Skip to main content
Top
Published in: Annals of Surgical Oncology 9/2018

01-09-2018 | Health Services Research and Global Oncology

Practices and Perceptions Among Surgical Oncologists in the Perioperative Care of Obese Cancer Patients

Authors: Tasha M. Hughes, MD, MPH, Elizabeth N. Palmer, PhD, Quinn Capers, MD, Sherif Abdel-Misih, MD, Alan Harzmann, MD, Eliza Beal, MD, Ingrid Woelfel, MD, Sabrena Noria, MD, PhD, Doreen Agnese, MD, Mary Dillhoff, MD, Valerie Grignol, MD, J. Harrison Howard, MD, Lawrence A. Shirley, MD, Alicia Terando, MD, Carl Schmidt, MD, Jordan Cloyd, MD, Timothy Pawlik, MD, MPH, PhD

Published in: Annals of Surgical Oncology | Issue 9/2018

Login to get access

Abstract

Background

Obesity and cancer are two common diseases in the United States. Although there is an interaction of obesity and cancer, little is known about surgeon perceptions and practices in the care of obese cancer patients. We sought to characterize perceptions and practices of surgical oncologists regarding the perioperative care of obese patients being treated for cancer.

Methods

A cross-sectional survey was designed, pilot tested, and utilized to assess perceptions and practices of surgeons treating cancer patients. Surgical oncologists were identified using a commercially available database, and Qualtrics® was used to distribute and manage the survey. Statistical analyses were completed by using SPSS.

Results

Of the 1731 electronic invitations, 172 recipients initiated the survey, and 157 submitted responses (91.2%). Many surgeons (65.7%) believed that obese patients are more likely to present with more advanced cancers and were more likely than system factors to explain this delayed treatment [t(87) = 4.84; p < 0.001]. Nearly two-thirds of providers (64.5%) reported that obesity had no impact on the timing of surgery; however, one-third of respondents (34.2%) were more likely to recommend preoperative nonsurgical therapy rather than upfront surgery among obese patients. For operations of the chest/abdomen and breast/soft tissue, surgeons perceived obesity to be more related to risk of postoperative than intraoperative complications (chest/abdomen mean 4.13 vs. 3.26; breast/soft tissue 4.11 vs. 2.60; p < 0.001).

