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Sleep, quality of life, and depression in endometrial cancer survivors with obesity seeking weight loss

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Abstract

Purpose

Incidence and mortality rates of uterine cancer are increasing and, obesity, which is also rising, has been associated with uterine cancer development and mortality. A recent study found that poor sleep quality is common among endometrial cancer survivors and those with obesity had more sleep disturbances than those having normal weight. However, it is unclear if higher levels of obesity (Class III, BMI ≥ 40 kg/m2), which are rising rapidly, are differentially associated with sleep as well as depression and quality of life in endometrial cancer survivors.

Methods

We evaluated sleep, depression, and quality of life in 100 Stage I endometrial cancer survivors with obesity seeking weight loss enrolled in a lifestyle intervention (NCT01870947) at baseline.

Results

The average age was 60 years and mean BMI was 42.1 kg/m2 with 58% having a BMI ≥ 40 kg/m2. Most survivors (72.3%) had poor sleep quality and most (71.2%) reported sleeping < 7 h/night. Survivors with class III compared with class I obesity had significantly more sleep disturbances and daytime dysfunction; and, those with poor sleep had higher depression and lower quality of life. Survivors with a BMI ≥ 50 kg/m2 (~ 25%) had the highest levels of depression and lowest physical and emotional well-being.

Conclusions

Our results reveal that endometrial cancer survivors with class III compared with class I obesity have poorer sleep quality, higher depression, and lower quality of life. Given the rising rates of obesity and uterine cancer mortality, interventions to combat both obesity and poor sleep are needed.

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Funding

This work was financially supported by the National Institutes of Health (NIH) National Cancer Institute (NCI) grant no. R01-CA175100 (awarded to NLN) and by the NIH National Center for Research Resources (NCRR) and the National Center for Advancing Translational Sciences (NCATS) grant no. UL1RR024989.

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Authors and Affiliations

  1. Department of Population and Quantitative Health Sciences, Case Western Reserve University, Wolstein Research Building, 2103 Cornell Road, Cleveland, OH, 44106, USA

    Nora L. Nock

  2. Case Comprehensive Cancer Center, Wolstein Research Building, 2103 Cornell Road, Cleveland, OH, 44106, USA

    Nora L. Nock

  3. Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA

    Anastasia Dimitropoulos

  4. Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA

    Kristine M. Zanotti, Steven Waggoner & Christa Nagel

  5. Gynecologic Oncology, University Hospitals Case Medical Center, Cleveland, OH, USA

    Kristine M. Zanotti, Steven Waggoner & Christa Nagel

  6. Center for Lifestyle Medicine, Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA

    Mladen Golubic

  7. Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA

    Chad M. Michener

  8. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    John P. Kirwan

  9. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Jay Alberts

Authors
  1. Nora L. Nock
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  2. Anastasia Dimitropoulos
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  3. Kristine M. Zanotti
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  4. Steven Waggoner
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  6. Mladen Golubic
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  7. Chad M. Michener
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  8. John P. Kirwan
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  9. Jay Alberts
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Contributions

NLN conceived the project and led the design of the study, data collection and analyses, and manuscript preparation. JA, AD, and JPK contributed to the study design and manuscript development. KZ, CN, SW, MG, and CM contributed to manuscript development. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Nora L. Nock.

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Informed written consent was obtained from all individual participants included in the study. The study was approved by the Institutional Review Boards of University Hospitals Case Medical Center and the Cleveland Clinic.

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The authors have no conflicts of interest to declare.

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Nock, N.L., Dimitropoulos, A., Zanotti, K.M. et al. Sleep, quality of life, and depression in endometrial cancer survivors with obesity seeking weight loss. Support Care Cancer 28, 2311–2319 (2020). https://doi.org/10.1007/s00520-019-05051-1

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