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  • Review Article
  • Published:

Clinical management of obese patients with cancer

Nature Reviews Clinical Oncology volume 10, pages 519–533 (2013)Cite this article

Subjects

Key Points

  • Obesity might affect the timing and accuracy of cancer diagnostics, owing to technical difficulties in medical imaging, haemodilution of tumour biomarkers and lower screening rates for some cancer types

  • Poorer treatment outcomes result from differences in physiology and pharmacokinetics in obese patients, complicating dosing of anticancer drugs, and increased organ motion and skin motility causing set-up errors in radiotherapy

  • Obesity does not seem to influence mortality after cancer surgery and the increased risk of some surgical complications can be decreased with minimally invasive surgery

  • Care of obese patients with cancer might be complicated by comorbidities, polypharmacy and sarcopenia; early diagnosis and treatment of sarcopenia is important for prognosis

  • Weight loss in obese patients with cancer might be beneficial for survival, but loss of skeletal muscle mass should be avoided through physical exercise and a high-protein diet

  • Lifestyle interventions and new pharmacological treatments might improve quality of life and prognosis for obese patients with cancer in the future, but further studies are required to confirm this hypothesis

Abstract

A large body of epidemiological evidence links obesity to increased cancer incidence, with some studies also indicating poorer survival in obese patients with cancer. Obese patients face several specific challenges related to diagnosis and treatment of cancer. Reduced participation in cancer screening programmes, lower tumour-marker expression and issues with medical imaging among obese individuals complicate cancer diagnosis. Chemotherapy and hormonal therapy in obese patients with cancer is affected by altered pharmacokinetics and hormone levels. In addition, the precision of radiotherapy might be adversely affected in this population by greater skin motility and increased motion of internal organs. Obese patients also face higher risk of minor complications after surgery. There is a need for additional research addressing issues specifically associated with the clinical management of obese patients with cancer, including comorbidity, polypharmacy, and problems related to sarcopenia and health-related quality of life. This Review summarizes the available literature addressing the clinical management of obese patients with cancer and discusses opportunities to improve the cancer care of these patients.

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Figure 1: Possible mechanisms linking obesity to cancer, including the influence of sex hormones, inflammation, cytokines, acute-phase reactants and stress.

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  1. Department of Molecular Medicine and Surgery, Unit of Upper Gastrointestinal Research, Norra Stationsgatan 67, Level 2, Karolinska Institutet, Stockholm, 171 76, Sweden

    Wenjing Tao & Jesper Lagergren

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J. Lagergren made a substantial contribution to discussion of content, and reviewed and edited the manuscript before submission. W. Tao researched the data for the article, made a substantial contribution to discussion of content, wrote and reviewed and edited the manuscript before submission.

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Tao, W., Lagergren, J. Clinical management of obese patients with cancer. Nat Rev Clin Oncol 10, 519–533 (2013). https://doi.org/10.1038/nrclinonc.2013.120

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