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Weight loss outcomes following referral of obese women with endometrial cancer and complex atypical hyperplasia to a bariatric specialist
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Abstracts / Gynecologic Oncology 141 (2016) 2–208
95.7% (95% CI 82.8%-99.0%). Age greater than 40 years was associated with worse survival compared with those younger than 40 years in patients with ETT (relative survival 62.9% [95% CI 33.8%-82.0%] vs 97.4% [95% CI 82.5-99.6%]) and PSTT (relative survival 82.4% [95% CI 44.1%-95.5%)] vs 100%). Metastatic disease was associated with worse survival in patients with ETT, with relative survival of 93.5% (95% CI 75.3%-98.4%) compared with 100% in those with localized disease. Conclusions: Despite a common origin in intermediate trophoblast, ETT and PSTT are distinguished by histologic findings and, we may now begin to make observations regarding distinct clinical features. Demographic and prognostic factors, as presented here, may be helpful in clarifying diagnosis and recommending treatment. This study provides the only population-based description in the literature, and provides new insights into the descriptive epidemiology of these rare neoplasms.
Although the small numbers limit our ability to demonstrate statistical significance, bariatric surgery results in the most profound and durable weight loss.
doi:10.1016/j.ygyno.2016.04.286
Objectives: To report changes in quality of life (QOL), function, and symptoms 1 year after the referral of obese women with endometrial cancer (EC) and complex atypical hyperplasia (CAH) to a bariatric specialist. Methods: Obese women with stage I-II EC or CAH were offered a bariatric referral (BR). Validated QOL questionnaires (EORTC QLQC30 and EN24) were administered at the time of BR and 12 months later. Descriptive statistics and 2-sided t tests were used. Results: Both baseline and 12-month surveys were completed by 51 (38.6%) of 132 participants. Mean age was 54.4 years (95% CI 51.9– 56.8 years) and body mass index (BMI) was 41.4 kg/m2 (95% CI 39.1– 43.7) kg/m2. Most had early-stage EC (37 IA, 4 IB, 4 II), but 6 (11.8%) had CAH. Forty (78.4%) initiated a WLA: 12 (23.5%) complied with a BR (10 medical, 2 surgical), 29 (72.5%) initiated self-guided weight loss attempts (SG-WLA), 4 (7.8%) joined a commercial program, 32 (62.7%) started a diet, and 25 (49.02%) exercised. Twelve months after referral, women who initiated any WLA or a SG-WLA demonstrated a greater improvement in global health QOL scores than those did nothing (+5.4 vs –8.3, P = .0306; +5.5 vs –8.3, P = .0341). Compared with those who did nothing, women who complied with a BR did not demonstrate significantly changed QOL, function, or symptom scores at 12 months. However, trends suggested that women who complied with a BR experienced improvement in poor body image symptoms (–28.8 vs –5.6, P = .0584) but more financial difficulties (+ 16.7 vs –4.4, P = .0501) compared with the remaining cohort. Women who went on a diet as part of their WLA reported an improvement in global health QOL (+7.3 vs –5.7, P = .0258) and a greater reduction in fatigue (–8.7 vs +2.9, P = .0410), gastrointestinal (–7.5 vs –1.4, P = .0023), and poor body image symptoms (–15.7 vs –0.9, P = .0252). Exercise was associated with a greater increase in sexual activity at 12 months (+9.1 vs –8.7, P = .0179). Conclusions: Twelve months after a BR, initiation of a WLA, even if self-guided, is associated with improved global health QOL. Dieting is associated with improved fatigue, gastrointestinal symptoms, and body image. Exercise resulted in greater sexual activity. Compliance with a BR may cause financial strain for obese survivors and providers should remain sensitive to this barrier to weight loss.
