Obesity, physical inactivity and quality of life after ovarian cancer treatment  Kate Webber, Nation

Obesity, physical inactivity and quality of life after ovarian cancer treatment Kate Webber, Nation


My presentation is a little bit
different to the ones we’ve been talking about so far. I’m going to present some
results from large international survey looking at the symptoms and
quality-of-life concerns of women who have had treatment for ovarian cancer. So
I guess by way of background, ovarian cancer survivors are relatively
understudied compared to other populations of survivors but they’re due to
improvements in our diagnosis and treatment over the last few decades
that there is a growing population of long-term survivors of ovarian cancer.
Even among the women though whose disease will inevitably relapse, the usual
trajectory for these women is that they go through periods of relapse and
remission, and during these periods of time, survivorship concerns are equally
relevant for these, these patients and so it’s really important that we understand
what it is that’s troubling these women and what we might be able to do to help
them. Prior to this survey this was the largest study that had really looked at
survivorship concerns in ovarian cancer. It was done in the UK and included only
a hundred patients. I don’t really expect you to see what all of that says but
basically the blue bars are the symptoms and concerns patients reported, and the
red bars are what the doctor said they they felt they had in their clinical
letters so there was a big disconnect between what patients were complaining
of and what the doctors were reporting that they had. So we undertook an
internet-based questionnaire and this is what it looked like: basically what we did was we developed
in conjunction with and ANZOV, it was piloted and tested with consumers from
ovarian cancer Australia, and then it was distributed by ovarian cancer consumer
groups in Australia, the UK, the US, and Canada. It was basically rebadged for
those different groups, eligibility was deliberately broad to try and capture as
many women as possible who had completed treatment for ovarian cancer and the
survey was relatively long and we were a little bit nervous about that, but the
women were actually were really committed once they started that. They
largely finished it, they self-reported their cancer
diagnosis and treatment history, and we used in standardized
instruments to look at the symptoms and quality-of-life concerns and then
there’s some free text comments at the end. They were incredibly generous about
completing and we did some standard statistical analyses and in particular
will look, look as well as its symptoms and quality of life, and their
relationship between physical activity and obesity. So over a thousand women
completed the survey, we think they were broadly representative of the population
of ovarian cancer survivors who are out there. The majority had presented with advanced
stage disease as is the usual for this this cancer and about a third of
respondents had had recurrent ovarian cancer. Most of them have received standard
platinum and taxane base chemotherapy and um, I guess there, and their median of
four years since diagnosis. So this is the symptoms and basically what we can see
is the green bars the whole population the dark blue bar those who don’t have
recurrent disease, in the light blue bar those who have recurrent ovarian cancer
and this is the proportion who had above threshold symptom levels. What you can see that peripheral
neuropathy was incredibly common in this population. This was because of the
taxanes involved in their chemotherapy largely, um, so over three-quarters of women
were complaining of persistent peripheral neuropathy, some degree over half
women were complaining of significant fatigue, and just under half significant
mood disturbance and about a quarter, insomnia. Interestingly, we always thought women
with recurrent ovarian cancer might have worse symptoms, it wasn’t the case, in
fact it was women who do not have recurrent disease that had statistically
significantly higher rates of mood disturbance and insomnia. There was some
international variation in mood disturbance but not in other symptoms. This is looking at their factored
quality-of-life scores compared to population norms. Interesting, the
Australian population norms are better than the US population norm, so more
variations was saying when we can place the Australian population, that their
deficits across all areas with the exception of social well-being. When we look at physical inactivity, we know
basically a significant proportion of our women, more than half, of them were
categorized as overweight or obese, and a similarly large proportion where
physically inactive. Somewhat perhaps unexpectedly, the US had the most
overweight or obese but um, everywhere else was not far behind and oh, and
something funny happened to that slide but the picture is clear, basically on
multivariable analysis, overweight obesity and/or physical inactivity were
independently associated with all the symptoms of interest and they were poor
fact G and fact O, our quality of life scores in the overweight and obese, but in
those patients and the difference is restricted to physical
well-being. Other aspects of quality of life seemed relatively put, preserved um, but
physical activity, inactivity, was associated with poor quality of life
across the range of domains. They’re also association seen between obesity and
physical inactivity, and unmet supportive care needs, which were across again
relatively restricted to physical care needs for the O base, but across a range of
domains for the physically and inactive. So in conclusion, women with ovarian
cancer reported a high symptom burden which was strongly associated with
physical inactivity and obesity. Now we know that as an internet-based
cross-sectional survey there will be selection and response bias is involved
we probably under sampled called communities, and the list are socially
advantaged populations but nevertheless this was a very large study and of course
it’s cross-sectional, so we can talk about associations rather than causality. Nevertheless, the association seen
between obesity and physical inactivity and quality-of-life provide support for
prospective evaluation of interventions in this population. Relations and importantly consumer groups
were very, very engaged in this study and they’re incredibly well placed to look
at delivering, disseminating information and delivering relevant interventions in
this population group and these are all the people that helped contribute. Thanks,
thanks.

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