Obesity surgery and risk of colorectal and other obesity-related cancers: An English population-based cohort study

Background: The association between obesity surgery (OS) and cancer risk remains unclear. We investigated this association across the English National Health Service. A population-based Swedish study has previously suggested that OS may increase the risk of developing colorectal cancer (CRC). Methods: A retrospective observational study of individuals who underwent OS (surgery cohort) or diagnosed with obesity, but had no OS (no-surgery cohort) (1997–2013) were identified using Hospital Episode Statistics. Subsequent diagnosis of CRC, breast, endometrial, kidney and lung cancer, as well as time ‘at risk’, were determined by linkage to National Cancer Registration & Analysis Service and Office of National Statistics data, respectively. Standardised incidence ratios (SIR) in relation to OS were calculated. Results: 1 002 607 obese patients were identified, of whom 3.9% (n = 39 747) underwent OS. In the no-surgery obese population, 3 237 developed CRC (SIR 1.12 [95% CI 1.08–1.16]). In those who underwent OS, 43 developed CRC (SIR 1.26 [95% CI 0.92–1.71]). The OS cohort demonstrated decreased breast cancer risk (SIR 0.76 [95% CI 0.62–0.92]), unlike the no surgery cohort (SIR 1.08 [95% CI 1.04–1.11]). Increased risk of endometrial and kidney cancer was observed in surgery and no-surgery cohorts. Conclusions: CRC risk is increased in individuals diagnosed as obese. Prior obesity surgery was not associated with an increased CRC risk. However, the OS population was small, with limited follow-up. Risk of breast cancer after OS is reduced compared with the obese no-surgery population, while the risk of endometrial and kidney cancers remained elevated after OS

Exercise, Diet, and Weight Management during Cancer Treatment: ASCO Guideline

PURPOSE: To provide guidance on exercise, diet, and weight management during active cancer treatment in adults. METHODS: A systematic review of the literature identified systematic reviews and randomized controlled trials evaluating the impact of aerobic and resistance exercise, specific diets and foods, and intentional weight loss and avoidance of weight gain in adults during cancer treatment, on quality of life, treatment toxicity, and cancer control. PubMed and the Cochrane Library were searched from January 2000 to May 2021. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS: The evidence base consisted of 52 systematic reviews (42 for exercise, nine for diet, and one for weight management), and an additional 23 randomized controlled trials. The most commonly studied types of cancer were breast, prostate, lung, and colorectal. Exercise during cancer treatment led to improvements in cardiorespiratory fitness, strength, fatigue, and other patient-reported outcomes. Preoperative exercise in patients with lung cancer led to a reduction in postoperative length of hospital stay and complications. Neutropenic diets did not decrease risk of infection during cancer treatment. RECOMMENDATIONS: Oncology providers should recommend regular aerobic and resistance exercise during active treatment with curative intent and may recommend preoperative exercise for patients undergoing surgery for lung cancer. Neutropenic diets are not recommended to prevent infection in patients with cancer during active treatment. Evidence for other dietary and weight loss interventions during cancer treatment was very limited. The guideline discusses special considerations, such as exercise in individuals with advanced cancer, and highlights the critical need for more research in this area, particularly regarding diet and weight loss interventions during cancer treatment.Additional information is available at www.asco.org/supportive-care-guidelines. © American Society of Clinical Oncology.12 month embargo; published online: 16 May 2022This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Protocol for a feasibility and early efficacy study of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2)

Background: Although androgen deprivation therapy (ADT) for prostate cancer demonstrates improved overall and disease-free survival, it is associated with adverse effects such as obesity and metabolic syndrome that increase risk of cardiometabolic disease and diabetes type 2. ADT also leads to fatigue, depression and erectile dysfunction, which reduce quality of life (QoL). Lifestyle modification has shown promise in reducing obesity, metabolic syndrome and diabetes type 2 in other disease types. However, there is a paucity of data regarding the utility of lifestyle modification in men receiving ADT for prostate cancer. Methods: The primary aim of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2) is to test the feasibility of conducting a 24-week lifestyle modification intervention in men on ADT for prostate cancer. Additionally, it will also determine the effect of this intervention on weight loss, cardiometabolic markers (secondary aim and markers of interest: serum glucose, insulin resistance, hemoglobin A1C and lipid panel), and QoL (tertiary aim). The intervention will be delivered weekly via telephone for the first 10 weeks and bi-weekly for the remaining 14 weeks. Questionnaires and serum samples will be collected at baseline, week 12, and week 24. Anthropometric measurements will be collected at baseline, week 6, week 12, week 18 and week 24. Results: We hypothesize that the CLIPP2 intervention will produce a 7% weight loss that will result in improved markers associated with cardiometabolic disease and type 2 diabetes in the study population. Conclusion: Results will provide insight into the role of lifestyle modification in addressing ADT adverse effects as well as provide preliminary data to inform the development of future lifestyle interventions in this area. Trial registration: NCT04228055 Clinicaltrials. gov. © 2021Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

A phase III randomized trial of weight loss to reduce cancer-related fatigue among overweight and obese breast cancer patients: MEDEA Study design

