Is Obesity in Children With Cancer Tied to Worse Survival?

TOPLINE:

Overall, obesity at the time of cancer diagnosis is independently associated with worse survival outcomes in pediatric patients. The association, however, varied by cancer type with the strongest link in those with acute lymphoblastic leukemia and central nervous system (CNS) tumors but with no significant associations found in those with lymphomas or non-CNS solid tumors.

METHODOLOGY:

• Research suggested that obesity at the time of a cancer diagnosis adversely affects outcomes in children, but findings across studies have been inconsistent. The impact of obesity on outcomes of patients with pediatric cancers, other than acute lymphoblastic leukemia, remains unclear.
• Researchers analyzed data from 11,291 pediatric patients with cancer (median age at cancer diagnosis, 7.6 years) using the Cancer in Young People in Canada database.
• The primary outcomes were 5-year event-free survival (EFS) and overall survival. Outcomes were compared between patients with and without obesity at diagnosis.
• The median follow‐up duration for EFS was 4.5 years and for overall survival was 4.7 years.
• Overall, 37.1% patients had leukemias (82.5% of which were acute lymphoblastic leukemia), 14.5% had lymphomas, 21.8% had CNS tumors, and 26.6% had non-CNS solid tumors; 10.5% (n = 1181) patients had obesity at diagnosis.

TAKEAWAY:

• Overall, in the study cohort, obesity was independently associated with inferior 5-year EFS (adjusted hazard ratio [aHR], 1.16; P = .02) and overall survival (aHR, 1.29; P = .001).
• Among children with acute lymphoblastic leukemia, those with obesity had significantly lower 5-year EFS rates (84.5% vs 89.8%; P P
• Similarly, in children with CNS tumors, obesity was associated with inferior 5-year EFS (68.1% vs 74.2% in those without obesity; P = .02) and overall survival (73.1% vs 79.3% in those without obesity; P = .01), which was further confirmed on multivariable analysis (aHR, 1.38 for EFS; aHR, 1.47 for overall survival).
• Researchers, however, found no significant associations between obesity and 5-year survival outcomes in patients with lymphomas or non-CNS solid tumors. For instance, for those with lymphomas, the 5‐year EFS rate was similar for patients with obesity and those without (87.1% vs 87.3%; P = .93) as was 5-year overall survival rate (95.2% vs 94.4%; P = .67).

IN PRACTICE:

“Although obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, this finding was likely driven by the trends detected in children with ALL [acute lymphoblastic leukemia] and CNS tumors,” the authors wrote.

SOURCE:

This study, led by Samuel Sassine, MD, MSc, Division of Pediatric Hematology-Oncology, Department of Pediatrics, Charles-Bruneau Cancer Center, Centre Hospitalier Universitaire de Sainte-Justine, Montreal, Quebec, Canada, was published online in Cancer.

LIMITATIONS:

Body mass index, which does not accurately represent body composition or nutritional status, was used as the primary measure of obesity. The exclusion of 1782 patients (13.6% of the cohort) due to missing weight and height measurements within 30 days of diagnosis could have introduced selection bias. The absence of established guidelines for chemotherapy dose adjustment in children with obesity made it impossible to determine whether patients received treatment based on actual or ideal weight due to unavailability of data in the database.

DISCLOSURES:

Two authors received funding from Fonds de Recherche du Québec-Santé. One author disclosed receiving personal fees from Jazz Pharmaceuticals Inc and Servier Pharmaceuticals LLC outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.