Conclusions

One in three surgeons reported that patient obesity would change the timing/sequence of when resection would be offered. Many surgeons perceived that obesity was related to a wide array of intra- and postoperative adverse outcomes.
Appendix
Available only for authorised users
Literature
2.
go back to reference World Health Organization. Obesity: preventing and managing the global epidemic. World Health Organization, Geneva, Switzerland; 2000. World Health Organization. Obesity: preventing and managing the global epidemic. World Health Organization, Geneva, Switzerland; 2000.
3.
go back to reference Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2014. In: Bethesda, MD: National Cancer Institute; 2017. Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2014. In: Bethesda, MD: National Cancer Institute; 2017.
4.
go back to reference Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Lancet. 2014;384(9945):755–65.CrossRefPubMedPubMedCentral Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Lancet. 2014;384(9945):755–65.CrossRefPubMedPubMedCentral
5.
go back to reference Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569-78.CrossRefPubMed Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569-78.CrossRefPubMed
6.
go back to reference Ewertz M, Land LH, Dalton SO, Cronin-Fenton D, Jensen MB. Influence of specific comorbidities on survival after early-stage breast cancer. Acta Oncol. 2018;57(1):129–34.CrossRefPubMed Ewertz M, Land LH, Dalton SO, Cronin-Fenton D, Jensen MB. Influence of specific comorbidities on survival after early-stage breast cancer. Acta Oncol. 2018;57(1):129–34.CrossRefPubMed
7.
go back to reference Chan DS, Vieira AR, Aune D, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25(10):1901–14.CrossRefPubMedPubMedCentral Chan DS, Vieira AR, Aune D, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25(10):1901–14.CrossRefPubMedPubMedCentral
8.
go back to reference Pecorelli N, Carrara G, De Cobelli F, et al. Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery. Br J Surg. 2016;103(4):434–42.CrossRefPubMed Pecorelli N, Carrara G, De Cobelli F, et al. Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery. Br J Surg. 2016;103(4):434–42.CrossRefPubMed
9.
go back to reference Sandini M, Bernasconi DP, Fior D, et al. A high visceral adipose tissue-to-skeletal muscle ratio as a determinant of major complications after pancreatoduodenectomy for cancer. Nutrition. 2016;32(11–12):1231–7.CrossRefPubMed Sandini M, Bernasconi DP, Fior D, et al. A high visceral adipose tissue-to-skeletal muscle ratio as a determinant of major complications after pancreatoduodenectomy for cancer. Nutrition. 2016;32(11–12):1231–7.CrossRefPubMed
10.
go back to reference Lippman ME, Krueger KA, Eckert S, et al. Indicators of lifetime estrogen exposure: effect on breast cancer incidence and interaction with raloxifene therapy in the multiple outcomes of raloxifene evaluation study participants. J Clin Oncol. 2001;19(12):3111–6.CrossRefPubMed Lippman ME, Krueger KA, Eckert S, et al. Indicators of lifetime estrogen exposure: effect on breast cancer incidence and interaction with raloxifene therapy in the multiple outcomes of raloxifene evaluation study participants. J Clin Oncol. 2001;19(12):3111–6.CrossRefPubMed
11.
go back to reference Samavat H, Kurzer MS. Estrogen metabolism and breast cancer. Cancer Lett. 2015;356(2 Pt A):231–43.CrossRefPubMed Samavat H, Kurzer MS. Estrogen metabolism and breast cancer. Cancer Lett. 2015;356(2 Pt A):231–43.CrossRefPubMed
12.
go back to reference Deng T, Lyon CJ, Bergin S, Caligiuri MA, Hsueh WA. Obesity, inflammation, and cancer. Annu Rev Pathol. 2016;11:421–49.CrossRefPubMed Deng T, Lyon CJ, Bergin S, Caligiuri MA, Hsueh WA. Obesity, inflammation, and cancer. Annu Rev Pathol. 2016;11:421–49.CrossRefPubMed
14.
go back to reference Hede P, Sorensson MA, Polleryd P, Persson K, Hallgren T. Influence of BMI on short-term surgical outcome after colorectal cancer surgery: a study based on the Swedish national quality registry. Int J Colorectal Dis. 2015;30(9):1201–7.CrossRefPubMed Hede P, Sorensson MA, Polleryd P, Persson K, Hallgren T. Influence of BMI on short-term surgical outcome after colorectal cancer surgery: a study based on the Swedish national quality registry. Int J Colorectal Dis. 2015;30(9):1201–7.CrossRefPubMed
15.
go back to reference Smith RK, Broach RB, Hedrick TL, Mahmoud NN, Paulson EC. Impact of BMI on postoperative outcomes in patients undergoing proctectomy for rectal cancer: a national surgical quality improvement program analysis. Dis Colon Rectum. 2014;57(6):687–93.CrossRefPubMed Smith RK, Broach RB, Hedrick TL, Mahmoud NN, Paulson EC. Impact of BMI on postoperative outcomes in patients undergoing proctectomy for rectal cancer: a national surgical quality improvement program analysis. Dis Colon Rectum. 2014;57(6):687–93.CrossRefPubMed
16.
