October 6, 2023

Helping endometrial cancer survivors stay healthy after treatment

U of A researchers are testing a digital health program designed to reduce the risk of heart problems

Sophia Pin, Carla Prado, Christa Aubrey (photos: supplied)

When Sandy Morton was diagnosed with endometrial cancer, she considered herself lucky. 

“My family doctor had been very vigilant about screening me for it every year,” says Morton, who had been experiencing period-like bleeding despite reaching menopause and being in her early 60s. Vaginal bleeding is a hallmark symptom of endometrial cancer, which affects the cells lining the uterus and is the fourth most common cancer in Canadian women.

After four years of negative results, Morton received an early diagnosis and successful treatment — laparoscopic surgery — in late 2019. “The day after my surgery, I went to a Christmas party without any painkillers at all,” says Morton, a retired school teacher.

Although Morton’s cancer prognosis is good, survivors of endometrial cancer live with a higher-than-average risk of dying from heart problems. One important reason for this is likely body composition, says Carla Prado, a professor in the Department of Agriculture, Nutrition and Food Sciences and member of the Women and Children’s Health Research Institute (WCHRI). She explains that survivors of endometrial cancer often have obesity — which is linked to a number of health issues, including hypertension and heart disease — as well as low muscle mass. Having cancer and receiving treatment for it can lead to further muscle loss.

“We look at low muscle mass as a hidden condition,” says Prado, whose groundbreaking research as a graduate student showed that patients with cancer could have excess fat and low muscle mass simultaneously. Although muscle is associated with body movement, it also plays important roles in metabolism and immunity.

Fortunately, research suggests that healthy behaviours like physical activity, balanced nutrition and stress management can change a person’s body composition and reduce the risk of cardiovascular problems and premature death. But making changes is easier said than done, notes Prado: “Everyone knows that nutrition and exercise can help build muscles and reduce fat, but that isn’t enough to change behaviour.”

Endometrial cancer survivors, in particular, have been underrepresented in research on nutrition and physical activity. Prado, who directs the Human Nutrition Unit and holds a Campus Alberta Innovation Program Chair in Nutrition, Food and Health, is leading a multi-site research project called RESILIENCE to evaluate an online intervention designed to help endometrial cancer survivors make healthy lifestyle and behaviour changes. Using a digital health program called My Viva Plan, the intervention will focus on nutrition, physical activity and mindfulness. “The program makes you stop and think about your health and goals,” she says. “It empowers survivors to take control of their health.”

Prado’s study will include about 150 survivors of early-stage, low-grade endometrial cancer in both Edmonton and Toronto. Over the course of 24 weeks, one group of participants will receive access to the digital health program, plus support from a multidisciplinary care team for the first 16 weeks, while the control group receives a handout on healthy behaviours (the usual care offered).

PhD student and research coordinator Camila Orsso explains that during the study, participants will be assessed for waist circumference, the study’s primary outcome measurement. “Waist circumference is a surrogate measure for abdominal obesity, which is one of the risk factors for developing cardiovascular disease,” she says, noting that data will also be collected on secondary outcomes like body composition (including muscle mass), body weight and other measures that can also depict heart health.

Researchers Sophia Pin and Christa Aubrey are co-invesigators for RESILIENCE and WCHRI membership brought them together. Prado connected with Pin after spotting an article about her study on weight loss and surgical outcomes in endometrial cancer surgery. This study involved local endometrial cancer survivors like Morton and showed that losing weight before surgery decreased surgical complications and improved outcomes. The RESILIENCE researchers will recruit from the same population of survivors, as well as through other channels.

To fund RESILIENCE, Prado leveraged Pin’s Clinical/Community Research Integration Support Program project to receive larger grants for a total of nearly $2M to help advance research on women’s health and cancer survivorship.

Pin says WCHRI is instrumental in helping women’s health researchers connect across disciplines and physical locations.

“WCHRI is a great way to collaborate and find individuals with similar interests with whom you can pursue further studies,” she says. “There are many studies happening within Alberta that people aren’t always aware of.”

Sophia Pin’s Clinical/Community Research Integration Support Program project was supported by the Alberta Women’s Health Foundation through WCHRI.