Photo Credit: Nambitomo
Interventions targeting biobehavioral factors such as physical activity, sleep, and circadian rhythms may improve patient QOL following EC surgery.
Patients who have been successfully treated for endometrial cancer (EC) still face QOL issues. A recent study developed by Elizabeth Ver Hoeve, PhD; Jessica Gorzelitz, PhD, MS, and colleagues found that disruptions of sleep, activity, and rest cycles increase the likelihood of psychological and physical symptoms in patients who have undergone EC surgery. The researchers published their findings in Gynecologic Oncology. Dr. Ver Hoeve and Dr. Gorzelitz spoke with Physician’s Weekly (PW) about how the study’s findings can be applied.
PW: Why did you feel this topic needed exploration?
Dr. Gorzelitz: This project was a collaboration with excellent researchers at the University of Wisconsin-Madison. EC is the most common gynecologic malignancy and is one of the rare cancers increasing in incidence. We have excellent treatments for this disease, and most patients with EC will survive the first five years of their disease. Thus, we have more EC survivors than ever, and this population is expected to grow significantly.
Despite this growing population, we have limited evidence and few studies on EC. Our previous work has shown that EC survivors complete low levels of physical activity, especially following surgery, and this study allowed us to explore the psychosocial changes in symptom burden following EC treatment. Understanding the natural changes in activity, sleep, and symptom burden allows us to identify these patterns to inform future interventions.
Dr. Ver Hoeve: Fatigue, pain, and sleep disturbance are commonly reported symptoms among EC survivors. In fact, for many survivors, these symptoms tend to co-occur and persist over many years post-treatment. This paper sought to explore how specific biobehavioral processes may be associated with the long-term symptom burden among EC survivors.
How can the study’s findings be incorporated into practice?
Dr. Ver Hoeve: The findings can support clinician recommendations regarding patient health behaviors during post-treatment recovery. Specifically, when clinicians discuss post-treatment recovery with their patients, they can feel increasingly confident in recommending that engagement in daytime physical activity, receipt of quality nighttime sleep, and maintenance of a consistent 24-hour rest-activity pattern can improve the management of patients’ post-treatment fatigue, pain, mood, and sleep-related challenges.
Dr. Gorzelitz: Oncologists and providers want what’s best for their patients, and they deliver excellent care. Our results identify that those who have less activity and more sleep disturbances often had the highest symptom burden, including more psychological and physical symptoms.
With these preliminary results, our next steps include identifying these patients early for intervention. We also want to identify effective intervention strategies to connect patients to interventions to address activity, sleep, and symptom burden. Finally, we will want to identify implementation strategies for patients and providers to ensure that these approaches do not interfere with the standard of care, existing treatment, or excess burden for any party.
What interventions can help address efficient diagnosis and treatment?
Dr. Ver Hoeve: The study’s findings suggest that shared biobehavioral mechanisms may drive physical and psychological symptoms among EC survivors. In this study, patients with lower physical activity, poorer sleep, and less consistent 24-hour rhythms reported poorer mental and physical health outcomes. The important clinical implication from these associations is that interventions targeting one or more of these shared mechanisms can potentially mitigate multiple symptoms.
Evidence-based approaches for increasing physical activity have already demonstrated acceptability among EC survivors. Similarly, evidence-based interventions such as cognitive behavioral therapy for insomnia (CBT-I) have also improved sleep quality. Further applying and evaluating these intervention approaches in EC survivors, a relatively understudied patient population for behavioral interventions, is an important next step.
How could early diagnosis positively impact the patient’s prognosis?
Dr. Gorzelitz: Early diagnosis of EC can significantly improve a patient’s overall prognosis by allowing for timely interventions that address physical and psychological symptoms. By identifying and managing disruptions in physical activity, sleep, and circadian rhythms early on, healthcare providers can help mitigate persistent issues such as fatigue, pain, and emotional distress. This proactive approach enhances survivors’ quality of life and supports better long-term health outcomes.
Is there anything else you feel clinicians should know about this research?
Dr. Gorzelitz: Clinicians might find it valuable to know that this research highlights the importance of monitoring biobehavioral factors such as physical activity, sleep, and circadian rhythms in EC survivors. The study suggests that targeted interventions to improve these factors could potentially reduce the severity of symptoms like fatigue, pain, and emotional distress. Additionally, the findings underscore the need for a holistic approach to post-surgery care, emphasizing the interconnectedness of physical and psychological health in recovery.