RO
OF
256 – Poster Quality of life, function, and symptom scores following referral of obese women with endometrial cancer and complex atypical hyperplasia to a bariatric specialist A.M. Jernigana, K. Maurerb,c, K.R. Cooperc, P.G. Rosec, P.R. Schauera, C.M. Michenerc. aCleveland Clinic Foundation, Cleveland, OH, USA, b University of Utah, Salt Lake City, UT, USA, cCleveland Clinic, Cleveland, OH, USA
DP
255 – Poster Weight loss outcomes following referral of obese women with endometrial cancer and complex atypical hyperplasia to a bariatric specialist A.M. Jernigana, K. Maurerb, K.R. Cooperb, P.G. Roseb, P.R. Schauera, C.M. Michenerb. aCleveland Clinic Foundation, Cleveland, OH, USA, b Cleveland Clinic, Cleveland, OH, USA
doi:10.1016/j.ygyno.2016.04.287
UN
CO
RR
EC
TE
Objectives: To report weight loss outcomes following the referral of obese women with endometrial cancer (EC) or complex atypical hyperplasia (CAH) to bariatric specialists. Methods: Women with stage I-II EC or CAH with a body mass index (BMI) higher than 30 kg/m2 were offered a medical bariatric referral (BR); if their BMI was higher than 35 kg/m2 with an obesity-related comorbidity or higher than 40 kg/m2 they were also offered a surgical BR. Descriptive statistics and 2-sided t tests were used. Results: Of 156 women approached, 6 were already seeing a bariatrician and 18 declined. Of the remaining 132, 11 had CAH and the rest had stage IA (n = 102), IB (n = 13), or II (n = 6) endometrioid adenocarcinoma. Mean BMI was 42.8 kg/m2 (95% CI 41.2–44.4 kg/m2). Mean follow-up was 10.7 months (95% CI 9.811.5 months) from the time of their BR. Seventy-eight (59.1%) reported any weight loss attempt (WLA): 51 (38.64%) initiated a self-guided WLA, in the form of diet (n = 40) and/or exercise (n = 28), 7 (5.3%) joined a commercial weight loss program, and 24 (18.2%) initiated a physician-guided WLA which included physiciansupervised diet (n = 21), medications (n = 2), nutritionist visits (n = 17), therapy (n = 2), and surgery (n = 2). Compared with the remaining cohort, at 3 months, physician-guided WLA resulted in a mean loss of 4.8 versus 0.8 lbs (P = .0173) and initiating any WLA was associated with a weight loss of 3.3 lbs versus gain of 0.7 lbs (P = .0215). However, at 6 months, 12 months, and last recorded weight, neither the group initiating any WLA nor the group initiating a physician-guided WLA had lost more weight than the remaining cohort. Self-guided diet was not associated with significant weight loss at any point, but those who reported exercise lost more weight at 6 months than those who did not (6.9 vs 2.0 lbs, P = .0161). Only 2 women had bariatric surgery. At 3, 6, and 12 months and last follow-up, they lost a mean of 5.3, 4.0, 30.2, and 61.5 lbs compared with the remaining cohort who lost 1.8, 3.0, 1.2, and 0.3 lbs at those time points. Conclusions: Most EC and CAH survivors will initiate a WLA after a BR is offered, but very few use surgery. Both self- and physicianguided WLA are associated with short-term weight loss, but this effect diminishes over time. Exercise may help keep weight off for a few more months, but also fails to result in long-term weight loss.
doi:10.1016/j.ygyno.2016.04.288
257 – Poster Vulvar and vaginal melanoma: A distinct subclass of melanoma based on a comprehensive molecular analysis of 51 cases C. Baptistea, W.M. Burkeb, R. Feldmanc, J.D. Wrightb, A.I. Tergasa, J.Y. Houb. aNYP/Columbia University Medical Center, New York, NY, USA, b Columbia University College of Physicians and Surgeons, New York, NY, USA, cCaris Life Sciences, Irving, TX, USA
Abstracts / Gynecologic Oncology 141 (2016) 2–208
95.7% (95% CI 82.8%-99.0%). Age greater than 40 years was associated with worse survival compared with those younger than 40 years in patients with ETT (relative survival 62.9% [95% CI 33.8%-82.0%] vs 97.4% [95% CI 82.5-99.6%]) and PSTT (relative survival 82.4% [95% CI 44.1%-95.5%)] vs 100%). Metastatic disease was associated with worse survival in patients with ETT, with relative survival of 93.5% (95% CI 75.3%-98.4%) compared with 100% in those with localized disease. Conclusions: Despite a common origin in intermediate trophoblast, ETT and PSTT are distinguished by histologic findings and, we may now begin to make observations regarding distinct clinical features. Demographic and prognostic factors, as presented here, may be helpful in clarifying diagnosis and recommending treatment. This study provides the only population-based description in the literature, and provides new insights into the descriptive epidemiology of these rare neoplasms.
Although the small numbers limit our ability to demonstrate statistical significance, bariatric surgery results in the most profound and durable weight loss.
doi:10.1016/j.ygyno.2016.04.286
Objectives: To report changes in quality of life (QOL), function, and symptoms 1 year after the referral of obese women with endometrial cancer (EC) and complex atypical hyperplasia (CAH) to a bariatric specialist. Methods: Obese women with stage I-II EC or CAH were offered a bariatric referral (BR). Validated QOL questionnaires (EORTC QLQC30 and EN24) were administered at the time of BR and 12 months later. Descriptive statistics and 2-sided t tests were used. Results: Both baseline and 12-month surveys were completed by 51 (38.6%) of 132 participants. Mean age was 54.4 years (95% CI 51.9– 56.8 years) and body mass index (BMI) was 41.4 kg/m2 (95% CI 39.1– 43.7) kg/m2. Most had early-stage EC (37 IA, 4 IB, 4 II), but 6 (11.8%) had CAH. Forty (78.4%) initiated a WLA: 12 (23.5%) complied with a BR (10 medical, 2 surgical), 29 (72.5%) initiated self-guided weight loss attempts (SG-WLA), 4 (7.8%) joined a commercial program, 32 (62.7%) started a diet, and 25 (49.02%) exercised. Twelve months after referral, women who initiated any WLA or a SG-WLA demonstrated a greater improvement in global health QOL scores than those did nothing (+5.4 vs –8.3, P = .0306; +5.5 vs –8.3, P = .0341). Compared with those who did nothing, women who complied with a BR did not demonstrate significantly changed QOL, function, or symptom scores at 12 months. However, trends suggested that women who complied with a BR experienced improvement in poor body image symptoms (–28.8 vs –5.6, P = .0584) but more financial difficulties (+ 16.7 vs –4.4, P = .0501) compared with the remaining cohort. Women who went on a diet as part of their WLA reported an improvement in global health QOL (+7.3 vs –5.7, P = .0258) and a greater reduction in fatigue (–8.7 vs +2.9, P = .0410), gastrointestinal (–7.5 vs –1.4, P = .0023), and poor body image symptoms (–15.7 vs –0.9, P = .0252). Exercise was associated with a greater increase in sexual activity at 12 months (+9.1 vs –8.7, P = .0179). Conclusions: Twelve months after a BR, initiation of a WLA, even if self-guided, is associated with improved global health QOL. Dieting is associated with improved fatigue, gastrointestinal symptoms, and body image. Exercise resulted in greater sexual activity. Compliance with a BR may cause financial strain for obese survivors and providers should remain sensitive to this barrier to weight loss.
