PURPOSE: Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood. PATIENTS AND METHODS: We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index ≥ 30 kg/m2) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM). RESULTS: Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form-36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity. CONCLUSION: Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk.
PURPOSE: Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood. PATIENTS AND METHODS: We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index ≥ 30 kg/m2) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM). RESULTS: Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form-36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity. CONCLUSION: Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk.
Authors: Kevin C Oeffinger; Ann C Mertens; Charles A Sklar; Yutaka Yasui; Thomas Fears; Marilyn Stovall; Terry A Vik; Peter D Inskip; Leslie L Robison Journal: J Clin Oncol Date: 2003-04-01 Impact factor: 50.717
Authors: Marilyn Stovall; Sarah S Donaldson; Rita E Weathers; Leslie L Robison; Ann C Mertens; Jeanette Falck Winther; Jorgen H Olsen; John D Boice Journal: Int J Radiat Oncol Biol Phys Date: 2004-10-01 Impact factor: 8.013
Authors: Judy Y Ou; Rochelle R Smits-Seemann; Sapna Kaul; Mark N Fluchel; Carol Sweeney; Anne C Kirchhoff Journal: Cancer Epidemiol Date: 2017-07-19 Impact factor: 2.984
Authors: Melissa M Hudson; Kevin C Oeffinger; Kendra Jones; Tara M Brinkman; Kevin R Krull; Daniel A Mulrooney; Ann Mertens; Sharon M Castellino; Jacqueline Casillas; James G Gurney; Paul C Nathan; Wendy Leisenring; Leslie L Robison; Kirsten K Ness Journal: J Clin Oncol Date: 2014-12-29 Impact factor: 44.544
Authors: Austin L Brown; Philip J Lupo; Heather E Danysh; Mehmet F Okcu; Michael E Scheurer; Kala Y Kamdar Journal: J Pediatr Hematol Oncol Date: 2016-08 Impact factor: 1.289
Authors: Marilyn Stern; Jennifer Bleck; Linda J Ewing; Esther Davila; Courtney Lynn; Gregory Hale; Suzanne Mazzeo Journal: Pediatr Blood Cancer Date: 2018-01-19 Impact factor: 3.167
Authors: Margaret Raber; Maria C Swartz; Diane Santa Maria; Teresia O'Connor; Tom Baranowski; Rhea Li; Joya Chandra Journal: Pediatr Res Date: 2016-04-11 Impact factor: 3.756