Research in Nursing & Health

Frailty and the Survival of Patients With Endometrial Cancer: A Meta‐Analysis

ABSTRACTThe aim of this study is to investigate the association between frailty and overall survival (OS) and progression‐free survival (PFS) in women with endometrial cancer (EC). Frailty is increasingly recognized as a significant predictor of outcomes in cancer patients, yet its impact on survival among EC patients remains unclear. This study is a systematic review and meta‐analysis. PubMed, Embase, and Web of Science from database inception to September 28, 2024 were searched for cohort studies evaluating frailty in relation to survival in EC patients. Inclusion criteria focused on studies reporting hazard ratios (HRs) for OS or PFS, comparing frail versus nonfrail patients. A random‐effects model was applied. Eight cohort studies involving 486,138 women reported the outcome of OS, and 4 of them involving 378 women also reported the outcome of PFS. Frailty was associated with poor OS (HR: 1.78, 95% confidence interval [CI]: 1.56–2.03, p < 0.001) without significant heterogeneity (I2 = 0%). Sensitivity analyses confirmed the stability of this association. Subgroup analyses according to the mean age of the patients, tools for evaluating frailty, follow‐up duration, and study quality score showed consistent results (p for subgroup difference: 0.35–0.98). Four studies indicated a significant association between frailty and worse PFS (HR: 1.91, 95% CI: 1.24–2.95, p = 0.003), also with no heterogeneity (I2 = 0%). The results of the study conclude that frailty is associated with poor survival in EC. Although these findings should be validated in large prospective cohort studies, this meta‐analysis highlights the possible role of frailty assessment in risk stratification and prognostic prediction of patients with EC. No patient or public contribution.

Obesity and patient‐reported sexual health outcomes in gynecologic cancer survivors: A systematic review

AbstractAs obesity prevalence among gynecologic cancer (GC) survivors is expected to increase, the role of obesity in sexual health needs to be understood. This systematic review examined the impact of obesity on patient‐reported sexual health outcomes (SHOs) in this population. PubMed, Embase, Web of Science, CINAHL, and PsycINFO were searched for original studies published between 2015 and 2020 following the Preferred Reporting Items for Systematic Review and Meta‐Analyses guideline. We performed a narrative synthesis of findings via cancer type, cancer treatment, sexual health measures, and countries. Eleven observational studies were included. Most were conducted in European countries (n = 7), reported on endometrial cancer survivors (n = 7), and defined obesity as body mass index ≥30 kg/m2 (n = 10). Studies about cervical cancer survivors reported negative effects of obesity on sexual activity and body image while studies about endometrial cancer survivors reported positive effects of obesity on vaginal/sexual symptoms. Findings suggested interaction effects of radiotherapy and obesity on SHOs. Sexual functioning measured by the Female Sexual Function Index was less likely to be associated with obesity than other SHOs. A positive effect of obesity on SHOs was only found in studies conducted in European countries. Current evidence on the association between obesity and sexual health in GC survivors lacks in both quantity and quality. To better understand the effect of obesity on SHOs in the population, more studies are needed with critical evaluations of obesity and sexual health measures, careful considerations of cancer type and treatment, and a focus on the cultural context of obesity.