Abstract
Purpose
Endometrial cancer (EC) survivors are the second largest group of female cancer survivors in the USA, with high prevalence of obesity and physical inactivity. While higher pre-diagnosis body mass index (BMI) has been associated with higher all-cause and disease-specific mortality, pre-diagnosis physical activity has shown mixed evidence of an association with mortality. However, the association between BMI, physical activity, and TV viewing measured after diagnosis and mortality risk among EC survivors is unknown.
Methods
We identified 580 women with EC in the NIH-AARP Diet and Health Study who completed a post-diagnosis questionnaire on BMI, leisure time moderate- to vigorous-intensity physical activity (MVPA), and TV viewing. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.
Results
With a median follow-up time of 7.1 years, we observed 91 total deaths. We found a positive association between BMI (\({\text{HR}}_{{35+\,{\text{ vs.}}\, <25 {\text{kg/m}}^{2} }}\) = 2.14, 95% CI 1.08–4.24 and mortality, and no statistically significant association between TV viewing (HR5+ vs. <3 h/day = 1.46, 95% CI 0.86–2.46) and mortality nor MVPA with mortality (HR15+ vs. 0 MET h/week = 0.72, 95% CI 0.43–1.21) after adjusting for tumor characteristics and demographic factors. Further adjustment for lifestyle and health status attenuated BMI associations (\({\text{HR}}_{{35+\,{\text{ vs.}}\, <25 {\text{kg/m}}^{2} }}\) = 1.47, 95% CI 0.71–3.07), but strengthened the association between TV viewing and mortality (HR5+ vs. <3 h/day = 2.28, 95% CI 1.05–4.95).
Conclusions
Our results suggest that higher post-diagnosis BMI and TV viewing may be associated with higher mortality risk among EC patients, but that there may be complicated interrelationships between lifestyle factors of BMI, PA, and TV viewing and the mediating role of health status that need to be clarified.
This is a preview of subscription content, log in via an institution to check access.
References
Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I (2005) Endometrial cancer. Lancet 366(9484):491–505
Gierach GL, Chang SC, Brinton LA, Lacey JV Jr, Hollenbeck AR, Schatzkin A et al (2009) Physical activity, sedentary behavior, and endometrial cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer 124(9):2139–2147
Courneya KS, Karvinen KH, Campbell KL, Pearcey RG, Dundas G, Capstick V et al (2005) Associations among exercise, body weight, and quality of life in a population-based sample of endometrial cancer survivors. Gynecol Oncol 97(2):422–430
American Cancer Society (2012) Cancer treatment and survivorship facts and figures 2012–2013. American Cancer Society, Atlanta
Ward KK, Shah NR, Saenz CC, McHale MT, Alvarez EA, Plaxe SC (2012) Cardiovascular disease is the leading cause of death among endometrial cancer patients. Gynecol Oncol 126(2):176–179
Can I get another cancer after having endometrial cancer? American Cancer Society. http://www.cancer.org/cancer/endometrialcancer/detailedguide/endometrial-uterine-cancer-after-second-cancers
Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24):5814–5830
Arem H, Park Y, Pelser C, Ballard-Barbash R, Irwin ML, Hollenbeck A et al (2013) Prediagnosis body mass index, physical activity, and mortality in endometrial cancer patients. J Natl Cancer Inst 105(5):342–349
Koster A, Caserotti P, Patel KV, Matthews CE, Berrigan D, Van Domelen DR et al (2012) Association of sedentary time with mortality independent of moderate to vigorous physical activity. PLoS ONE 7(6):e37696
Katzmarzyk PT, Church TS, Craig CL, Bouchard C (2009) Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc 41(5):998–1005
Wijndaele K, Brage S, Besson H, Khaw K-T, Sharp SJ, Luben R et al (2011) Television viewing time independently predicts all-cause and cardiovascular mortality: the EPIC Norfolk study. Int J Epidemiol 40(1):150–159
Schatzkin A, Subar AF, Thompson FE, Harlan LC, Tangrea J, Hollenbeck AR et al (2001) Design and serendipity in establishing a large cohort with wide dietary intake distributions: the National Institutes of Health-American Association of Retired Persons Diet and Health Study. Am J Epidemiol 154(12):1119–1125
Wolf AM, Hunter DJ, Colditz GA, Manson JE, Stampfer MJ, Corsano KA et al (1994) reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol 23(5):991–999
Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Supplement):S498–S516
WHO Technical Report 894 (2000) Obesity: preventing and managing the global epidemic. World Health Organization, Geneva
World Cancer Research Fund International/American Institute for Cancer Research Continuous Update Project Report: Diet, Nutrition, Physical Activity, and Breast Cancer Survivors (2014) Available at: https://www.wcrf.org/sites/default/files/Breast-Cancer-Survivors-2014-Report.pdf
Arem H, Pfeiffer RM, Engels EA, Alfano CM, Hollenbeck A, Park Y et al (2015) Pre-and postdiagnosis physical activity, television viewing, and mortality among patients with colorectal cancer in the National Institutes of Health-AARP Diet and Health Study. J Clin Oncol 33(2):180–188
Funding
This study was funded by the intramural research program at the US National Cancer Institute.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Arem, H., Pfeiffer, R.M., Moore, S.C. et al. Body mass index, physical activity, and television time in relation to mortality risk among endometrial cancer survivors in the NIH-AARP Diet and Health Study cohort. Cancer Causes Control 27, 1403–1409 (2016). https://doi.org/10.1007/s10552-016-0813-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-016-0813-7