go back to reference Eom BW, Joo J, Yoon HM, Ryu KW, Kim YW, Lee JH. A body shape index has a good correlation with postoperative complications in gastric cancer surgery. Ann Surg Oncol. 2014;21(4):1115–22.CrossRefPubMed Eom BW, Joo J, Yoon HM, Ryu KW, Kim YW, Lee JH. A body shape index has a good correlation with postoperative complications in gastric cancer surgery. Ann Surg Oncol. 2014;21(4):1115–22.CrossRefPubMed
17.
go back to reference Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol. 2013;20(3):780–7.CrossRefPubMed Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol. 2013;20(3):780–7.CrossRefPubMed
18.
go back to reference Hughes TM, Shah K, Noria S, Pawlik T. Is BMI associated with post-operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review. J Surg Oncol. 2018;117(5):1009–19.CrossRefPubMed Hughes TM, Shah K, Noria S, Pawlik T. Is BMI associated with post-operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review. J Surg Oncol. 2018;117(5):1009–19.CrossRefPubMed
19.
go back to reference Nobuoka D, Gotohda N, Kato Y, Takahashi S, Konishi M, Kinoshita T. Influence of excess body weight on the surgical outcomes of total gastrectomy. Surg Today. 2011;41(7):928–34.CrossRefPubMed Nobuoka D, Gotohda N, Kato Y, Takahashi S, Konishi M, Kinoshita T. Influence of excess body weight on the surgical outcomes of total gastrectomy. Surg Today. 2011;41(7):928–34.CrossRefPubMed
20.
go back to reference Gupta PK, Turaga KK, Miller WJ, Loggie BW, Foster JM. Determinants of outcomes in pancreatic surgery and use of hospital resources. J Surg Oncol. 2011;104(6):634–40.CrossRefPubMed Gupta PK, Turaga KK, Miller WJ, Loggie BW, Foster JM. Determinants of outcomes in pancreatic surgery and use of hospital resources. J Surg Oncol. 2011;104(6):634–40.CrossRefPubMed
21.
go back to reference Govaert JA, Lijftogt N, van Dijk WA, et al. Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry. J Surg Oncol. 2016;113(5):489–95.CrossRefPubMed Govaert JA, Lijftogt N, van Dijk WA, et al. Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry. J Surg Oncol. 2016;113(5):489–95.CrossRefPubMed
22.
go back to reference Jung JH, Ryu SY, Jung MR, Park YK, Jeong O. Laparoscopic distal gastrectomy for gastric cancer in morbidly obese patients in South Korea. J Gastric Cancer. 2014;14(3):187–95.CrossRefPubMedPubMedCentral Jung JH, Ryu SY, Jung MR, Park YK, Jeong O. Laparoscopic distal gastrectomy for gastric cancer in morbidly obese patients in South Korea. J Gastric Cancer. 2014;14(3):187–95.CrossRefPubMedPubMedCentral
23.
go back to reference Kim MG, Yook JH, Kim KC, et al. Influence of obesity on early surgical outcomes of laparoscopic-assisted gastrectomy in gastric cancer. Surg Laprosc Endosc Percutan Tech. 2011;21(3):151–4.CrossRef Kim MG, Yook JH, Kim KC, et al. Influence of obesity on early surgical outcomes of laparoscopic-assisted gastrectomy in gastric cancer. Surg Laprosc Endosc Percutan Tech. 2011;21(3):151–4.CrossRef
24.
go back to reference Khandalavala BN, Rojanala A, Geske JA, Koran-Scholl JB, Guck TP. Obesity bias in primary care providers. Fam Med. 2014;46(7):532–5.PubMed Khandalavala BN, Rojanala A, Geske JA, Koran-Scholl JB, Guck TP. Obesity bias in primary care providers. Fam Med. 2014;46(7):532–5.PubMed
25.
go back to reference Foster GD, Wadden TA, Makris AP, et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11(10):1168–77.CrossRef Foster GD, Wadden TA, Makris AP, et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11(10):1168–77.CrossRef
27.
go back to reference Ferrante JM, Fyffe DC, Vega ML, Piasecki AK, Ohman-Strickland PA, Crabtree BF. Family physicians’ barriers to cancer screening in extremely obese patients. Obesity (Silver Spring). 2010;18(6):1153–9.CrossRef Ferrante JM, Fyffe DC, Vega ML, Piasecki AK, Ohman-Strickland PA, Crabtree BF. Family physicians’ barriers to cancer screening in extremely obese patients. Obesity (Silver Spring). 2010;18(6):1153–9.CrossRef
28.
go back to reference Qualtrics Labs, Inc [computer program]. Version August 2017. Provo, Utah, USA 2009. Qualtrics Labs, Inc [computer program]. Version August 2017. Provo, Utah, USA 2009.
29.
go back to reference Feldt L, Woodruff D, Salih F. Statistical inference for coefficient alpha. Appl Psychol Meas. 1987;11(1):93–103.CrossRef Feldt L, Woodruff D, Salih F. Statistical inference for coefficient alpha. Appl Psychol Meas. 1987;11(1):93–103.CrossRef
30.
go back to reference Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26.CrossRefPubMedPubMedCentral Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26.CrossRefPubMedPubMedCentral
31.
go back to reference Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for White and African-American obese women. Int J Obes (Lond). 2006;30(1):147–55.CrossRef Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for White and African-American obese women. Int J Obes (Lond). 2006;30(1):147–55.CrossRef
32.
go back to reference Ferrante JM, Ohman-Strickland P, Hudson SV, Hahn KA, Scott JG, Crabtree BF. Colorectal cancer screening among obese versus non-obese patients in primary care practices. Cancer Detect Prev. 2006;30(5):459–65.CrossRefPubMedPubMedCentral Ferrante JM, Ohman-Strickland P, Hudson SV, Hahn KA, Scott JG, Crabtree BF. Colorectal cancer screening among obese versus non-obese patients in primary care practices. Cancer Detect Prev. 2006;30(5):459–65.CrossRefPubMedPubMedCentral
