Frederic Pamoukdjian1, Thomas Aparicio2, Florence Canoui-Poitrine3, Boris Duchemann4, Vincent Lévy5, Philippe Wind6, Nathalie Ganne7, Georges Sebbane8, Laurent Zelek9, Elena Paillaud10. 1. Oncogeriatric Coordination Unit, Geriatric Department, Avicenne Hospital, APHP, F-93000, Bobigny, France; Université Paris-Est, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), F-94000, Créteil, France. Electronic address: frederic.pamoukdjian@aphp.fr. 2. Department of Gastroenterology, APHP, Avicenne Hospital, F-93000, Bobigny, France. 3. Université Paris-Est, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), F-94000, Créteil, France; Public Health Department, APHP, Henri-Mondor Hospital, F-94000, Créteil, France. 4. Department of Medical Oncology, APHP, Avicenne Hospital, F-93000, Bobigny, France. 5. Clinical Research Unit and Clinical Research Centre, APHP, Avicenne Hospital, F-93000, Bobigny, France. 6. Department of Surgery, APHP, Avicenne Hospital, F-93000, Bobigny, France. 7. Liver Unit, APHP, Jean Verdier Hospital, F-93140, Bondy, France; UFR SMBH, Université Paris 13, Sorbonne Paris Cité, F-93000, Bobigny, France; INSERM UMR 1162, Universités Paris 5, 27 Rue Juliette Dodu, Paris 7 et Paris 13, F-75010, Paris, France. 8. Oncogeriatric Coordination Unit, Geriatric Department, Avicenne Hospital, APHP, F-93000, Bobigny, France. 9. Department of Medical Oncology, APHP, Avicenne Hospital, F-93000, Bobigny, France; Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), U1125, Inra, Cnam, Paris 13 University, Nutritional Epidemiology Research Team (EREN), F-93000, Bobigny, France; French Network for Nutrition and Cancer Research (NACRe Network), F-78352, Jouy-en-Josas, France. 10. Université Paris-Est, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), F-94000, Créteil, France; Geriatric Oncology Unit, Geriatric Department, APHP, Henri-Mondor Hospital, F-94000, Créteil, France.
Abstract
BACKGROUND & AIMS: the obesity survival paradox is an emergent issue in oncology, but its existence remains unclear particularly in older cancer patients. We aimed to assess the obesity survival paradox in older cancer patients. METHODS: all consecutive cancer outpatients 65 years and older referred for geriatric assessment (GA) before a decision on cancer treatment between November 2013 and September 2016 were enrolled in the PF-EC cohort study. The main outcome was 6-month mortality. A Cox univariate and multivariate proportional hazard regression models were performed with baseline GA, oncological variables (cancer site, extension and treatment modalities) and C-reactive protein (CRP). We assessed the prognostic value of body mass index categories (i.e. malnutrition <21, 21 ≤ normal weight ≤24.9, 25 ≤ overweight ≤29.9 and obesity ≥30 kg/m2) in the whole study population and according to the metastatic status. RESULTS: 433 patients with a mean age of 81.2 ± 6.0 years were included, 51% were women, 44.3% had digestive cancers, 18% breast cancer and 14.5% lung cancer and 45% metastatic cancers. Eighty-eight of these patients (20.3%) were obese at baseline. Mortality rate was 17% during the 6-month follow-up period. After adjustment for sex, gait speed, Mini-Mental State Examination, cancer site and exclusive supportive care, obesity (compared to normal weight) was independently and negatively associated with 6-month mortality only in metastatic patients (aHR 0.17, 95% CI [0.03-0.92], P = 0.04). CONCLUSION: our study confirms the obesity survival paradox in older cancer patients only in the metastatic group.
BACKGROUND & AIMS: the obesity survival paradox is an emergent issue in oncology, but its existence remains unclear particularly in older cancerpatients. We aimed to assess the obesity survival paradox in older cancerpatients. METHODS: all consecutive cancer outpatients 65 years and older referred for geriatric assessment (GA) before a decision on cancer treatment between November 2013 and September 2016 were enrolled in the PF-EC cohort study. The main outcome was 6-month mortality. A Cox univariate and multivariate proportional hazard regression models were performed with baseline GA, oncological variables (cancer site, extension and treatment modalities) and C-reactive protein (CRP). We assessed the prognostic value of body mass index categories (i.e. malnutrition <21, 21 ≤ normal weight ≤24.9, 25 ≤ overweight ≤29.9 and obesity ≥30 kg/m2) in the whole study population and according to the metastatic status. RESULTS: 433 patients with a mean age of 81.2 ± 6.0 years were included, 51% were women, 44.3% had digestive cancers, 18% breast cancer and 14.5% lung cancer and 45% metastatic cancers. Eighty-eight of these patients (20.3%) were obese at baseline. Mortality rate was 17% during the 6-month follow-up period. After adjustment for sex, gait speed, Mini-Mental State Examination, cancer site and exclusive supportive care, obesity (compared to normal weight) was independently and negatively associated with 6-month mortality only in metastatic patients (aHR 0.17, 95% CI [0.03-0.92], P = 0.04). CONCLUSION: our study confirms the obesity survival paradox in older cancerpatients only in the metastatic group.