A.F. Haggerty

The use of novel technology-based weight loss interventions for obese women with endometrial hyperplasia and cancer

OBJECTIVE Obesity significantly increases the risk of the development of both endometrial hyperplasia and cancer. Our objective was to assess the feasibility of two technology-based weight loss interventions in this patient population. METHODS Women with obesity (BMI≥30kg/m(2)) and endometrial hyperplasia or Type I endometrial cancer were randomized 1:1 to a technology-based 6month lifestyle intervention via either telemedicine or text messaging. The telemedicine arm received weekly phone calls, with weights tracked online using Withings© Wi-Fi scales. The text arm received 3-5 personalized messages daily via Text4Diet™. Participants maintained a 1200-1800calorie/day diet, self-monitored food intake and received exercise goals. Biomarkers (IGFBP-1, adiponectin, VEGF, IL1-beta, IL2, IL6, and IL7) were assessed pre- and post-treatment. RESULTS Twenty women were randomized (Telemedicine: n=10, Text4Diet: n=10), and 90% lost weight. Many were early stage (70%) and grade (43.8%) disease with a median age of 60.5years. We observed a statistically greater weight loss in the Telemedicine arm [median loss: 9.7kg (range: 1.6-22.9kg)] versus 3.9kg (range: 0.3-11.4kg) in the Text4Diet arm (p=0.0231). Similarly, percent weight loss was greater in the Telemedicine (7.6%) as compared to the Text4Diet arm (4.1%, p=0.014). Mean serum levels of IL-2 were significantly (27.15pg/mL vs. 5.18pg/mL, p=0.0495) lower at intervention end as compared to baseline. CONCLUSIONS A technology-based weight loss intervention is feasible in women with Type I endometrial cancer/hyperplasia. Both interventions produced weight loss, although more person-to-person contact produced more significant outcomes. Reductions in expression of IL-2 were related to weight loss.

The prescription or proscription of exercise in endometrial cancer care.

OBJECTIVE To determine the proportion of endometrial cancer patients who can be safely prescribed community/home based unsupervised exercise. A better understanding of the physical dysfunction secondary to comorbidities among endometrial cancer patients would assist clinicians in delineating which patients to send to medically-based supervised rehabilitation versus a community/home based unsupervised exercise program. METHODS A literature review identified health issues which could impede patients from successfully completing an unsupervised exercise program after a cancer diagnosis. The charts of 479 endometrial cancer patients treated between 2006 and 2010 were reviewed to determine the health status at the time of diagnosis and the type and percentage of health-issues that could preclude an unsupervised exercise program in this population. Univariable modeling and multivariable modeling were used to evaluate the association of demographic, cancer-related characteristics and clinical variables with ability to participate in unsupervised exercise. RESULTS We determined that 14.2% of endometrial cancer patients were able to exercise without supervision based on their health status at the time of diagnosis. After excluding common comorbidities (hypertension, diabetes and morbid obesity) from the identified health-issues, the proportion increased to 20.5%. Older at diagnosis (P=0.007) and higher BMI (P<0.001) are more likely to exclude patients from community/home based unsupervised exercise program. CONCLUSIONS Only 14.2% to 20.5% of endometrial cancer patients were deemed able to exercise without supervision based on their health status at diagnosis. Our data suggest that approximately 80% of endometrial cancer patients would benefit from a referral to a medically-based supervised exercise program.

Adjuvant Therapy in Early-Stage Endometrial Cancer: A Systematic Review of the Evidence, Guidelines, and Clinical Practice in the U.S.

Endometrial cancer is the most common gynecologic malignancy in the U.S., with an increasing incidence likely secondary to the obesity epidemic. Surgery is usually the primary treatment for early stage endometrial cancer, followed by adjuvant therapy in selected cases. This includes radiation therapy [RT] with or without chemotherapy, based on stratification of patients into categories dependent on their future recurrence risk. Several prospective trials (PORTEC-1, GOG#99, and PORTEC-2) have shown that the use of adjuvant RT in the intermediate risk (IR) and the high-intermediate risk (HIR) groups decreases locoregional recurrence (LRR) but has no effect on overall survival. The ad hoc analyses from these studies have shown that an even larger LRR risk reduction was seen within the HIR group compared with the IR group. Vaginal brachytherapy is as good as external beam radiotherapy in controlling vaginal relapse where the majority of recurrence occur, and with less toxicity. In the high-risk group, multimodality therapy (chemotherapy and RT) may play a significant role. Although adjuvant RT has been evaluated in many cost-effectiveness studies, high-quality data in this area are still lacking. The uptake of the above prospective trial results in the U.S. has not been promising. Factors that are driving current practices and defining quality-of-care measures for patients with early-stage disease are what future studies need to address.

Correlation of pelvic magnetic resonance imaging diagnosis with pathology for indeterminate adnexal masses.

Objectives The aim of this study was to determine the accuracy of pelvic magnetic resonance imaging (MRI) diagnoses compared with the final pathology diagnoses for a series of women with indeterminate adnexal masses. Materials and Methods We performed a retrospective cohort study of women who underwent pelvic MRI with a diagnosis of an adnexal mass between June 2009 and 2010 after indeterminate ultrasound at our tertiary care institution. Chart abstraction was performed for demographic information and radiologic interpretations (benign or malignant) and favored a specific histologic subtype on MRI reports. The radiologic diagnoses were compared with the diagnoses by surgical pathology. Results Data from 237 female patients who underwent pelvic MRI were included, and 41.35% underwent surgical intervention for the adnexal mass. Pelvic MRI (n = 88) was determined to have a sensitivity of 95.0% and specificity of 94.1%. The predicted specific histologic subtype by MRI (n = 84) was accurate in 56 (98.25%) of 57 women with an anticipated benign diagnosis and in 23 (85.19%) of 27 women with an anticipated malignancy. The agreement between a benign diagnosis from MRI and benign final surgical pathology was 0.85 (95% confidence interval, 0.716–0.976). Conclusions In our tertiary care center, MRI is used to further characterize indeterminate adnexal masses and can accurately differentiate benign versus malignant adnexal masses. The diagnosis on MRI was highly correlative with the final histopathology. The majority of the cohort (59%) were able to be managed expectantly based on reassuring results of the MRI. Magnetic resonance imaging offered diagnostic value, more detailed patient counseling, appropriate subspecialty referral, and surgical planning, as well as reassurance to pursue conservative management of benign masses by MRI.

