by a lack of exercise and/or excess body weight. Exercise has been shown to enhance QoL in several other cancer survivor groups [10] but no study has examined exercise in endometrial cancer survivors. Studies on body weight have reported that the majority of endometrial cancer survivors are obese [11], [12] but no study has examined the association between body weight and QoL in endometrial cancer survivors. In the general population, body weight is often negatively associated with QoL [13], [14].

The primary purpose of the present study was to examine the associations among exercise, body weight, and QoL in a population-based sample of endometrial cancer survivors. A secondary purpose was to report the prevalence rates of exercise and obesity in this population. Our primary hypothesis was that endometrial cancer survivors meeting current public health guidelines for exercise and body weight would report higher QoL than survivors not meeting these guidelines.

Section snippets

Participants and procedures

Ethical approval for this study was obtained from the Alberta Cancer Board and the University of Alberta. Eligible participants were: (a) 18 years of age or older, (b) able to provide written informed consent in English, (c) approved for contact by their primary oncologist or family physician (as required by our ethics boards), and (d) had histologically confirmed endometrial cancer. We obtained contact information from the Alberta Cancer Registry for all endometrial cancer survivors residing

Results

We contacted 248 oncologists/physicians representing 1549 endometrial cancer survivors. A response was received from 198 oncologists/physicians (79.8%) and approval was granted to contact 879 (56.7%) survivors. The main reason for the failure to obtain physician approval was lack of response from the physician after repeated attempts at contact. Of the 879 survivors that were sent a questionnaire package, we received 386 completed surveys, 100 unopened surveys (return to sender), 46 telephone

Discussion

The primary purpose of this study was to examine the associations among exercise, body weight, and QoL in endometrial cancer survivors. Our data indicated low rates of exercise and high rates of obesity in this population. The key finding of our study was that exercise and BMI were meaningfully and independently associated with QoL. These findings were not altered after controlling for important demographic and medical variables. Moreover, there were no interactions among exercise, BMI, age, or

Acknowledgments

This study was funded by a Social Sciences Research Grant from the University of Alberta. Kerry S. Courneya is supported by the Canada Research Chairs Program and a Research Team Grant from the National Cancer Institute of Canada (NCIC) with funds from the Canadian Cancer Society (CCS) and the NCIC/CCS Sociobehavioral Cancer Research Network. Kristina H. Karvinen is supported by an Epidemiology Graduate Studentship from the Alberta Cancer Board. Kristin L. Campbell is supported by a Health

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