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Menopausal hormone therapy and mortality among endometrial cancer patients in the NIH-AARP Diet and Health Study.

ABSTRACT: BACKGROUND:While menopausal hormone therapy (MHT) is an established endometrial cancer risk factor, its relationship with mortality among endometrial cancer patients is understudied. METHODS:Within the NIH-AARP Diet and Health Study, we examined the associations of pre-diagnosis MHT use with 10-year all-cause and endometrial cancer-specific mortality among 890 endometrial cancer patients. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) adjusted for tumor characteristics, treatment, and other risk factors. RESULTS:Endometrial cancer cases were diagnosed a median of 4.6 years (range 0.0-10.1 years) after the second risk factor questionnaire was completed. We identified a total of 241 deaths, of which 104 were due to endometrial cancer. Compared with non-MHT use, pre-diagnosis use of estrogen plus progestin therapy (EPT)-only was associated with lower 10-year all-cause (HR 0.65, 95 % CI 0.43-0.99, based on 29 deaths) and endometrial cancer-specific mortality (HR 0.51, 95 % CI 0.26-0.98, based on 11 deaths). Recency of MHT use, assessed approximately 5 years prior to the endometrial cancer diagnosis, was associated with mortality. Compared with non-MHT users, former ET users had higher all-cause (HR 1.71, 95 % CI 1.02-2.88, based on 18 deaths) and endometrial cancer-specific mortality (HR 2.17, 95 % CI 0.96-4.90, based on 8 deaths), whereas current EPT users had nonsignificant lower risks of death. CONCLUSION:Based on small numbers, we observed that pre-diagnosis use of EPT was related to lower mortality among endometrial cancer patients. Future studies examining the biological mechanisms underlying this association are warranted.

SUBMITTER: Felix AS

PROVIDER: S-EPMC5160007 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Menopausal hormone therapy and mortality among endometrial cancer patients in the NIH-AARP Diet and Health Study.

Felix Ashley S AS Arem Hannah H Trabert Britton B Gierach Gretchen L GL Park Yikyung Y Pfeiffer Ruth M RM Brinton Louise A LA

Cancer causes & control : CCC 20150512 8

<h4>Background</h4>While menopausal hormone therapy (MHT) is an established endometrial cancer risk factor, its relationship with mortality among endometrial cancer patients is understudied.<h4>Methods</h4>Within the NIH-AARP Diet and Health Study, we examined the associations of pre-diagnosis MHT use with 10-year all-cause and endometrial cancer-specific mortality among 890 endometrial cancer patients. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95 % c ...[more]

PMID: 25962764

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Project description:BackgroundThere is limited evidence describing associations between cancer and function in diverse cancer types and its relationship with mortality. We investigated the relationship between cancer and poor ambulatory function and associations between ambulatory function and subsequent mortality.MethodsParticipants included 233,135 adults (n = 30,403 cancer and n = 202,732 cancer free) in the NIH-American Association of Retired Persons Diet and Health Study (1994-1996) who self-reported ambulatory function (e.g., walking pace and mobility disability: being unable to walk or walking at the slowest pace) in 2004-2006. Participants were followed for mortality from the assessment of ambulatory function through 2011. Multinomial logistic regression quantified the association between cancer and ambulatory function. We then explored the independent effects of walking pace and mobility disability in cancer survivors, and the joint effects of both a cancer diagnosis and poor ambulatory function on mortality using Cox proportional hazards models. Models explored type-specific associations across 15 cancer types.ResultsSurvivors had 42% greater odds of walking at the slowest pace [OR, 1.42 (confidence interval (CI), 1.30-1.54)] and 24% greater odds of mobility disability [OR, 1.24 (CI, 1.17-1.31)], compared with cancer-free participants, adjusting for baseline demographics, health indicators, and cancer type. Survivors reporting the slowest pace were at increased hazards than those who walked the fastest: all-cause mortality [HR, 2.22 (CI, 2.06-2.39)] and cancer mortality [HR, 2.12 (CI, 1.83-2.45)]. Similar trends emerged for mobility disability (HRs > 1.64). All-cause mortality associations were significant for more than nine cancer types.ConclusionsA diagnosis of cancer is associated with poorer ambulatory function, which is subsequently associated with increased mortality.ImpactWidespread efforts should target ambulatory function during cancer survivorship for survival benefits.

Dataset Information

Menopausal hormone therapy and mortality among endometrial cancer patients in the NIH-AARP Diet and Health Study.

Publications

Menopausal hormone therapy and mortality among endometrial cancer patients in the NIH-AARP Diet and Health Study.

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