Low quality of life and activity levels persist in obese endometrial cancer survivors despite participation in a behavioral weight loss intervention

Abstract

<h3>Objectives:</h3> Obesity is inversely related to quality of life (QOL) in endometrial cancer (EC) survivors. With over 600,000 EC survivors in the U.S., many women experience obesity-related comorbidities following cancer cure, including poor QOL. We previously reported no change in weight after 6 months participation in a randomized trial comparing a text-message-based behavioral intervention and enhanced usual care (brief meeting, pamphlets with food diary). Here, we assessed changes in validated psychosocial (PS) measures between intervention groups. Based on previous literature, we also evaluated the effect of other factors (BMI, income, race, cancer stage, recurrence status) and hypothesized that these may predict improvement in QOL among EC survivors, over the intervention. <h3>Methods:</h3> EC survivors with a BMI ≥30kg/m² participating in a randomized behavioral weight loss study in our gynecologic oncology clinic completed a survey of validated PS measures at baseline and at 6-month study exit. These included the generalized mental and physical health QOL 12-Item Short Form Health Survey (SF-12; score 0-100, higher numbers indicating better QOL), the International Physical Activity Questionnaire-short form (IPAQ) to assess activity levels, and the Patient Health Questionnaire 9-Item Version depression assessment (PHQ9; score 0-27, higher scores indicating greater depression). The Kruskal-Wallis test was used to identify significant changes. <h3>Results:</h3> Between May and December 2017, 80 women enrolled and completed the PS assessments. 42.5% of participants had a baseline BMI ≥40kg/m², including 16.3% with a BMI ≥50kg/m². Between intervention groups, there were no differences in mean scores or changes within any of the PS analyses. For all participants, median SF-12 scores were at or below 50, consistent with generally low perceived QOL. Activity levels were low; at baseline, 26% reported no walking, 49% no moderate physical activity and 65% no vigorous physical activity within the last 7 days. Median total PHQ9 scores (5.5) were consistent with mild depression. Among all study participants, women with BMI ≥40kg/m²had a mean change from baseline in PHQ9 scores of -0.07 (±3.8) compared to -1.86 (±3.7) for BMI<40kg/m²(p=0.02). The change in SF-12 physical health QOL scores in non-WhiteWhite participants was 4.04 (±7.7) compared to -2.1 (±9.0) for WhiteWhite women (p=0.04), and 0.72 (±7.9) in early stage compared to -5.55 (±10.6) for Stages III-IV (p=0.046).There were no differences in PS scores based on income or recurrence. <h3>Conclusions:</h3> A technology-based behavior intervention did not improve QOL over enhanced usual care. Women with a BMI <40 kg/m² had improvement in depression scores, and physical health QOL improved to a greater degree in early-stage and non-WhiteWhite participants. Overall, obese EC survivors remain minimally physically active, with generally low perceived QOL and mild depressive symptoms. Further studies aimed at improving QOL for this growing population of women are warranted.