33.
go back to reference Ewertz M, Jensen MB, Gunnarsdóttir K, et al. Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol. 2011;29(1):25–31.CrossRefPubMed Ewertz M, Jensen MB, Gunnarsdóttir K, et al. Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol. 2011;29(1):25–31.CrossRefPubMed
34.
go back to reference Griggs JJ, Mangu PB, Temin S, Lyman GH. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. J Oncol Pract. 2012;8(4):e59–61.CrossRefPubMedPubMedCentral Griggs JJ, Mangu PB, Temin S, Lyman GH. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. J Oncol Pract. 2012;8(4):e59–61.CrossRefPubMedPubMedCentral
35.
go back to reference Bischof DA, Kim Y, Dodson R, et al. Open versus minimally invasive resection of gastric GIST: a multi-institutional analysis of short- and long-term outcomes. Ann Surg Oncol. 2014;21(9):2941–8.CrossRefPubMed Bischof DA, Kim Y, Dodson R, et al. Open versus minimally invasive resection of gastric GIST: a multi-institutional analysis of short- and long-term outcomes. Ann Surg Oncol. 2014;21(9):2941–8.CrossRefPubMed
36.
go back to reference Spolverato G, Kim Y, Ejaz A, et al. A multi-institutional analysis of open versus minimally-invasive surgery for gastric adenocarcinoma: results of the US gastric cancer collaborative. J Gastrointest Surg. 2014;18(9):1563–74.CrossRefPubMed Spolverato G, Kim Y, Ejaz A, et al. A multi-institutional analysis of open versus minimally-invasive surgery for gastric adenocarcinoma: results of the US gastric cancer collaborative. J Gastrointest Surg. 2014;18(9):1563–74.CrossRefPubMed
37.
go back to reference Bagante F, Spolverato G, Strasberg SM, et al. Minimally invasive vs. open hepatectomy: a comparative analysis of the national surgical quality improvement program database. J Gastrointest Surg. 2016;20(9):1608–17.CrossRefPubMed Bagante F, Spolverato G, Strasberg SM, et al. Minimally invasive vs. open hepatectomy: a comparative analysis of the national surgical quality improvement program database. J Gastrointest Surg. 2016;20(9):1608–17.CrossRefPubMed
38.
go back to reference Teachman BA, Brownell KD. Implicit anti-fat bias among health professionals: Is anyone immune? Int J Obes Relat Metab Disord. 2001;25(10):1525–31.CrossRefPubMed Teachman BA, Brownell KD. Implicit anti-fat bias among health professionals: Is anyone immune? Int J Obes Relat Metab Disord. 2001;25(10):1525–31.CrossRefPubMed
39.
go back to reference Davis NJ, Shishodia H, Taqui B, Dumfeh C, Wylie-Rosett J. Resident physician attitudes and competence about obesity treatment: need for improved education. Med Educ Online. 2008;13:5.CrossRefPubMedPubMedCentral Davis NJ, Shishodia H, Taqui B, Dumfeh C, Wylie-Rosett J. Resident physician attitudes and competence about obesity treatment: need for improved education. Med Educ Online. 2008;13:5.CrossRefPubMedPubMedCentral
40.
go back to reference Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billington C. Weight bias among health professionals specializing in obesity. Obes Res. 2003;11(9):1033–9.CrossRefPubMed Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billington C. Weight bias among health professionals specializing in obesity. Obes Res. 2003;11(9):1033–9.CrossRefPubMed
41.
go back to reference Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS ONE. 2012;7(11):e48448.CrossRefPubMedPubMedCentral Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS ONE. 2012;7(11):e48448.CrossRefPubMedPubMedCentral
43.
go back to reference Haider AH, Schneider EB, Sriram N, et al. Unconscious race and class bias: its association with decision making by trauma and acute care surgeons. J Trauma Acute Care Surg. 2014;77(3):409–16.CrossRefPubMed Haider AH, Schneider EB, Sriram N, et al. Unconscious race and class bias: its association with decision making by trauma and acute care surgeons. J Trauma Acute Care Surg. 2014;77(3):409–16.CrossRefPubMed
44.
go back to reference Sabin J, Nosek BA, Greenwald A, Rivara FP. Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender. J Health Care Poor Underserved. 2009;20(3):896–913.CrossRefPubMedPubMedCentral Sabin J, Nosek BA, Greenwald A, Rivara FP. Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender. J Health Care Poor Underserved. 2009;20(3):896–913.CrossRefPubMedPubMedCentral
Metadata
Title
Practices and Perceptions Among Surgical Oncologists in the Perioperative Care of Obese Cancer Patients
Authors
Tasha M. Hughes, MD, MPH
Elizabeth N. Palmer, PhD
Quinn Capers, MD
Sherif Abdel-Misih, MD
Alan Harzmann, MD
Eliza Beal, MD
Ingrid Woelfel, MD
Sabrena Noria, MD, PhD
Doreen Agnese, MD
Mary Dillhoff, MD
Valerie Grignol, MD
J. Harrison Howard, MD
Lawrence A. Shirley, MD
Alicia Terando, MD
Carl Schmidt, MD
Jordan Cloyd, MD
Timothy Pawlik, MD, MPH, PhD
Publication date
01-09-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 9/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6564-9

Other articles of this Issue 9/2018

Annals of Surgical Oncology 9/2018 Go to the issue