Obesity is more prevalent in cancer survivors, specifically in those with a history of breast or colorectal cancer (CRC), compared with those without any history of disease, according to findings of a large population-based study. The results suggest an important area of focus for practitioners who provide care to the nation’s increasing population of cancer survivors.
For their study, researchers at Colombia University’s Mailman School of Public Health analyzed data from a nationally representative sample of 538,969 adults aged 18 to 85 years who self-reported their height and weight as part of the ongoing National Health Interview Survey (NHIS) during the time period 1997-2014; 32,447 of the participants were cancer survivors.
Researchers found a consistently increasing burden of obesity (defined as ≥30 kg/m2
for non-Asian participants and ≥27 kg/m2
for Asians) among men and women with a history of cancer when compared with adults without a history of cancer. Adult cancer survivors had an increase in obesity prevalence from 22.4% in 1997 to 31.7% in 2014, compared with 20.9% to 29.5% over that same timespan in adults without a history of cancer (P
This increase was more pronounced in female survivors overall, in breast and CRC survivors, and among non-Hispanic blacks.
“The prevalence of obesity grew more rapidly in in nearly every subgroup of colorectal and breast cancer survivors, compared with the corresponding groups of adults without a history of cancer,” the authors wrote.
Additionally, the occurrence of class I obesity (BMI: 30 to <35 kg/m2
) increased in women who were cancer survivors from 13.6% in 1997 to 21.0% in 2014, exceeding that of non-survivors (12.2% to 16.6%). This trend held true across all time periods, with differences expanding over time, the authors stated.
Principal investigator Heather Greenlee, ND, PhD, assistant professor of Epidemiology at the Mailman School, explained in a statement that the populations identified “are important populations in which oncology care providers should focus weight management efforts.”
The study authors also noted that speciﬁc cancer treatments—such as chemotherapy, steroid medications, and hormonal therapy—can play a role in weight gain for survivors.
It is also important, they added, to consider obesity among cancer survivors not only in relation to disease outcomes, but also in relation to other comorbid diseases. Obesity can cause additional health hazards for patients and can be associated with other medical conditions, such as diabetes, heart disease, hypertension, and hypercholesterolemia, which could affect overall survival. Studies of breast, colon, and prostate cancer have shown that comorbid conditions increase 5-year all-cause and cancer-speciﬁc mortality.
The researchers on this NHIS analysis predicted that, based on their findings, the US obesity burden will continue to trend upward, which will not only “increase the number of obesity-related cancers, but also result in an increased burden of obesity among cancer survivors.”
Greenlee said that these results “suggest that obesity is a growing public health burden for cancer survivors, which requires targeted interventions including weight management efforts to stave off the increasing obesity trends we are seeing in cancer survivors.”
She added that although “the findings can be partially explained by the growing population of patients with breast and colorectal cancer—the two cancers most closely associated with obesity—we identified additional populations of cancer survivors at risk of obesity not as well understand and which require further study.”
Greenlee H, Shi Z, Sardo CL, et al. Trends in obesity prevalence in adults with a history of cancer: results From the US National Health Interview Survey, 1997 to 2014. [published online ahead of print July 25, 2016] J Clin Onc. doi: 10.1200/JCO.2016.66.4391