Dr. Abigail Zamorano
Of 358 endometrial cancer survivors with a body mass index of at least 30 kg/m2 who were approached for participation in the randomized ScaleDown trial, 80 participated and 278 declined. The results of that study, which compared a “high-tech” weight loss intervention to “enhanced usual care,” were reported last year (Gynecol Oncol. 2019 Jun;154[1]:20).
The goal of the ScaleDown trial was to identify a “better mechanism of weight loss encouragement for our patients,” said Abigail Zamorano, MD, of Washington University, St. Louis. “Unfortunately, we found that there was no difference in those two groups. It was rather disappointing.”
Dr. Zamorano and colleagues hypothesized that although the women who participated in the study failed to lose weight, perhaps they gained less weight than women who did not participate. Therefore, the researchers performed a retrospective study comparing the two groups.
The researchers reported results from this study in an abstract that had been slated for presentation at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer. The meeting was canceled because of the COVID-19 pandemic.
Retrospective results
At both 6 months and 12 months of follow-up, there were no significant differences between the ScaleDown participants and nonparticipants with respect to BMI change from baseline (P = .77 and P = .76, respectively).
“In essence, we unfortunately found no difference in BMI change in these two groups either,” Dr. Zamorano said.
At 12 months, rates of weight loss and weight gain were similar in ScaleDown participants and nonparticipants:
- 49.2% and 47%, respectively, gained weight.
- 13.9% and 23.2%, respectively, lost 0% to 2.5% of weight.
- 10.8% and 7.1%, respectively, lost 2.5% to 4% of weight.
- 3.1% and 4.8%, respectively, lost 4% to 5% of weight.
- 23.1% and 17.9%, respectively, lost 5% or more of weight.
Compared with participants, the nonparticipants were significantly more likely to be white and were older (63.4 years vs. 59.3 years), on more medications (median of 7 vs. 4), had a lower median BMI (39.1 kg/m2 vs. 41.7 kg/m2), were more likely to have recurrent cancer (15.2% vs. 5.1%), and were less likely to have had genetic counseling (10.8% vs. 20%). There were no differences between the groups in cancer histology, stage, or receipt of initial chemotherapy or radiation therapy.
How can oncologists help patients lose weight?
“Overall, I would say that the findings for the primary endpoint were not particularly encouraging,” Dr. Zamorano said.
However, she said an important message emerged from some of the survey results: Patients were very frustrated with their weight loss journey. Many said that, despite having a desire to lose weight, they didn’t know how, and nothing seemed to work. This suggests that, with the right strategies, oncologists are in a position to help, Dr. Zamorano said.
“As their oncologists who see them really regularly for years and years, even after they’ve completed their primary cancer therapy ... we have a unique relationship with them,” she explained. “We have this very unique role that we can play, so we should think a little outside the box about how else we can help our patients potentially lose weight.”
It’s important to try because thousands of women are diagnosed with endometrial cancer in the United States each year, and although many will be “successfully treated from a cancer perspective because they are diagnosed at early stages,” they also can have significant comorbidities – most often obesity, Dr. Zamorano said.
“And in conjunction with that ... diabetes and cardiovascular disease,” she added. “That means they have very high risk of long-term complications of obesity, and even though we are addressing their cancer, we weren’t addressing those other complications.”
One potential solution is bariatric surgery. Weight loss surgery has been shown to improve health care outcomes and reduce mortality rates and costs, yet 89% of ScaleDown participants said they had never considered it, and 67% said they would decline a referral.
This suggests that, despite the available evidence of benefit in patients who are candidates, there is a knowledge gap in awareness of the effectiveness and safety of bariatric surgery in this population, Dr. Zamorano said.
“Given the obesity-related health problems that this population has, we should really address weight as part of the essential cancer management strategy rather than as an afterthought,” she said, adding that it should be incorporated at the start and should potentially include a referral to surgical weight loss.
Dr. Zamorano reported having no disclosures. The research was funded by Washington University.
SOURCE: Zamorano A et al. SGO 2020, Abstract 20.