Quality of Life Research

, Volume 26, Issue 5, pp 1263–1271 | Cite as

Health-related quality of life factors associated with completion of a study delivering lifestyle exercise intervention for endometrial cancer survivors

  • Jaejoon SongEmail author
  • Melissa Karlsten
  • José-Miguel Yamal
  • Karen Basen-Engquist



The aim of this study was to examine associations between participants’ quality of life and study completion. This is a secondary analysis of an exercise intervention study for endometrial cancer survivors.


We considered data for one-hundred post-treatment endometrial cancer survivors from a single-arm, six-month longitudinal exercise study. Participants received a home-based intervention consisting of exercise recommendations and telephone counseling sessions to encourage adherence. In addition to monitoring adherence to physical exercise recommendations, participants completed multiple psychological assessments, including health-related quality of life. Associations between study completion and health-related quality of life factors were analyzed using generalized additive models, to allow for possibly nonlinear associations.


Measures of bodily pain contributed to the odds of study completion in a nonlinear way (p = 0.025), suggesting that improvements in these factors were associated with study completion, especially for individuals reporting very high levels of pain. In addition, association between participants’ levels of anxiety and study completion showed an inverse U-shaped relation: Whereas increase in anxiety was associated with higher odds of completion for individuals with low anxiety score (0–4), increase in anxiety contributed to lower odds of study completion for individuals with anxiety scores of approximately 5–10 (p = 0.035).


Results from this study indicate that baseline health-related quality of life factors may be associated with study completion in exercise intervention studies. In order to increase study completion rates, individually tailored study strategies may be prepared based on the baseline quality of life responses.


Health-related quality of life Study completion Endometrial cancer survivors Generalized additive models Markov Chain Monte Carlo 



This study was supported by R01 CA 109919, R25T CA057730, R25E CA056452, P30 CA016672 (PROSPR Shared Resource), Center for Energy Balance in Cancer Prevention and Survivorship, Duncan Family Institute for Cancer Prevention and Risk Assessment, and by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant (NCI Grant P30 CA016672).

Compliance with ethical standards

Conflict of interest

None of the authors have any relevant financial interests or conflicts to disclose.