Conservative management of endometrial hyperplasia or carcinoma with the levonorgestrel intrauterine system may be less effective in morbidly obese patients

Highlights • Endometrial hyperplasia/carcinoma regression rates with LNG-IUS were examined by BMI.• Morbidly obese patients with EH/EHA/EC are more likely to progress.• Despite addition of oral progesterone to LNG-IUS, morbid obesity increases the odds of progression.

Adjuvant chemotherapy for stage I ovarian clear cell carcinoma: Patterns of use and outcomes

OBJECTIVE The aim of this study was to investigate the patterns of use and outcomes of adjuvant chemotherapy for patients diagnosed with FIGO stage I ovarian clear cell carcinoma (OCCC). METHODS A cohort of patients diagnosed between 2004 and 2015 with OCCC was drawn from the National Cancer Database. Those with stage I disease who had primary surgery and underwent systematic lymphadenectomy (defined as at least 10 lymph nodes removed) were selected for further analysis. Factors associated with the administration of adjuvant chemotherapy were investigated with multivariate logistic regression. Overall survival (OS) was evaluated using Kaplan-Meier curves for patients diagnosed between 2004 and 2014, while comparisons were made with the log-rank test. Multivariate Cox analysis was performed to control for possible confounders. RESULTS A total of 2325 patients met the inclusion criteria. Median age was 55 years. The majority were White (86.6%). Adjuvant chemotherapy was administered to 1839 (79.1%) patients. Hospital type and location, patient age, disease sub-stage, and year of diagnosis were independently associated with the administration of chemotherapy. Patients who received adjuvant chemotherapy (n = 1629) had better OS than those who did not (n = 443), (5-year OS rates 89.2% vs 82.6%, p < 0.001). After controlling for disease sub-stage, age, race, hospital type and medical comorbidities, adjuvant chemotherapy was associated with better overall survival (HR: 0.59, 95% CI: 0.45, 0.78). CONCLUSIONS Adjuvant chemotherapy could be associated with a survival benefit for patients with stage I OCCC.

A Randomized, Controlled, Multicenter Study of Technology-Based Weight Loss Interventions among Endometrial Cancer Survivors: Technology-Based Weight Loss and Endometrial Cancer

The aim of this study was to test the efficacy of technology‐based weight loss interventions for endometrial cancer (EC) survivors with obesity.

Abstract 3726: Race-based disparities in loss of functional independence after uterine cancer

Proceedings: AACR 106th Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA Introduction Racial disparities in uterine cancer-related outcomes have been reported. Black uterine cancer patients are more likely to have worse clinical outcomes, which are not fully explained by number of comorbidities. Few studies have investigated the factors that may influence functional independence following surgery for uterine cancer. The goal of this study was to determine if race, preoperative body mass index (BMI) and medical comorbidities are predictors of loss of functional independence. Method: Data from the 2011 and 2012 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) were used. All patients were identified by post-operative ICD-9 code. Functional independence was defined as: the patient not requiring assistance from another person for any activities of daily living preoperatively. Loss of independence was defined as requiring discharge to a post-care facility or death, in the immediate postoperative period following hysterectomy. Demographic factors, comorbidities, BMI, intraoperative and postoperative outcomes and discharge status were captured within 30 days of surgery. Statistical analyses included multivariate logistic regression and Wald tests for interaction. Results: 4115 patients were identified with a diagnosis of uterine cancer and were functionally independent preoperatively: 310 (7.5%) were Black and 3805 (92.5%) were non-black. Compared with non-black, Black uterine cancer patients were notable for greater BMI (median 35.4 vs. 32.3, P<0.001), more likely to have one or more comorbidities (76.9% vs. 59.8%, P<0.001), and longer operative time (179.9 mins vs. 159.5 mins, P<0.001). After adjusting for BMI, age, number of comorbidities, pre-operative conditions, major complications, disseminated cancer and days of hospitalization prior to surgery, Black women were not significantly more likely to lose functional independence during the postoperative period than non-Black women. However, a significant interaction (OR 1.14 per 1-unit BMI increase, P<0.001) was found between Black and BMI on loss of functional independence. Interaction plots revealed worse functional outcomes per unit increase in BMI for Black women but not in non-Blacks. Conclusions: The significant interaction between Black race and BMI suggests a 14% increased odds of losing functional independence for each unit of BMI increase for Black uterine cancer patients, meaning that a 10-point increase in BMI would confer a 140% increase in odds of losing functional independence. Black uterine cancer patients with high BMIs may especially benefit from weight loss or interventions to optimize physical function and comorbidity profiles prior to and following surgery, in order to reduce the likelihood of losing functional independence after surgery. Together these efforts may improve disease specific as well as overall health outcomes in Black women with uterine cancer. Citation Format: Lorraine Dean, Xiaochen Zhang, Nawar Latif, Ashley Haggerty, Robert Giuntoli, Sarah Kim, David Shalowitz, Caitlin Stashwick, Mark Morgan, Emily Ko, Kathryn Schmitz. Race-based disparities in loss of functional independence after uterine cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3726. doi:10.1158/1538-7445.AM2015-3726