RO
OF
256 – Poster Quality of life, function, and symptom scores following referral of obese women with endometrial cancer and complex atypical hyperplasia to a bariatric specialist A.M. Jernigana, K. Maurerb,c, K.R. Cooperc, P.G. Rosec, P.R. Schauera, C.M. Michenerc. aCleveland Clinic Foundation, Cleveland, OH, USA, b University of Utah, Salt Lake City, UT, USA, cCleveland Clinic, Cleveland, OH, USA
DP
255 – Poster Weight loss outcomes following referral of obese women with endometrial cancer and complex atypical hyperplasia to a bariatric specialist A.M. Jernigana, K. Maurerb, K.R. Cooperb, P.G. Roseb, P.R. Schauera, C.M. Michenerb. aCleveland Clinic Foundation, Cleveland, OH, USA, b Cleveland Clinic, Cleveland, OH, USA
doi:10.1016/j.ygyno.2016.04.287
UN
CO
RR
EC
TE
Objectives: To report weight loss outcomes following the referral of obese women with endometrial cancer (EC) or complex atypical hyperplasia (CAH) to bariatric specialists. Methods: Women with stage I-II EC or CAH with a body mass index (BMI) higher than 30 kg/m2 were offered a medical bariatric referral (BR); if their BMI was higher than 35 kg/m2 with an obesity-related comorbidity or higher than 40 kg/m2 they were also offered a surgical BR. Descriptive statistics and 2-sided t tests were used. Results: Of 156 women approached, 6 were already seeing a bariatrician and 18 declined. Of the remaining 132, 11 had CAH and the rest had stage IA (n = 102), IB (n = 13), or II (n = 6) endometrioid adenocarcinoma. Mean BMI was 42.8 kg/m2 (95% CI 41.2–44.4 kg/m2). Mean follow-up was 10.7 months (95% CI 9.811.5 months) from the time of their BR. Seventy-eight (59.1%) reported any weight loss attempt (WLA): 51 (38.64%) initiated a self-guided WLA, in the form of diet (n = 40) and/or exercise (n = 28), 7 (5.3%) joined a commercial weight loss program, and 24 (18.2%) initiated a physician-guided WLA which included physiciansupervised diet (n = 21), medications (n = 2), nutritionist visits (n = 17), therapy (n = 2), and surgery (n = 2). Compared with the remaining cohort, at 3 months, physician-guided WLA resulted in a mean loss of 4.8 versus 0.8 lbs (P = .0173) and initiating any WLA was associated with a weight loss of 3.3 lbs versus gain of 0.7 lbs (P = .0215). However, at 6 months, 12 months, and last recorded weight, neither the group initiating any WLA nor the group initiating a physician-guided WLA had lost more weight than the remaining cohort. Self-guided diet was not associated with significant weight loss at any point, but those who reported exercise lost more weight at 6 months than those who did not (6.9 vs 2.0 lbs, P = .0161). Only 2 women had bariatric surgery. At 3, 6, and 12 months and last follow-up, they lost a mean of 5.3, 4.0, 30.2, and 61.5 lbs compared with the remaining cohort who lost 1.8, 3.0, 1.2, and 0.3 lbs at those time points. Conclusions: Most EC and CAH survivors will initiate a WLA after a BR is offered, but very few use surgery. Both self- and physicianguided WLA are associated with short-term weight loss, but this effect diminishes over time. Exercise may help keep weight off for a few more months, but also fails to result in long-term weight loss.
doi:10.1016/j.ygyno.2016.04.288
257 – Poster Vulvar and vaginal melanoma: A distinct subclass of melanoma based on a comprehensive molecular analysis of 51 cases C. Baptistea, W.M. Burkeb, R. Feldmanc, J.D. Wrightb, A.I. Tergasa, J.Y. Houb. aNYP/Columbia University Medical Center, New York, NY, USA, b Columbia University College of Physicians and Surgeons, New York, NY, USA, cCaris Life Sciences, Irving, TX, USA