Weight perceptions in older adults: findings from the English Longitudinal Study of Ageing

Objectives: To explore weight perceptions in a large, nationally-representative sample of older adults, and the extent to which they differ according to age and perceived health status. Setting: England. Participants: 5,240 men and women (≥50y) participating in the English Longitudinal Study of Ageing (2016/17). Main outcome measures: Weight perception was self-reported as too heavy, too light, or about right. Results: The majority of older adults endorsed a weight perception that matched their (objectively measured) BMI classification. However, one in ten (9.9%) older adults classified by BMI as normal-weight (18.5-24.9kg/m2) felt too light, with women at the upper end of the older age spectrum (OR=1.04, 95%CI=1.01-1.09), and men (OR=3.70, 95%CI=1.88-7.28) and women (OR=2.61, 95%CI=1.27-5.35) in poorer health more likely to do so. Almost half (44.8%) of older adults classified as overweight (25-29.9kg/m2) and one in ten (10.3%) classified as obese (≥30kg/m2) felt about the right weight, with this observed more frequently among men and women at the upper end of the older age spectrum (OR range 1.04-1.06). Conclusion: Older adults’ perceptions of their own weight generally correspond with traditional BMI cut-offs for normal-weight, overweight, and obesity. However, a substantial minority ‘underestimate’ their weight status, with those at the upper end of the age spectrum and those in poorer health more likely to do so

Potential ovarian toxicity and infertility risk following targeted anti-cancer therapies

Unlike traditional chemotherapy agents which are generally cytotoxic to all cells, targeted anti-cancer therapies are designed to specifically target proliferation mechanisms in cancer cells but spare normal cells, resulting in high potency and reduced toxicity. There has therefore been a rapid increase in their development and use in clinical settings, including in curative-intent treatment regimens. However, the targets of some of these drugs including kinases, epigenetic regulatory proteins, DNA damage repair enzymes and proteasomes, have fundamental roles in governing normal ovarian physiology. Inhibiting their action could have significant consequences for ovarian function, with potentially long-lasting adverse effects which persist after cessation of treatment, but there is limited evidence of their effects on reproductive function. In this review, we will use literature that examines these pathways to infer the potential toxicity of targeted anti-cancer drugs on the ovary

Assessment of Ovarian Function in Phase 3 (Neo)adjuvant Breast Cancer Clinical Trials: A Systematic Evaluation

BACKGROUND: Loss of ovarian function is a recognized adverse effect of chemotherapy for breast cancer and of great importance to patients. Little is known about the ovarian toxicity of newer cancer treatments. This study examined whether breast cancer clinical trials include assessment of the impact of trial interventions on ovarian function. METHODS: Eligible trials were phase III (neo)adjuvant trials of pharmacologic treatments for breast cancer, recruiting between June 2008 and October 2019, which included premenopausal women. MEDLINE, EMBASE, Clinicaltrials.gov, and EudraCT were searched. Data were extracted from trial publications, protocols, databases, and a survey sent to all trial chairs. Tests of statistical significance were 2-sided. RESULTS: Of 2354 records identified, 141 trials were eligible. Investigational treatments included chemotherapy (36.9%), HER2 targeted (24.8%), endocrine (12.8%), immunotherapy (7.8%), cyclin-dependent kinase 4/6 inhibitors (5.0%), and poly-ADP-ribose polymerase inhibitors (2.8%). Ovarian function was a prespecified endpoint in 13 (9.2%) trials. Forty-five (31.9%) trials collected ovarian function data, but only 33 (23.4%) collected posttrial-intervention data. Common postintervention data collected included menstruation (15.6%), pregnancy (13.5%), estradiol (9.9%), and follicle-stimulating hormone levels (8.5%). Only 4 (2.8%) trials collected postintervention anti-müllerian hormone levels, and 3 (2.1%) trials collected antral follicle count. Of 22 trials investigating immunotherapy, cyclin-dependent kinase 4/6 inhibitors, or poly-ADP-ribose polymerase inhibitors, none specified ovarian function as an endpoint, but 4 (18.2%) collected postintervention ovarian function data. CONCLUSIONS: The impact of pharmacologic interventions on ovarian function is infrequently assessed in phase III breast cancer (neo)adjuvant trials that include premenopausal women. Trialists should consider inclusion of ovarian function endpoints when designing clinical trials, given its importance for informed decision making