title: Referring survivors of endometrial cancer and complex atypical hyperplasia to bariatric specialists: a prospective cohort study.
abstract: OBJECTIVE
  The purpose of this study was to describe the acceptability of bariatric referrals when offered by gynecologic oncologists to women with a history of complex atypical hyperplasia or early-stage endometrial cancer and to detail compliance with referrals and weight loss attempts that are initiated 3 months after the referral.
  
  
  METHODS
  Obese women with complex atypical hyperplasia or early-stage endometrial cancer were approached for inclusion in this prospective cohort study. Those women who were not in the care of a bariatric specialist were offered a medical referral with or without a surgical referral. A survey was administered at inclusion and after 3 months.
  
  
  RESULTS
  Of 121 women who were approached, 106 women were consented. Women reported that it was acceptable for their gynecologic oncologist to discuss weight loss (91.09%) and that a 10% loss of body weight would be beneficial (86.14%). Six women were already in the care of a bariatric specialist. Of the remaining 100 women, 43 accepted a referral: 35 of 100 medical and 8 of 66 surgical referrals that were offered. At 3 months, 17 women complied with a referral (16 medical and 1 surgical), and 59 women had initiated any weight loss attempt. On multivariate analysis, a higher initial weight (P = .0403), Charlson Comorbidity Index ≥5 (P = .0278), and shorter time from surgery to bariatric referral (P = .0338) predicted acceptance of a referral.
  
  
  CONCLUSIONS
  Weight-loss counseling is well received by these women. After being offered bariatric referral, only 17% comply, but most women (59%) subsequently initiate a weight loss attempt. Referrals should be offered early in the course of cancer care to maximize acceptance.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Institute and Section of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH. Electronic address: jerniga@ccf.org.
authors.forename: Amelia M
authors.initials: AM
authors.lastname: Jernigan
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Institute and Section of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Maurer
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH; Department of Obstetrics and Gynecology, Center for Specialized Women's Health, Cleveland, OH.
authors.forename: Karen
authors.initials: K
authors.lastname: Cooper
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Institute and Section of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Institute and Section of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Michener
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D052938:Bariatric Medicine; D050110:Bariatric Surgery; D049088:Bariatrics; D018269:Carcinoma, Endometrioid / Q000150:complications / Q000628:therapy*; D015331:Cohort Studies; D004714:Endometrial Hyperplasia / Q000150:complications / Q000628:therapy*; D016889:Endometrial Neoplasms / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D017741:Survivors
keywords: bariatric referral; endometrial cancer; obesity; survivorship; weight loss