Obesity, Cancer Survivorship, and Race Relevance
Unwinding the tangle of obesity, comorbidities, race and ethnicity, and cancer survival and adverse treatment outcomes will require studies specifically designed with these goals in mind. A scaffolding to frame the complexity of these relationships is depicted in Figure 1. As reviewed above, the effects of obesity on cancer recurrence and adverse treatment outcomes show some variability. It could be hypothesized that some of this variability may be due to upstream variability across research cohorts with regard to homogeneity of comorbid health conditions and race or ethnicity. Throughout the review, we have noted unanswered questions specific to understanding the role of obesity in cancer survival and adverse treatment effects. Additional pressing questions appear below. These questions address the potential for the relationships of obesity, chronic disease, and race or ethnicity to confound, alter, or mediate relationships among obesity, cancer recurrence, and adverse treatment effects.
Possible methodological approaches could include meta-analysis or pooling projects of prospective cohort studies with the aim of exploring these complex relationships and how they impact survival. Further, large national databases (SEER, National Cancer Registry, or pooling large registries [ie, California, Texas, NY]) that include comorbidities, obesity subgroups, treatment, pathology race/ethnicity, and socioeconomic status could be leveraged to study relationships between obesity and related comorbidities on cancer treatment outcomes/survival by race/ethnicity. Ultimately, it may be necessary to design and conduct large observational cohort studies with the primary aim of determining the relative importance of race and ethnicity in the link between obesity and cancer survival.
Pressing Questions
Unwinding the tangle of obesity, comorbidities, race and ethnicity, and cancer survival and adverse treatment outcomes will require studies specifically designed with these goals in mind. A scaffolding to frame the complexity of these relationships is depicted in Figure 1. As reviewed above, the effects of obesity on cancer recurrence and adverse treatment outcomes show some variability. It could be hypothesized that some of this variability may be due to upstream variability across research cohorts with regard to homogeneity of comorbid health conditions and race or ethnicity. Throughout the review, we have noted unanswered questions specific to understanding the role of obesity in cancer survival and adverse treatment effects. Additional pressing questions appear below. These questions address the potential for the relationships of obesity, chronic disease, and race or ethnicity to confound, alter, or mediate relationships among obesity, cancer recurrence, and adverse treatment effects.
What are the combined and independent contributions of race, comorbidities, and obesity on DFS, recurrence, and overall mortality in cancer patients?
What are the combined and independent contributions of race, comorbidities, and obesity on HRQOL and other adverse treatment effects?
Is there variability in the effect of obesity on cancer survival across racial and ethnic minority groups (both within-race and across-race analyses are needed)?
To what extent does race or ethnicity modify the effect of obesity or comorbid health conditions on adverse treatment effects such as lymphedema and CRF?
Possible methodological approaches could include meta-analysis or pooling projects of prospective cohort studies with the aim of exploring these complex relationships and how they impact survival. Further, large national databases (SEER, National Cancer Registry, or pooling large registries [ie, California, Texas, NY]) that include comorbidities, obesity subgroups, treatment, pathology race/ethnicity, and socioeconomic status could be leveraged to study relationships between obesity and related comorbidities on cancer treatment outcomes/survival by race/ethnicity. Ultimately, it may be necessary to design and conduct large observational cohort studies with the primary aim of determining the relative importance of race and ethnicity in the link between obesity and cancer survival.