GUEST EDITOR
Jennifer A. Ligibel, MD
Prevention in Oncology is guest edited by Jennifer A. Ligibel, MD, Chair of ASCO’s Energy Balance Working Group and a member of ASCO’s Cancer Survivorship and Cancer Prevention Committees. Dr. Ligibel is Director of the Leonard P. Zakim Center for Integrative Therapies at Dana-Farber Cancer Institute.
Each Prevention in Oncology column will address one of five areas in cancer prevention—alcohol use, obesity, tobacco use, vaccines to prevent cancer-causing infections, and germline genetics—with the goal of providing strategies to reduce the risk of cancer, as well as preventing cancer recurrence and second malignancy during cancer survivorship.
In 2013, ASCO launched an Obesity Initiative that was designed to increase awareness among oncologists and the general public about the relationship between obesity and the risk for cancer and to promote research in this area. A review of more than 1,000 epidemiologic studies by the International Agency for Research on Cancer showed how strong the link is between obesity and cancer. According to the review, being overweight or obese increases the risk of developing at least 13 types of cancer, including colorectal, pancreatic, ovarian, and postmenopausal breast cancers.1
Recognizing that combating the obesity epidemic in the United States—more than two-thirds of adults2 and nearly one-third of children in the United States are overweight or obese3—requires a broad-based effort, in 2016 ASCO hosted the Summit on Addressing Obesity Through Multidisciplinary Collaboration.
The Summit brought together 18 organizations across a wide spectrum of medical specialties, including the American Academy of Family Physicians, the Academy of Nutrition and Dietetics, and the American Academy of Pediatrics, to discuss the current challenges in addressing obesity within the various health-care provider communities and identify priorities that would most benefit from a collective and cross-disciplinary approach.
The group’s efforts led to the development of a blueprint for multidisciplinary provider collaboration focused on obesity prevention and treatment in the following four main areas4:
- Provider education and training: Recommendations include establishing a core set of competencies for all health-care providers related to obesity; increasing obesity education and training for health-care providers-in-training; ensuring guidelines are consistent and translatable to patient care across the medical spectrum; and extending educational offerings to the entire care team.
- Public education and activation: Recommendations include increasing the understanding of optimal messaging to targeted populations; engaging in joint messaging to the public; and developing better methods of connecting patients to available resources.
- Research: Recommendations include evaluating existing studies and data resources across organizations for the potential to answer additional research questions; capitalizing on current funding opportunities by promoting the development of ancillary subsidies by multidisciplinary research teams; identifying and promoting alternative funding structures to help assist with secondary research; and encouraging junior-level investigators to work in this field through the creation of Requests for Applications for early-career investigators and through funding for post- and predoctoral studies as a part of large obesity prevention and treatment studies.
- Policy and advocacy. Recommendations include supporting increased funding for obesity research at the national level; advocating for adequate coverage and reimbursement for nutrition and physical activity services and access to physical activity support services; establishing “centers of excellence” accreditation for centers that have the skills and personnel necessary to deliver optimal obesity care and could serve as a resource to smaller community-based practices; supporting the efforts of existing obesity coalitions; and leveraging the collective voices of professional organizations to advocate for large systemic changes to the known environmental contributors to obesity.
“ASCO realized there were many different organizations coming together to think about how to tackle specific issues around obesity, and we wanted to see how we could contribute to this broader effort,” said Jennifer A. Ligibel, MD, Associate Professor of Medicine at Harvard Medical School and Senior Physician at Dana-Farber Cancer Institute; Chair of the ASCO Obesity and Energy Balance Subcommittee; and lead author of the Summit on Addressing Obesity Through Multidisciplinary Collaboration report.4 “We are hoping this Summit will lead to collaboration among groups focused on obesity treatment and prevention, leading over time to coordinated efforts to educate providers, activate the lay public, and influence public policy.”
The ASCO Post talked with Dr. Ligibel about the challenges of addressing the obesity epidemic within the health-care system; how these challenges impact care for patients with cancer; and ASCO’s next steps for developing multidisciplinary collaborations to advance obesity prevention and treatment efforts.
Addressing the Obesity Challenges
What are some of the challenges in addressing obesity within the health-care system?
The factors that lead to obesity in our society are complex and pervasive. Obesity has a small genetic component, but the factors that most influence obesity are lifestyle factors, such as diet and exercise. There is a strong relationship between obesity and socioeconomic status. Healthy foods are more expensive, and parts of the country are food deserts, where access to fresh vegetables and fruit is limited. It is also often more difficult for people with limited financial resources to achieve regular exercise.