BACKGROUND: Elevated body mass index (BMI) represents a risk factor for cancer-related fatigue (CRF). Weight loss interventions are feasible and safe in cancer survivors, leading to improved cardio-metabolic and quality of life (QOL) outcomes and modulating inflammatory biomarkers. Randomized data are lacking showing that a lifestyle intervention aimed at weight loss, combining improved diet, exercise, and motivational counseling, reduces CRF. Motivating to Exercise and Diet, and Educating to healthy behaviors After breast cancer (MEDEA) is a multi-center, randomized controlled trial evaluating the impact of weight loss on CRF in overweight or obese survivors of breast cancer. Herein, we described the MEDEA methodology. METHODS: Patients (N = 220) with stage I-III breast cancer and BMI ≥ 25 kg/m2, within 12 months of primary treatment, and able to walk ≥ 400 m are eligible to enroll. Participants are randomized 1:1 to health education alone vs. a personalized telephone-based weight loss intervention plus health education. Both arms receive a health education program focusing on healthy living. Patients in the intervention arm are paired with an individual lifestyle coach, who delivers the intervention through 24 semi-structured telephone calls over 1 year. Intervention goals include weight loss ≥ 10% of baseline, caloric restriction of 500-1000 Kcal/day, and increased physical activity (PA) to 150 (initial phase) and 225-300 min/week (maintenance phase). The intervention is based on the social cognitive theory and is adapted from the Breast Cancer Weight Loss trial (BWEL, A011401). The primary endpoint is the difference in self-reported CRF (EORTC QLQ-C30) between arms. Secondary endpoints include the following: QOL (EORTC QLQ-C30, -BR45, -FA12), anxiety, and depression (HADS); weight and BMI, dietary habits and quality, PA, and sleep; health care costs (hospital-admissions, all-drug consumption, sick leaves) and cost-effectiveness (cost per quality-adjusted life-year); and patient motivation and satisfaction. The primary analysis of MEDEA will compare self-reported CRF at 12 months post-randomization between arms, with 80.0% power (two-sided α = 0.05) to detect a standardized effect size of 0.40. DISCUSSION: MEDEA will test the impact of a weight loss intervention on CRF among overweight or obese BC survivors, potentially providing additional management strategies and contributing to establish weight loss support as a new standard of clinical care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04304924. © 2022. The Author(s).Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Mode de vie et cancer du sein: quels conseils pour la prise en charge de l’après cancer ?

National audienceIt is widely admitted that after adjuvant therapy, about one half of women with localized breast cancer experience a weight gain of 3 kg. It can however reach 8 to 10 kg in numerous cases. Risk factors associated with weight gain are unclear, but women undergoing chemotherapy seem to have an increased risk, especially before the menopause. Retrospective studies suggest that post-treatment weight gain mightincrease the risk of relapse. Furthermore, the only intervention trial in adjuvant breast cancer, though impaired by methodological pitfalls, suggests that limiting weight gain could increase disease free survival. The use of nutritional complements by cancer patients is usually underestimated. Several compounds, such as vitamins C and, E, selenium or carotenoids, have been investigated in clinical trials whose quality is usually poor. Available date nevertheless suggest a deleterious effect of supplementation with anti-oxydants, in particular at supraphysiological doses. The WHEL trial is the only large randomised trial investigating an healthy diet with vegetables, fruits and fiber after localized breast cancer. An effect of survival is observed in the experimental arm only in patients with sufficient level of physical activity. Physical activity, when practiced regularly, improves asthenia, quality of life and even survival, without any detrimental effect. It should however be initiated after an evaluation of patient’s ability and comorbidities, and be realized in specific centers with careful medical follow-up. Its mechanisms of action include regulation of estrogen, insulin, IGF1 and adipokines. Adapted physical activity should be proposed to patients fulfilling precise inclusion criteria.On estime que près de la moitié des femmes traitées pour un cancer du sein localisé sont affectées par un gain de l’ordre de 3 kg, mais des prises de poids de l’ordre de 8 à 10 kg ne sont pas exceptionnelles. Les facteurs de risque ne sont pas clairement individualisés, mais les patientes recevant une chimiothérapie semblent plus concernées, en particulier avant la ménopause. Les études rétrospectives montrent que la prise de poids pourrait être un facteur de risque de rechute, qui plus est, le seules said’ intervention actuellement publié dans le cancer du sein, bien que sujet à des critiques d’ordre méthodologique, suggère un effet positif de la réduction du surpoids sur la survie sans récidive. L’utilisation de compléments nutritionnels par les patients est, quant à elle, largement sous-estimée. De nombreux composés ont fait l’objet d’essais cliniques dont la méthodologie est globalement peu convaincante (vitamines C et E, sélénium, caroténoïdes). Les données disponibles suggèrent un effet négatif de la supplémentation en antioxydants(en particulier à des doses supra-physiologiques) pouvant éventuellement affecter l’efficacité du traitement antitumoral. L’essai WHEL (Women’s Healthy Eating and Living) est le seul grand essai randomisé d’intervention, basé sur une supplémentation en fruits et légumes après traitement d’un cancer du sein localisé : il suggère un effet positif de la supplémentation uniquement si elle est associée à une activité physique suffisante. L’ activité physique régulière lors des soins en cancérologie améliore la qualité de vie, la fatigue, la survie, enparticulier pour les patientes por-teuses de cancer du sein, et ce, sans effet secondaire à condition d’être mise en place après un bilan précis des capacités, des comorbidités, d’être réalisée dans des structures adaptées avec un suivi médical des progrès et des difficultés. Les mécanismes d’action passent par des modifications de sécrétion d’estrogène, d’insuline, d’IGF1 et des adipokines. L’activité physique adaptée en cancérologie doit être proposée aux malades répondant à des critères d’inclusion précis