Jennifer A. Ligibel and Elizabeth S. Frank, Dana-Farber Cancer Institute, Boston, MA; Catherine M. Alfano, Elvan C. Daniels, and Kevin D. Stein, American Cancer Society, Atlanta, GA; Dawn Hershman, Columbia University; Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; Rachel M. Ballard, National Institutes of Health; Worta McCaskill-Stevens and Lori M. Minasian, National Cancer Institute, Bethesda, MD; Suanna S. Bruinooge and Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta; Pamela J. Goodwin, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; Melinda L. Irwin, Yale School of Public Health, New Haven, CT; Mark A. O'Rourke, Greenville Hospital System, Greenville, SC; John P. Pierce, University of California San Diego Moores Cancer Center, San Diego, CA; and Cynthia A. Thomson, University of Arizona, Tucson, AZ.
J Clin Oncol. 2015 Nov 20;33(33):3961-7. doi: 10.1200/JCO.2015.63.1440. Epub 2015 Aug 31.
Observational evidence has established a relationship between obesity and cancer risk and outcomes. Interventional studies have demonstrated the feasibility and benefits of lifestyle change after cancer diagnosis, and guidelines recommend weight management and regular physical activity in cancer survivors; however, lifestyle interventions are not a routine part of cancer care. The ASCO Research Summit on Advancing Obesity Clinical Trials in Cancer Survivors sought to identify the knowledge gaps that clinical trials addressing energy balance factors in cancer survivors have not answered and to develop a roadmap for the design and implementation of studies with the potential to generate data that could lead to the evidence-based incorporation of weight management and physical activity programs into standard oncology practice. Recommendations highlight the need for large-scale trials evaluating the impact of energy balance interventions on cancer outcomes, as well as the concurrent conduct of studies focused on dissemination and implementation of interventions in diverse populations of cancer survivors, including answering critical questions about the degree of benefit in key subgroups of survivors. Other considerations include the importance of incorporating economic metrics into energy balance intervention trials, the need to establish intermediate biomarkers, and the importance of integrating traditional and nontraditional funding sources. Establishing lifestyle change after cancer diagnosis as a routine part of cancer care will require a multipronged effort to overcome barriers related to study development, funding, and stakeholder engagement. Given the prevalence of obesity and inactivity in cancer survivors in the United States and elsewhere, energy balance interventions hold the potential to reduce cancer morbidity and mortality in millions of patients, and it is essential that we move forward in determining their role in cancer care with the same care and precision used to test pharmacologic and other interventions.
观察性证据已经确立了肥胖与癌症风险和结果之间的关系。干预性研究已经证明了癌症诊断后生活方式改变的可行性和益处，并且指南建议癌症幸存者进行体重管理和定期体育锻炼；然而，生活方式干预并不是癌症护理的常规部分。ASCO 癌症幸存者推进肥胖临床试验研究峰会旨在确定临床试验在解决癌症幸存者能量平衡因素方面尚未回答的知识空白，并制定设计和实施研究的路线图，这些研究有可能产生数据，从而将体重管理和体育活动计划纳入标准肿瘤学实践。建议强调需要进行大规模试验，评估能量平衡干预对癌症结果的影响，同时开展专注于在不同癌症幸存者人群中传播和实施干预措施的研究，包括回答关键亚组幸存者的受益程度等关键问题。其他考虑因素包括将经济指标纳入能量平衡干预试验的重要性、需要建立中间生物标志物以及整合传统和非传统资金来源的重要性。将癌症诊断后的生活方式改变作为癌症护理的常规部分，需要多方努力克服与研究开发、资金和利益相关者参与相关的障碍。鉴于美国和其他地方癌症幸存者中肥胖和缺乏运动的普遍存在，能量平衡干预有可能降低数百万患者的癌症发病率和死亡率，因此我们必须下定决心，以与测试药物和其他干预措施相同的谨慎和精确性，确定它们在癌症护理中的作用。
