Exploring the potential health benefits of implementing an exercise health promotion strategy for women with type one endometrial cancer: A narrative systematic review
Supervisor: Kate White
Endometrial cancer is the most common gynaecological cancer in developing countries. Type one is the most common and accounts for 80 percent of cases. Risk factors for the disease include diabetes, hypertension and obesity, all of which are also common co-morbidities strongly associated with the disease(1).
Obesity is an important risk factor due to the conversion of androgen to oestrogen in fat cells and the subsequent slow release of oestrogen onto the lining of the endometrium. The increasing incidence of endometrial cancer in developing countries is largely attributed to the increase in obesity in these countries. Although the incidence of endometrial cancer is relatively high (15.4 per 100,000 in 2005), the mortality rate is low (2.6 per 100,000 in 2005) indicating that a majority of women diagnosed with endometrial cancer will become cancer survivors(2).
The aim of this phase of the research was to undertake a descriptive systematic review of the role of exercise and lifestyle interventions post cancer diagnosis. Outcomes reviewed included physical activity, body weight and composition, cardiopulmonary outcomes, fasting insulin, glucose, insulin resistance and quality of life.
Results from the review highlighted that limited research has been conducted in endometrial cancer survivors. Therefore, literature on breast cancer survivors was included in the review. The majority of research on exercise interventions in cancer patients has been conducted in breast cancer patients and there are similarities between the two cancers, including risk factors and hormonal influences which may allow extrapolation of data and the application to endometrial cancer survivors.
Currently the evidence to support exercise as a management strategy within the cancer population is limited with many of the studies conducted having small sample sizes and using a wide range of interventions. Despite this, the review found that there may be potential benefits for both exercise and lifestyle interventions for endometrial cancer patients including improvements in body composition, cardiopulmonary fitness, overall quality of life and physical functioning. Although the review indicates that currently the majority of endometrial cancer patients are not meeting public health guidelines for exercise and body weight and are unlikely to change their behaviour post diagnosis, it also indicated that they can change their behaviour post lifestyle intervention.
As a result of their cancer experience endometrial cancer patients may be motivated to change their health behaviours and be more willing to participate in nurse initiated health promotion programs. Nurses are in a position to be able to promote and encourage this change in health behaviour through the utilisation of the “teachable moment”. Benefits from this may include a positive impact on other health states such as diabetes, hypertension and obesity. A nurse–led lifestyle intervention utilising the nurse-patient relationship may have the potential to assist these women to change their lifestyle behaviour.