January 20, 2020
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Obesity linked to worse psychosocial outcomes among patients with breast, prostate cancer

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The physical symptoms of cancer often are accompanied by equally profound psychosocial struggles.

Most patients with cancer grapple with some degree of anxiety, depression or shock as they undertake treatment for their disease. However, certain patients may experience more intense psychosocial effects than others. According to a study published in Psycho-Oncology, older patients with obesity and breast cancer or prostate cancer had poorer psychosocial health than their counterparts without obesity.

“The relationship between excess weight and psychological distress is complex and not fully understood,” Errol J. Philip, PhD, of University of California, San Francisco School of Medicine, said in an interview with Healio. “We know that excess weight can exacerbate both physical and psychological problems outside of a cancer diagnosis, with obesity associated with increased rates of depression, pain and sleep disorders.”

Philip and colleagues retrospectively studied problem-related distress among 4,159 adults aged older than age 55 years with cancer of the breast (52.2%), prostate (38.7%) or colon (9.1%). The researchers used one-way analysis of covariance to evaluate significant differences in distress according to weight.

Results showed consistent associations between obesity and greater symptom burden, as well as experiences of distress, among patients with breast and prostate cancer. Researchers observed few weight-based differences among patients with colon cancer, who had significant symptoms and distress regardless of weight.

Philip spoke with Healio about the impact of obesity on the psychosocial outcomes of patients with certain cancers.

Question: What are some potential explanations for the association of obesity with poorer psychosocial health among older patients with breast or prostate cancer?

Answer: Individuals with obesity are often managing comorbid diseases, which can increase the complexity of cancer care and contribute to higher rates of distress. Additionally, a growing body of evidence documents the stigma experienced by patients with obesity and the associated distress this can cause.

Q: How does age factor into psychosocial outcomes of patients with cancer?

A: Older age can play an important role when considering psychosocial outcomes in the context of cancer. In addition to the comorbidities I mentioned, older patients are more likely to be taking multiple medications and dealing with functional limitations and impaired mobility, as well as different clinical and supportive care needs, compared with their younger counterparts. It’s also important to note that some studies have found that older adults are better equipped emotionally to cope with cancer than younger patients.

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Q : You also found that patients with colon cancer did not have increased anxiety in relation to weight. Why is this?

A: This is an interesting question that requires further investigation. We had a smaller sample of patients with colon cancer, and this may have played a role. However, these individuals had relatively high stress regardless of weight status.

Q : Your study found that regardless of weight, patients struggled psychologically with sleep, financial issues, anxiety, managing emotions and fear of medical procedures. What can oncologists do or recommend to help patients with these issues?

A: Addressing these issues is critical to providing comprehensive patient-centered cancer care. The fields of psycho-oncology and supportive cancer care now have robust treatments to help patients manage anxiety, depression, sleep dysfunction, pain and fear, and can help coordinate care resources to address financial issues. That said, access to supportive care and mental health services is still limited in many care settings, which is something we need to improve.

Oncologists should assess patients for these issues as part of their routine care or using a validated screening measure. If patients have such issues, it is important to address them, as untreated distress can be associated with poorer adherence to medication and quality of life. Once distress is identified, it is important to offer supportive care services, such as a counselor or a social worker. Counselors will often employ aspects of cognitive behavioral therapy to help patients cope with cancer and its associated effects. Further, for some individuals, a cancer diagnosis can represent an opportunity for patients to make positive lifestyle changes after treatment, and all members of the care team should seek to promote such changes.

Q: How should the obesity component of this issue be handled?

A: Evidence is forthcoming as to whether purposeful weight loss can impact cancer risk and disease outcomes, with several trials currently underway. We have suggestive evidence that weight loss may impact cancer risk, and combined with the strong body of evidence concerning the impact of weight loss on such conditions as cardiovascular disease and diabetes, we should be doing everything in our power to support healthy lifestyle changes among our patients and survivors. - by Jennifer Byrne

Reference:

Philip EJ, et al. Psychooncology. 2019;doi:10.1002/pon.5181.

For more information:

Errol J. Philip, PhD, can be reached at 533 Parnassus Ave., San Francisco, CA 94143; email: errol.philip@ucsf.edu.

Disclosures: Philip reports no relevant financial disclosures.