Updated: Oct 26, 2022
Dr. Shannon Armbruster presented to our CPF teachers in training on October 22, 2022. She is an gynecologic oncologist in Roanoke, VA and is affiliated with Virginia Tech Carilion School of Medicine. She received her medical degree from University of Toledo College of Medicine and fellowship at MD Anderson Cancer Center. She specializes in gynecologic cancer and is experienced in survivorship research and behavioral interventions.
Read about some of her research here:
Obese, rural endometrial cancer survivors’ health behaviors and lifestyle intervention preferences: What’s COVID got to do with it?
Shannon D. Armbruster1, Katie Brow2, Tonja Locklear3, Brandon Ganjineh2, and Samantha M. Harden4
Virginia Tech Carilion School of Medicine: The Division of Gynecologic Oncology, Roanoke VA1, Virginia Tech School of Medicine, Roanoke VA 2, Carilion Clinic: Health Analytics Research Team, Roanoke, VA 3, Virginia Tech: The Department of Human Nutrition, Foods, and Exercise, Blacksburg, VA4
Objectives: To determine (1) if health disparities experienced by rural, obese endometrial cancer survivors (ECS) were exacerbated by the COVID-19 pandemic and (2) preferred components and delivery methods for behavioral interventions.
Methods: A cross-sectional survey was distributed to obese, early-stage ECS to ascertain demographic information, physical activity (PA level), self-efficacy, lifestyle intervention preferences, as well as the impact of COVID-19 on PA, diet, and mental health. Responses were compared between obese (BMI= 30-39.9 kg/m2) and morbidly obese (BMI= 40+ kg/m2) survivors as well as those who did or did not meet national PA recommendations.
Results: Seventy of 335 (20.9%) eligible survivors completed surveys. The median age was 63 years (IQR= 14 years). Survivors were 37 months from diagnosis (IQR=37 months). Median BMI was 39.2 kg/m2 (IQR= 8.4 kg/m2).
Overall, only one-quarter of ECS were fairly or fully confident in their ability to undertake moderate PA. More morbidly obese survivors reported low self-efficacy in performing moderate PA, than obese survivors (90% versus 65%; p= 0.02). Pre-COVID-19, 66% of survivors (n=47) were not meeting PA guidelines and were more likely to be morbidly obese than obese, but the difference was not significant (78% versus 58%; p=0.08). Post-COVID-19, 83% of survivors (n=58) were not meeting PA guidelines, with no difference between BMI groups (82% versus 84%; p>0.05). After COVID-19, 54% (n=38) of survivors reported a decrease in PA, 32% (n=23) made poorer nutritional choices, and 47% (n=33) reported worsening mental health. Post-COVID-19, there was no difference in the nutrition or mental health changes seen between survivors who were meeting PA guidelines and those who were not (p>0.05).
Regarding lifestyle interventions, survivors preferred information delivered electronically [online (56%) or via email (41%)] versus in person (30%) or via text (21%). Preferences for PA included exercising at home (46%) or online with a coach (33%) versus with a group fitness class (18%) or at the gym (17%). Combining a health promotion with exercise was appealing to the majority of participants (37%), while others were not interested (27%) or unsure (31%). Responses were similar between patients meeting and not meeting PA recommendations (p>0.05). The most preferred lifestyle intervention components included: tracking progress (56%), health recipes (56%), one-on-one counseling (46%), tips for cheap and healthy eating (41%), exercising alone (41%), and online sessions (39%).
Conclusions: As a result of COVID-19, rural, obese ECS experienced a decrease in PA, worse nutritional decision-making, and poorer mental health. Preferred components of lifestyle interventions in this patient population were identified and can be used to develop future, evidence-based behavioral interventions. These interventions may be scalable in rural communities with limited access during the COVID-19 pandemic and beyond.