IMPORTANCE Obesity, defined as a body mass index (BMI) greater than 30, is associated with a significant increase in the risk of many cancers and in overall mortality. However, various studies have suggested that patients with cancer and no obesity (ie, BMI 20-25) have worse outcomes than patients with obesity.OBJECTIVE To assess the association between obesity and outcomes after a diagnosis of cancer.
Introduction Coronavirus disease 2019 (COVID-19) has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak impacted on access to cancer diagnosis and treatment for LC pts compared to pre-pandemic time. Methods Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared to the same period in 2019. Differences between the two years were analyzed using chi-square test for categorical variables and Mann-Whitney U test for continuous variables. Results A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 vs 1637, p=0.09). Newly LC pts in 2020 were more likely to be diagnosed with stage IV disease (p<0.01) and to be current smokers (p<0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% vs -3.2%) compared to the other months included. More LC pts referred to low/medium volume hospital in 2020 compared to 2019 (p=0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (p=0.94), symptoms onset and cytohistological diagnosis (p=0.92), symptoms onset and treatment start (p=0.40), treatment start and first radiological revaluation (p=0.36). Conclusions Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.
BACKGROUND. Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, is associated with a significant increase in risk of many cancers. In last years, various studies suggested that obese cancer patients have better outcomes than non obese patients. This phenomenon, also known as the obesity paradox, is not well understood and presents controversial explanations. We performed a systematic review and metaanalysis to assess the association between obesity and outcome after a diagnosis of cancer. PATIENTS AND METHODS. PubMed, the Cochrane Library, and EMBASE were searched from inception to January 2020, for studies reporting prognosis of patients with obesity and cancer. Risk of death, cancer specific survival (CSS) and progression were pooled to provide an adjusted hazard ratio with a 95% confidence interval (HR 95%CI). The primary outcome of the study refers to overall survival (OS) in obese vs non obese patients with malignancies. Secondary endpoints were CSS and progression or disease free survival (PFS or RFS). RESULTS. Mortality and relapse associated with obesity in patients with cancer were evaluated among n=6,320,365 participants (n=203 studies). Overall, association of obesity and cancer was associated with a reduced OS (HR =1.14, 95% CI: 1.09 1.19; P<.01) and CSS (HR=1.17, 95%CI 1.12 1.23; P<.01). Patients were also at increased risk for relapse (HR=1.13, 95%CI 1.07 1.19; P<.01). Patients with breast, colorectal and uterine tumors were at increased risk of death. Conversely, obese with lung cancer, renal cell carcinoma and melanoma survived longer that non obese. CONCLUSIONS. In many cancer patients, obesity reduces survival and increases the risk of relapse. In lung cancer, renal cell carcinoma and melanoma obesity was protective in terms of outcome. More intensive follow up, adequate dosing of oncological treatments, calories intake restrictions, physical activity and monitoring of obesity related complications are effective measures for reducing mortality in these subjects.
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