There is a strong relationship between obesity and socioeconomic status. Healthy foods are more expensive, and parts of the country are food deserts, where access to fresh vegetables and fruit is limited.— Jennifer A. Ligibel, MD
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The messaging to prevent obesity is also complicated and often political. Unlike antismoking campaigns, which urge people not to smoke, you can’t tell people “don’t eat.” Thus, the factors that contribute to obesity are very complex and affect many dimensions of our society. Clearly, just being aware of the problem isn’t going to fix it.
Having a unified message from multiple physician organizations regarding the health risks of obesity, including the cancer risk, will help raise awareness of these connections and allow us to find achievable solutions. There is a lot of work to be done, and the scope of the problem is so large it can be difficult to feel there is anything meaningful an individual organization can do. We hope that efforts like the ASCO Summit will be helpful in fostering collaboration among organizations to effect meaningful change.
Raising Awareness About the Obesity-Cancer Link
What are ASCO’s plans to help raise awareness of the impact of obesity on cancer risk?
ASCO’s main focus is to represent oncologists and to provide high-quality resources in medical education; advocate for policies that support the health of our patients; support clinical research; and, most important, advance clinical care for patients with cancer. Through our members, ASCO is in a unique position to help educate cancer survivors about the importance of maintaining a healthy weight and engaging in regular exercise activity after a cancer diagnosis to improve outcomes and to avoid other health problems, such as heart disease and diabetes.
We are currently working on the development of a survey of ASCO members to learn about their awareness level of the obesity/cancer connection and whether they introduce these topics with their patients.— Jennifer A. Ligibel, MD
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One of the outcomes of ASCO’s Obesity Initiative was the development of the Obesity and Cancer Toolkit (www.asco.org/practice-guidelines/cancer-care-initiatives/prevention-survivorship/obesity-cancer), which is meant to help providers initiate conversations with their patients about weight management and assist patients in making healthy lifestyle changes after their cancer diagnosis.
We are currently working on the development of a survey of ASCO members to learn about their awareness level of the obesity/cancer connection and whether they introduce these topics with their patients. We hope to use this information to identify gaps in knowledge and practice that can be addressed in future efforts.
Next Steps
What are the next steps for ASCO and the other organizations involved in the Summit?
We are currently working to develop a roadmap for the ASCO Obesity and Energy Balance Subcommittee’s work over the next 2 to 5 years, including best ways to partner with other organizations to address unmet needs in obesity prevention and treatment, as they relate to patients with cancer. One outcome of the Summit is that ASCO is increasingly being recognized as having an active interest in this area, which is leading to inclusion in efforts from other organizations, such as the American College of Sports Medicine and the American Society for Metabolic and Bariatric Surgery. We hope these collaborations will lead to more joint initiatives in the future.
Determining Success
How will you measure success?
That is always a very difficult question to answer, and it’s one of the reasons we are interested in conducting a member survey to provide a benchmark for quantifying success over time. I think success for us would be an increased awareness on the part of health-care providers and the lay population regarding the connection between obesity and cancer, as well as an increased focus on these topics on the part of oncology providers during visits with their patients.
Hopefully, our work will contribute to broader efforts to make healthy lifestyle changes more achievable for patients with cancer and the general population over the years to come. ■
DISCLOSURE: Dr. Ligibel reported no conflicts of interest.
REFERENCES
1. Lauby-Secretan B, Scoccianti C, Loomis D, et al: Body fatness and cancer: Viewpoint of the IARC Working Group. N Engl J Med 375:794-798, 2016.
2. National Institute of Diabetes and Digestive and Kidney Diseases: Overweight & obesity statistics. Available at www.niddk.nih.gov/health-information/health-statistics/overweight-obesity. Updated August 2017. Accessed May 7, 2018.
3. The State of Obesity: The state of childhood obesity. Available at https://stateofobesity.org/childhood-obesity-trends. Accessed May 7, 2018.
4. Ligibel JA, Alfano CM, Hershman DL, et al: American Society of Clinical Oncology Summit on Addressing Obesity Through Multidisciplinary Provider Collaboration: Key Findings and Recommendations for Action. Obesity (Silver Spring) 25(suppl 2):S34-S39, 2017.
