Awareness of the association between obesity and peri-operative risk among newly diagnosed patients with complex atypical hyperplasia and endometrial cancer

Abstract

Objectives To evaluate knowledge of obesity-related peri-operative risks in with women newly diagnosed complex atypical hyperplasia and endometrial cancer. Methods Cross sectional study of patients newly diagnosed with complex atypical hyperplasia or endometrial cancer who underwent preoperative counseling between 2011 and 2014, using a 17-item questionnaire. Obesity was defined as body mass index (BMI) of 30 kg/m2 or greater. Bivariate analysis was conducted using Pearson's Chi-Square or Fisher's Exact tests where appropriate and Mann-Whitney U for continuous variables. Results Of 98 patients recruited, mean age was 58 years, 87% were obese, 83% white, and 51% had grade 1 endometrioid adenocarcinomas. Sixty-four percent of obese women reported that their physicians had discussed surgical risks related to obesity. However, 17% of obese and 42% of non-obese patients responded that they were unsure of the peri-operative risks associated with obesity. There was substantial lack of understanding among obese patients regarding their increased risks of respiratory problems (29%), thromboembolism (29%), heart attack (35%), or longer operating time (35%) and hospital stay (47%). However, obese patients were more aware of wound infection risks associated with obesity compared to their non-obese counterparts (72% vs. 31%, p=0.004). Conclusions Pre-operative counseling for obese women with newly diagnosed endometrial cancer should incorporate more focused education about obesity-related risks. They report being knowledgeable about the risks associated with their surgery, however, more than a quarter are unaware of the impact obesity has on respiratory problems, thromboembolism, wound infection, heart attack or longer operating time and hospital stay.

Obesity Education Strategies for Cancer Prevention in Women’s Health

“…Since this time, surveys continue to demonstrate both gaps in patients’ knowledge of the obesity-cancer link and providers’ lack of counseling, despite evidence to suggest utility. In a recent survey [44], only 50% of patients undergoing surgery for endometrial cancer recognized that weight increases the risk of cancer, and only 36% noted any relation to surgical outcomes based on weight. In another survey of over 450 gynecologic oncology providers [45], only 50% of gynecologic oncology providers acknowledged providing any weight loss counseling, although >80% felt it was important.…”

Patients with endometrial cancer continue to lack understanding of their risks for cancer

“…Each question had one correct answer, either true or false; “not sure” was an available answer choice for each knowledge question. Questions specifically related to obesity were modified from a previously published survey study on obesity-related risk factors (Kuroki et al, 2015). Those regarding sexual health and other risk factors (eg, hormone replacement therapy, family history, the role of Pap tests etc) were based on a prior survey that highlighted patients' lack of knowledge regarding differences between cervical and EC risks (Ackermann et al, 2005).…”

“…Obesity has been shown repeatedly to be one of the strongest EC risk factors that drives all-cause and cancer-specific mortality (Gunderson et al, 2014; Arem et al, 2013; von Gruenigen et al, 2006). Appropriately, an abundance of research has been dedicated to better understanding patients' knowledge of the impact of obesity on cancer, and multi-centered weight loss interventions have been implemented among EC survivors to help reduce their risk of death (Ackermann et al, 2005; Connor et al, 2017; Haggerty et al, 2017a, Haggerty et al, 2017b; Kuroki et al, 2015; Soliman et al, 2008). Unfortunately, positive outcomes of weight loss interventions are brief and reach only a small subset of women affected with EC (Haggerty et al, 2017a).…”