Obesity and ovarian cancer survival

As I wrote earlier, excess weight seems to increase certain types of cancers in men and women.   Some of my patients with ovarian cancer asked if obesity affect ovarian cancer survival.   A Canadian study evaluated1423 women diagnosed with epithelial ovarian cancer in a large population-based study. 

Information on risk factors and characteristics was collected by telephone. Vital status was determined both by computerized record-linkage and by chart review. Statistical analysis was done for height, weight and body mass index in association with ovarian cancer-specific mortality.

The study concluded that  weight does not affect the survival of patients with ovarian cancer.   Please note that this study is about survival not risk factors.

However, another study by Protani who reviewed multiple studies concluded differently.  It showed obese patients with ovarian cancer seemed to have worse survival. My recommendation is still the same in regards to maintaining your healthy weight to reduce risks of certain cancers, heart disease and diabetes.

Reference:

Kotsopoulos J, et al.  Height, weight, BMI and ovarian cancer survival. Gynecol Oncol. 2012 Oct;127

-         Protani MM, Nagle CM, Webb PM.Obesity and ovarian cancer survival: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2012 Jul;5(7):901-10.

 

Santoso's way to lose weight

You plan to lose weight for wellness not cosmetic.  Your goal is only to lose 5-10% of weight in 6 months.  Celebrate a little success and have a supportive partner/friend to do it together. Approach weight loss slowly.

 Do not use this dietary guideline if you are diabetic without informing your diabetic doctor.  This guideline should be done under a physician’s supervision. 

Santoso’s recommendations

-          Set the wellness goal: what is your weight – 5-10% of weight loss in 6 months.

-          Minimize going to eat fast food or going out to eat. 

o   All fast foods have excess calories.  Eats there only as a treat once a month

-          Drink only water (may drink diet soda once a month as a treat)

o   Most soft drink/sport drink/ fruit juice has about 100 cal per serving. 

o   I minimize diet soda since it makes us crave for more high sweet drink/food

-          Maximal 1200 calories/day of all food and drink (everything you put in your mouth)

o   soups – preferably vegetable based soups.  Warm it up so you eat slower

o   packaged prepared food with calorie label (lean cuisine, etc)

o    Add proteins (1-2 glass of milk/ day).   1 glass of skim milk = 80 cal. 

o   Eat 3 meals with 2-3 fruits/milk snacks.  You cannot lose weight by being hungry

o   Avoid large meals or snack at night

-          Exercise 30 minutes/day

o   Put exercise in your daily routine (park your car far, take stairs instead of elevator, wash your car manually, etc)

-          Food diary

o   Write everything that you put in your mouth

o   Write date, time, what you eat and estimate calorie

o   Example of food diary

Date        time                         what I ate                                how many calorie

9-2-12      6pm             3 oz of baked chicken                         100

                                    1 cup of vegetables                             50

                                    1 baked potates                                   300

                                    1 apple                                                 100

How to estimate calorie

-          Lean meat (beef, chicken, pork with fat mostly removed): 100 cal/3 oz.  3 oz is about the size of a deck of cards

-          Carbohydrates (pasta, rice, etc): 200 cal/cup.  One cup is the size of your fist.

-          Fresh fruits: a medium serving (apple, orange, etc): 100 cal/serving.  Please note that medium serving is not large size orange.

-          Vegetables (broccoli, cauliflower, etc): 50 cal/cup. 

-          Condiments (oil, cheese sauce, dressings): 100 cal/table spoon.  One table spoon is about your thumb size.

-          Fat, sugars, snacks: lots of calorie.  Read the labels.

-          Use your food diary to estimate calorie.  Then go to internet to check your calorie estimation.  With practice, you will improve your accuracy

Excess weight and cancer

Weight, weight gain, and obesity are associated with about 20% of all cancer cases. These cancers includes esophageal, thyroid, colon, renal, liver, melanoma, multiple myeloma, rectum, gallbladder, leukemia, lymphoma, and prostate in men; and postmenopausal breast and endometrium in women. Interestingly, Bariatric (weight loss) surgery has been associated with a 60 percent reduction in cancer mortality over seven year follow-up.  Thus, we have more incentives to lose weight.   Easy said than done.   So I will try to write my suggested weight loss recommendation at next blog.

