1. Physical Activity and Endometrial Cancer Survival
Janet Hildebrand
Joanne Kim

2. Background - Physical activity in cancer
Physical activity is associated with lower risk of breast, colon, and gynecologic cancers in women.
Evidence from clinical and observational studies suggests that physical activity improves survival after cancer diagnosis.
Most of the existing evidence comes from breast cancer studies.1
Physical activity in endometrial cancer is associated with improvement in quality of life,2 but studies on survival are lacking.3
Physical activity recommendations for cancer survivors do exist.
ACS recommends exercise during and after treatment for those who are able. (Cancer Facts & Figures 2018)
Exercise programs should be tailored to the survivor’s capabilities.
Exercise can hasten recovery from side effects of treatment and prevent long-term side effects.
Studies from breast cancer show that exercise lowers risk of death (24-67%) and risk of cancer recurrence (~50%). Results similar for colorectal cancer.
Observed benefits include improvement in fatigue, anxiety, depression, self-esteem, happiness, QOL.
Studies in endometrial cancer suggest improved sleep quality (Ref: Ambruster et al, Gynecologic oncology 2018), and QOL (Rossi et al Supportive Care in Cancer 2017)
1 Bouillet et al, Crit Rev Oncol Hematol 2015
2 Rossi et al, Supportive Care in Cancer 2017
3 Armbruster et al, Gynecologic Oncology 2017

3. Endometrial Cancer Facts
New cases in 2018
63,230 US (920 expected in SC)
Rates are increasing (>1% in Whites, 2.5% in African Americans, annually)
Obesity is a strong risk factor 
Median age at diagnosis = 62
Expected deaths N=11,350
5-year survival 82% (62% among Black women vs 84% among Whites)
Treatment by stage
Early stage (I, II)
Surgery alone
Surgery + radiation, hormonal, and/or chemo
Late stage (III, IV)
Surgery, radiation, chemo
Stage at Diagnosis
4th most commonly diagnosed cancer in women after breast, lung, colorectal and accounts for 7% of the total incident cancers
>70% of endometrial cancer patients are obese
Siegel et al., Cancer Statistics, 2018

4. Question ― Hypothesis
Does post-diagnosis physical activity improve overall survival or progression-free survival in women with endometrial cancer? We think so!

5. Study Design
Prospective cohort of women newly diagnosed with stage 1 and 2 endometrial cancer in South Carolina  
Coordinated enrollment and clinical data collection with participating oncology practices statewide
2-year enrollment period  
Pilot study among 2-3 oncology practices before full roll-out
Baseline data collection / exposure assessment within 90 days of diagnosis; follow-up at every 6 months to update exposure
Access to medical record by consent for tumor pathology factors I.e. stage
Additional variables of interest: demographic, pre-diagnosis physical activity, BMI, and smoking history
Follow-up to 5-years (maybe 10 years)
Questions – how many participants can we reasonably expect from approximately ~1800 new cases in 2 years? Should we have a pilot among 2-3 centers? Include multiple states?

6. Exposure and Outcome Assessment
Baseline physical activity and other information collected via in-clinic interview / health assessment administered by study coordinator
Physical activity and sedentary behavior assessed by accelerometry at baseline and each follow-up
Accelerometer worn for 1 week at each follow-up point
Both physical activity and sedentary time captured 
Analysis of cumulative weekly activity assessed as metabolic energy expenditure (Can also examine sedentary behavior e.g. sitting time)
Outcome
Overall and cause-specific survival ascertained through registry linkage at 5-years and 10 years
Accerlerometer is lightweight and worn on a strap around the waist or hip continuously for 1 week. (Broderick, Support Care Cancer (2014) 22:1121–1130 A guide to assessing physical activity using accelerometry in cancer patients)
Issue accelerometer at each clinical visit along with mail-in return envelope.
We are going to want to see if they are meeting standard PA recommendation of 150 min/week moderate-vigorous physical activity (MVPA).

7. Thanks!
Questions? Comments?