Abstract
Obesity is the greatest risk factor for endometrial cancer. There is often a lack of recognition amongst patients about this risk. Evidence for weight-loss in the management of endometrial cancer is emerging. This was questionnaire-based study, that examined opinions and attitudes of patients with endometrial cancer and obesity towards obesity as a risk factor for cancer as well as examining their willingness to engage in weight loss interventions as an alternative treatment to endometrial cancer. This survey was conducted in a gynaeoncology out-patient department in Ireland. A total of 45/50 (90%) of questionnaires were completed. The majority of the patients questioned (86.7%; 39/45) agreed that obesity is a disease. Just over half of the cohort (53.3%; 24/45) believed that obesity can cause cancer. Over one-third, 39.9% (18/45) either disagreed or strongly disagreed that obesity is a risk factor for endometrial cancer while 35.5% (16/45) agreed or strongly agreed. Two-thirds (66.6%; 30/45) knew that the greatest amount of weight could be lost through metabolic surgery. Over three-quarters (82.1%; 37/45) of patients surveyed would be willing to engage in a combination of treatments in order to achieve weight-loss should it be proven to have a role in the management of endometrial cancer. This study demonstrates a need for patient education regarding the strong relationship between obesity and endometrial cancer risk. Patients are willing to consider weight loss interventions if they were proven to be as safe and effective as pelvic surgery in the management of endometrial cancer.
Highlights
Endometrial cancer is the most common cancer of the female genital tract and the fourth commonest cancer in women overall in the developed world (Torre et al, 2015)
There are three main challenges that hinder the ability to treat obesity induced endometrial cancer, which include the lack of recognition by patients that obesity is a disease, lack of realisation that obesity contributes to cancer risk and the knowledge gap that exists amongst patients regarding the potential adjunctive treatments available (Mawardi et al, 2019)
Would there be a willingness amongst patients to engage in medical or surgical weightloss treatments as an alternative to the conventional hysterectomy should they be found to be safe and effective? The final part of this study aimed to assess whether patients with endometrial cancer and obesity would consider ‘if diet, medication and weight loss surgery were proven to be just as effective and as safe as a hysterectomy for the treatment of their endometrial cancer’ which option they would prefer? The majority 84.4% (38/45) of patients preferred a multimodal weight loss intervention compared to conventional surgical treatment (Fig. 3A)
Summary
Endometrial cancer is the most common cancer of the female genital tract and the fourth commonest cancer in women overall in the developed world (Torre et al, 2015). The question arises as to whether obesity is really perceived by patients as a risk factor for cancer?. Obese patients who seek out treatment for their disease are more likely to understand the impact of obesity on their health and are more likely to realise the social burden that obesity poses (Derksen et al, 2012). Up to 90% of patients with endometrial cancer are overweight (BMI 25–30 kg/m2) or obese (Crosbie et al, 2012). How many of these patients consider their weight as a cause or underlying risk for their disease? Some healthcare professionals feel that obesity is an uncomfortable topic to raise with their patients, whilst others cite time constraints as the reason not to broach the subject (Blackburn et al, 2015)
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