title: Obesity is associated with worse quality of life in women with gynecologic malignancies: an opportunity to improve patient-centered outcomes.
abstract: BACKGROUND
  The objective of the current study was to evaluate the effect of obesity on pretreatment quality of life (QoL) in gynecologic oncology patients.
  
  
  METHODS
  The authors analyzed collected data from an institution-wide cohort study of women with gynecologic cancers enrolled from August 2012 to June 2013. The Functional Assessment of Cancer Therapy-General, site-specific symptom scales, and the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) global mental and physical health tools were administered. Survey results were linked to clinical data abstracted from medical records (demographics and comorbid conditions). Bivariate tests and multivariate linear regression models were used to evaluate factors associated with QoL scores.
  
  
  RESULTS
  A total of 182 women with ovarian, uterine, cervical, and vulvar/vaginal cancers were identified; of these, 152 (84%) were assessed before surgery. Mean body mass index was 33.5 kg/m(2) and race included white (120 patients [79%]), black (22 patients [15%]), and other (10 patients [6.5%]). A total of 98 patients (64.5%) were obese (body mass index ≥30). On multivariate analysis, subscales for functional (17 vs 19; P = .04), emotional (16 vs 19; P = .008), and social (22 vs 24; P = .02) well-being as well as overall Functional Assessment of Cancer Therapy-General scores (77 vs 86; P = .002) and Patient-Reported Outcomes Measurement Information System global physical health scores (45 vs 49; P = .003) were found to be significantly lower in obese versus nonobese patients.
  
  
  CONCLUSIONS
  Before cancer treatment, obese patients with gynecologic malignancies appear to have worse baseline QoL than their normal-weight counterparts. Emerging models of QoL-based cancer outcome measures may disproportionately affect populations with a high obesity burden. The potential disparate impact of cancer therapy on longitudinal QoL in the obese versus nonobese patients needs to be evaluated.
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Cancer Care Quality Training Program, Division of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Kemi M
authors.initials: KM
authors.lastname: Doll
authors.forename: Alison K
authors.initials: AK
authors.lastname: Kalinowski
authors.forename: Anna C
authors.initials: AC
authors.lastname: Snavely
authors.forename: Debra E
authors.initials: DE
authors.lastname: Irwin
authors.forename: Jeannette T
authors.initials: JT
authors.lastname: Bensen
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Bae-Jump
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Kim
authors.forename: Linda
authors.initials: L
authors.lastname: Van Le
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Clarke-Pearson
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000523:psychology; D011788:Quality of Life; D016896:Treatment Outcome
keywords: female genital neoplasms; obesity; patient-centered outcomes research; preoperative period; quality of life