Ethical approval

Project Steps to Health procedures and materials have been reviewed and approved by the Institutional Review Boards of the University of Texas MD Anderson Cancer Center.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Surveillance Epidemiology and End Results. (2015). SEER state fact sheets: Corpus and uterus, NOS. Available from
  2. 2.
    Chang, S. C., Lacey, J. V., Jr., Brinton, L. A., et al. (2007). Lifetime weight history and endometrial cancer risk by type of menopausal hormone use in the NIH-AARP diet and health study. Cancer Epidemiology Biomarkers Prevention, 16(4), 723–730.CrossRefGoogle Scholar
  3. 3.
    Friedenreich, C., Cust, A., Lahmann, P., et al. (2007). Anthropometric factors and risk of endometrial cancer: The European prospective investigation into cancer and nutrition. Cancer Causes and Control, 18(4), 399–413.CrossRefPubMedGoogle Scholar
  4. 4.
    McCullough, M. L., Patel, A. V., Patel, R., et al. (2008). Body mass and endometrial cancer risk by hormone replacement therapy and cancer subtype. Cancer Epidemiology Biomarkers Prevention, 17(1), 73–79.CrossRefGoogle Scholar
  5. 5.
    Fader, A., Frasure, H., Gil, K., Berger, N., & von Gruenigen, V. (2011). Quality of life in endometrial cancer survivors: What does obesity have to do with it? Obstetrics and Gynecology International, 2011(308609), 01–06. doi: 10.1155/2011/308609.CrossRefGoogle Scholar
  6. 6.
    Rossi, A., Moadel-Robblee, A., Garber, C. E., et al. (2015). Physical activity for an ethnically diverse sample of endometrial cancer survivors: A needs assessment and pilot intervention. Journal of Gynecologic Oncology, 26(2), 141–147.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Smits, A., Lopes, A., Das, N., Bekkers, R., & Galalla, K. (2014). The impact of BMI on quality of life in obese endometrial cancer survivors: Does size matter? Gynecologic Oncology, 132(1), 137–141.CrossRefPubMedGoogle Scholar
  8. 8.
    Von Gruenigen, V., Waggoner, S., Frasure, H., et al. (2011). Lifestyle challenges in endometrial cancer survivorship. Obstetrics and Gynecology, 117(1), 93–100.CrossRefGoogle Scholar
  9. 9.
    McCarroll, M. L., Armbruster, S., Frasure, H. E., et al. (2013). Self-efficacy, quality of life, and weight loss in overweight/obese endometrial cancer survivors (SUCCEED): A randomized controlled trial. Gynecologic Oncology, 132(2), 397–402.CrossRefPubMedGoogle Scholar
  10. 10.
    Speck, R. M., Courneya, K. S., & Mȃsse, L. C. (2010). An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Journal of Cancer Survivorship, 4(2), 87–100.CrossRefPubMedGoogle Scholar
  11. 11.
    Blanchard, C. M., Courneya, K. S., & Stein, K. (2008). Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: Results from the American Cancer Society’s SCS-II. Journal of Clinical Oncology, 26(36), 2198–2204.CrossRefPubMedGoogle Scholar
  12. 12.
    Buffart, L. M., Thong, M. S. Y., Schep, G., et al. (2012). Self-reported physical activity: Its correlates and relationship with health-related quality of life in a large cohort of colorectal survivors. PLoS ONE, 7(5), 1–9. doi: 10.1371/journal.pone.0036164.CrossRefGoogle Scholar
  13. 13.
    Courneya, K. S., & Friedenreich, C. M. (1997). Relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. Journal of Alternative Complement Medicine, 3, 215–226.CrossRefGoogle Scholar
  14. 14.
    Basen-Engquist, K., Carmack, C. L., Li, Y., et al. (2013). Socialcognitive theory predictors of exercise behavior in endometrial cancer survivors. Health Psychology, 32, 1137–1148.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Basen-Engquist, K., Carmack, C. L., Perkins, H., et al. (2011). Design of the steps to health study of physical activity in survivors of endometrial cancer: Testing a social cognitive theory model. Psychology of Sport and Exercise, 12, 27–35.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Basen-Engquist, K., Carmack, C., Brown, J., et al. (2014). Response to an exercise intervention after endometrial cancer: Differences between obese and non-obese survivors. Gynecologic Oncology, 133, 48–55.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ware, J., Snow, K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston: Nimrod Press.Google Scholar
  18. 18.
    Avis, N. E., Smith, K. W., McGraw, S., et al. (2005). Assessing quality of life in adult cancer survivors (QLACS). Quality of Life Research, 14, 1007–1023.CrossRefPubMedGoogle Scholar
  19. 19.
    Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.CrossRefPubMedGoogle Scholar
  20. 20.
    Cole, S. (1999). Assessment of differential item functioning in the Perceived Stress Scale-10. Journal of Epidemiologic Community Health, 52, 319–320.CrossRefGoogle Scholar
  21. 21.
    Buyesse, D., Reynolds, C., Monk, T., Berman, S., & Kupfer, D. (1988). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.CrossRefGoogle Scholar
  22. 22.
    Derogatis, L. (2001). Brief symptom inventory (BSI) 18: Administration, scoring, and procedures manual. Minneapolis: NCA Pearson.Google Scholar
  23. 23.
    Hastie, T., & Tibshirani, R. (1986). Generalized additive models. Statistical Science, 1(3), 297–318.CrossRefGoogle Scholar
  24. 24.
    Scheipl, F. (2011). spikeSlabGAM: Bayesian variable selection, model choice and regularization for generalized additive mixed models in R. Journal of Statistical Software, 43(14), 1–24.CrossRefGoogle Scholar
  25. 25.
    Scheipl, F., Fahrmeir, L., & Kneib, T. (2012). Spike-and-slab priors for function selection in structured additive regression models. Journal of the American Statistical Association, 107(500), 1518–1532.CrossRefGoogle Scholar
  26. 26.
    Trevor, T., & Tibshirani, R. (1990). Generalized additive models. London: Chapman and Hall.Google Scholar
  27. 27.
    Keele, L. J. (2008). Semiparametric regression for the social sciences. West Sussex: Wiley.Google Scholar
  28. 28.
    Benjamini, Y., & Hochberg, Y. (1995). Controlling for false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B, 57(1), 289–300.Google Scholar
  29. 29.
    R Development Core Team. (2008). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing.Google Scholar
  30. 30.
    Wood, S. N. (2006). Generalized additive models: An introduction with R. Boca Raton: Chapman & Hall/CRC.Google Scholar
  31. 31.
    Arem, H., Chlebowski, R., Stefanick, M. L., et al. (2013). Body mass index, physical activity, and survival after endometrial cancer diagnosis: Results from the Women’s Health Initiative. Gynecologic Oncology, 128(2), 181–186.CrossRefPubMedGoogle Scholar
  32. 32.
    Demark-Wahnefried, W., Morey, M., Sloane, R., et al. (2012). Reach out to enhance wellness home-based diet–exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. Journal of Clinical Oncologyl, 30(19), 2354–2361.CrossRefGoogle Scholar
  33. 33.
    Demark-Wahnefried, W., Platz, E. A., Ligibel, J. A., et al. (2012). The role of obesity in cancer survival and recurrence. Cancer Epidemiology, Biomarkers and Prevention, 21, 1244–1259.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Sullivan-Marx, E. M., Mangione, K. K., Ackerson, T., et al. (2011). Recruitment and retention strategies among older African American women enrolled in an exercise study at a PACE program. The Gerontologist, 51(1), 73–81.CrossRefGoogle Scholar
  35. 35.
    Fitzpatrick, S. L., Jeffrey, R., Johnson, K. C., Roche, C. C., & Van Dorsten, B. (2013). Baseline predictors of missed visits in the Look AHEAD study. Obesity, 22(1), 131–140.CrossRefGoogle Scholar
  36. 36.
    Miller, A., & Dishon, S. (2006). Health-related quality of life in multiple sclerosis: The impact of disability, gender and employment status. Quality of Life Research, 15(2), 259–271.CrossRefPubMedGoogle Scholar
  37. 37.
    Dratva, J., Zemp, E., & Dietrich, F. (2010). Impact of road traffic noise annoyance on health-related quality of life: Results from a population-based study. Quality of Life Research, 19, 37–46.CrossRefPubMedGoogle Scholar
  38. 38.
    Stahl, E., Lindberg, A., Jansson, S.-A., et al. (2005). Health-related quality of life is related to COPD disease severity. Health and Quality of Life Outcomes, 3(56), 1–8.Google Scholar
  39. 39.
    Salehi, B., Cordero, I., & Sandi, C. (2010). Learning under stress: The inverted-U-shape function revisited. Learning Memory, 17, 522–530.CrossRefPubMedGoogle Scholar
  40. 40.
    Kerr, J. H. (1985). The experience of arousal: A new basis for studying arousal effects in sport. Journal of Sport Sciences, 3, 169–179.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of BiostatisticsUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Biostatistics, School of Public HealthUniversity of Texas Health Science CenterHoustonUSA
  3. 3.Department of PediatricsBaylor College of MedicineHoustonUSA
  4. 4.Department of Behavioral ScienceUniversity of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations