Risk factors for obesity in adult survivors of childhood cancer: A report from the childhood cancer survivor study Journal Article


Authors: Green, D. M.; Cox, C. L.; Zhu, L.; Krull, K. R.; Srivastava, D. K.; Stovall, M.; Nolan, V. G.; Ness, K. K.; Donaldson, S. S.; Oeffinger, K. C.; Meacham, L. R.; Sklar, C. A.; Armstrong, G. T.; Robison, L. L.
Article Title: Risk factors for obesity in adult survivors of childhood cancer: A report from the childhood cancer survivor study
Abstract: 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/m 2) 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. © 2011 by American Society of Clinical Oncology.
Keywords: adult; major clinical study; radiation dose; outcome assessment; cancer diagnosis; risperidone; obesity; cancer pain; risk factor; childhood cancer; cancer survivor; self report; questionnaire; body mass; public health service; anxiety disorder; physical activity; short form 36; educational status; venlafaxine; citalopram; escitalopram; fluoxetine; paroxetine; sertraline; valproic acid; lifestyle; amfebutamone; structural equation modeling; amitriptyline
Journal Title: Journal of Clinical Oncology
Volume: 30
Issue: 3
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2012-01-20
Start Page: 246
End Page: 255
Language: English
DOI: 10.1200/jco.2010.34.4267
PROVIDER: scopus
PMCID: PMC3269951
PUBMED: 22184380
DOI/URL:
Notes: --- - "Export Date: 1 March 2012" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Charles A Sklar
    279 Sklar
  2. Kevin Oeffinger
    255 Oeffinger