Reference:

-          Wolin KY, Carson K, Colditz GA.  Obesity and cancer. Oncologist. 2010;15(6):556

-          Adams TD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753

Patients with BRCA mutation and ovarian cancer prognosis

Approximately 10% of women with invasive epithelial ovarian cancer carry deleterious gene mutations in BRCA1 or BRCA2. A study in Journal American Medical Association suggested that BRCA2-related ovarian cancer seemed to have an improved prognosis, but the effect of BRCA1 remains unclear. The five-year all-cause mortality rate for noncarriers was 47 percent compared with 45 percent for BRCA1 mutation carriers and 36 percent for BRCA2 mutation carriers.


Reference:

Bolton KL, et al. Association between BRCA1 and BRCA2 mutations and survival in women with invasive epithelial ovarian cancer.  JAMA. 2012;307(4):382

Bevacizumab plus chemotherapy for platinum-resistant ovarian cancer

Many patients with ovarian cancer, unfortunately, experience cancer recurrent in significant number.   Gyn Oncologists triage these patients into "platinum sensitive" versus "platinum resistant" patients.   If you received platinum (Carboplatin or Cisplatin) chemo and then your cancer recur in less than 6 months, you are considered platinum resistant.  If your cancer recurs in more than 6 months, you are considered platinum sensitive.   Patients with platinum resistant cancer have poorer prognosis than platinum sensitive cancer. Unfortunately, there are few good treatment options for these women.  

One good news is the results of a phase III trial comparing standard chemotherapy with or without the antiangiogenesis agent bevacizumab (trade name: avastin) in women with platinum-resistant ovarian cancer were presented at the 2012 ASCO meeting. Chemotherapy plus bevacizumab significantly improved overall response rate and progression-free survival. Although overall survival was not reported, these results support the use of chemotherapy plus bevacizumab in this group of women with early recurrent ovarian cancer

Reference: Pujade-Lauraine E, Hilpert F, Weber B, et al. AURELIA: A randomized phase III trial evaluating bevacizumab (BEV) plus chemotherapy (CT) for platinum (PT)-resistant recurrent ovarian cancer (OC). J Clin Oncol 30, 2012

Where could patient stay for free while on active cancer treatment?

The  West Clinic and a few other organizations have supported the Amercian Cancer Society in building the Memphis Hope Lodge.   This lodge allows patients and their care givers who are on active cancer treatment in Memphis but lives 40 miles or further away to stay in Memphis Lodge for free.  It has guest suites with private bathroom.   The Lodge also provides free shuttle service from the Lodge to the West Clinic offices.  There are several requirements to qualify for this free stay that you could find out by calling 1800 227 2345 or 901 524 5500. 

What are the symptoms to know if my ovarian cancer recurs?

Recurrent of ovarian cancer is usually not symptomatic.   If you are not seen periodically by your oncologists who usually order Ca125 periodically, then by the time you have recurrence, you would have symptoms with your cancer recurrence.  Ca125 blood test is still the most sensitive test in detecting ovarian cancer recurrence.  This Ca125  test is commonly ordered every 3-6 months for patients after completing their adjuvant chemotherapy.   However, a recent randomized trial study published in Lancet recommends no Ca125 should be ordered since no difference in survival is noted whether the patient is diagnosed early versus late for cancer recurrence.   This study seems to be initially illogical.   I would think that the earlier you are diagnosed, the smaller the tumor is found and perhaps the higher chances of curing the recurrence.  However, this study found the opposite.


My medical experience seems to suggest that when my patient has early recurrence and localized, she has a better chance of cure if the disease is localized.   Last week I have such patient that i discharged from my practice.  She had cancer recurrence next to the spleen after her initial surgery and chemotherapy.   I went back to debulked this cancer and retreated her with carbo and taxol (patient was platinum sensitive).  Now she is cancer free for 5 years.  

My current thinking is some patients with localized disease and platinum sensitve would benefit from regular check of Ca125.   However, patients who are platinum resistant and wide spread recurrent, may not benefit from regular Ca125 as noted in the Lancet paper.   Since medicine is an ever changing science, I wait for more study confirmation of the study's recommendation.

REFERENCE:

Early versus delayed treatment of relapsed ovarian cancer: a randomized trial. Rustin GJ,et al.

Lancet. 2010 Oct 2;376(9747):1155-63.