1. Joint exposure to smoking, excessive weight, and physical inactivity and survival of ovarian cancer patients, evidence from the Ovarian Cancer Association Consortium
- Author
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Estrid Høgdall, J. Brian Szender, Anna H. Wu, Harvey A. Risch, Daniel W. Cramer, Christina M. Nagle, Susan J. Jordan, Brenda Diergaarde, Jennifer A. Doherty, Kunle Odunsi, Emese Zsiros, Rikki Cannioto, Francesmary Modugno, Kathryn L. Terry, Mary Anne Rossing, Penelope M. Webb, Albina N. Minlikeeva, Marc T. Goodman, Keitary Matsuo, P.C. Mayor, Robert Edwards, Celeste Leigh Pearce, Hani Almohanna, Susanne K. Kjaer, Ellen L. Goode, Mika Mizuno, Kirsten Starbuck, Elisa V. Bandera, Anna deFazio, Kirsten B. Moysich, Roberta B. Ness, Lisa E. Paddock, and Allan Jensen
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Carcinoma, Ovarian Epithelial ,Motor Activity ,Overweight ,Weight Gain ,Article ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Epidemiology ,Humans ,Medicine ,Obesity ,030212 general & internal medicine ,Proportional Hazards Models ,Ovarian Neoplasms ,Hematology ,business.industry ,Public health ,Smoking ,Hazard ratio ,medicine.disease ,Confidence interval ,030220 oncology & carcinogenesis ,Female ,Sedentary Behavior ,medicine.symptom ,business ,Ovarian cancer - Abstract
PURPOSE: Previous epidemiologic studies have shown that smoking, obesity, and physical inactivity are associated with poor survival following a diagnosis of ovarian cancer. Yet, the combined relationship of these unfavorable lifestyle factors on ovarian cancer survival has not been sufficiently investigated. METHODS: Using data pooled from 13 studies, we examined the associations between combined exposures to smoking, overweight/obesity weight, and physical inactivity and overall survival (OS) as well as progression-free survival (PFS) among women diagnosed with invasive epithelial ovarian carcinoma (N=7,022). Using age-, stage, and site-adjusted Cox proportional hazards regression models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) associated with joint exposure to these factors. RESULTS: Combined exposure to current smoking, overweight/obesity, and physical inactivity prior to diagnosis was associated with a significantly increased risk of mortality compared to women who never smoked, had normal body mass index (BMI), and were physically active (HR=1.37; 95% CI=1.10–1.70). The association for a joint exposure to these factors exceeded that of each exposure individually. In fact, exposure to both current smoking and overweight/obesity, and current smoking and physical inactivity was also associated with increased risk of death (HR=1.28; 95 % CI=1.08–1.52, and HR=1.26; 95% CI=1.04–1.54, respectively). The associations were of a similar magnitude when former smoking was assessed in combination with the other exposures and when excessive weight was limited to obesity only. No significant associations were observed between joint exposure to any of these factors and PFS. CONCLUSIONS: Joint exposure to smoking, excessive weight, and physical inactivity may negatively impact survival of ovarian cancer patients. These results suggest the importance of examining the combined effect of lifestyle factors on ovarian cancer patients’ survival.
- Published
- 2019