Prospective Cohort Study of Pre- and Postdiagnosis Physical Activity and Endometrial Cancer Survival

Abstract

PURPOSE The aim of this study was to evaluate associations between pre- and postdiagnosis physical activity and survival in survivors of endometrial cancer by physical activity domain, intensity, dose (metabolic-equivalent task [MET]-hours/week/year), and change from pre- to postdiagnosis. METHODS We conducted a prospective cohort study in Alberta, Canada, of 425 women who were diagnosed with histologically confirmed invasive endometrial cancer between 2002 and 2006 and observed to 2019. The interviewer-administered Lifetime Total Physical Activity Questionnaire recorded prediagnosis (assessed at a median of 4.4 months after diagnosis) and postdiagnosis physical activity (assessed at a median of 3.4 years after diagnosis). Associations between physical activity and overall and disease-free survival were assessed using Cox proportional hazards models adjusted for age, stage, grade, treatments, body mass index, menopausal status, hormone therapy use, family history of cancer, and comorbidities. RESULTS After a median follow-up of 14.5 years, there were 60 deaths, including 18 endometrial cancer deaths, and 80 disease-free survival events. Higher prediagnosis recreational physical activity was statistically significantly associated with improved disease-free survival (> 14 v ≤ 8 MET-hours/week/year; hazard ratio [HR], 0.54; 95% CI, 0.30 to 0.96; Ptrend = .04), but not overall survival (HR, 0.56; 95% CI, 0.29 to 1.07; Ptrend = .06). Higher postdiagnosis recreational physical activity (> 13 v ≤ 5 MET-hours/week/year) was strongly associated with both improved disease-free survival (HR, 0.33; 95% CI, 0.17 to 0.64; Ptrend = .001) and overall survival (HR, 0.33; 95% CI, 0.15 to 0.75; Ptrend = .007). Participants who maintained high recreational physical activity levels from pre- to postdiagnosis also had improved disease-free survival (HR, 0.35; 95% CI, 0.18 to 0.69) and overall survival (HR, 0.43; 95% CI, 0.20 to 0.94) compared with those who maintained low physical activity levels. CONCLUSION Recreational physical activity, especially postdiagnosis, is associated with improved survival in survivors of endometrial cancer.

Metabolic Activity of Visceral Adipose Tissue Is Associated with Metastatic Status of Lymph Nodes in Endometrial Cancer: A 18F-FDG PET/CT Study

“…Accumulating large prospective and epidemiologic studies have suggested that highlevels of physical activity against obesity can reduce the risk of endometrial cancer, whereas sedentary behavior can increase such risk [32][33][34]. Furthermore, recently, a prospective study by Friedenreich et al [35] has observed that increased physical activity after a diagnosis of endometrial cancer is associated with better survival and suggested that health care professionals should recommend physical activity as a therapeutic intervention to patients with newly diagnosed endometrial cancer and endometrial cancer survivors to improve their survival outcomes. Given that inflamed VAT can be regarded as a causal mechanism of obesity-induced endometrial cancer, it is conceivable that V/S ratio evaluated by 18 F-FDG PET/CT could be useful for assessing responses to therapeutic interventions for obesity such as exercise or lifestyle modification in patients with endometrial cancer.…”

Major clinical research advances in gynecologic cancer in 2020

“…It was suggested that active physical activity is associated with improved survival after an endometrial cancer diagnosis in a prospective cohort study by Friedenreich et al [ 71 ]. 425 women with endometrial cancer were followed up for a median of 14.5 years and the interviewer-administered Lifetime Total Physical Activity Questionnaire recorded pre- and post-diagnosis physical activity.…”

ENhAncing Lifestyle Behaviors in EndometriaL CancEr (ENABLE): A Pilot Randomized Controlled Trial

“…Despite guidelines for nutrition and exercise for people with cancer 7 , 8 and well-established benefits of pre and post-diagnosis physical activity (PA) including improvements in cardiovascular health, health-related quality of life (HRQoL), 9 , 10 fatigue, 11 and survival, 12 , 13 ; few endometrial cancer patients meet the recommendations (27% nutrition and 12% exercise). 4 , 14 Endometrial cancer survivors report that specific PA and nutrition recommendations were rarely made by oncologists.…”