Research shows a strong relationship between obesity and endometrial cancer in women, with 70 percent of survivors classified as obese. This population group is shown to have an increased risk of mortality and a lower quality of life. In fact, five years after diagnosis, these women are more likely to die of cardiovascular disease, of which obesity is a risk factor, than of cancer recurrence.
Katie Brow, a fourth-year student at the Virginia Tech Carilion School of Medicine (VTCSOM), has conducted research to identify the barriers to delivering a successful lifestyle modification program for overweight survivors of endometrial cancer.
Brow is one of nine students to receive a Letter of Distinction for her research, and she will provide an oral presentation at VTCSOM’s annual Medical Student Research Symposium, which will be held from noon-5 p.m. March 24. Her mentors were Shannon Armbruster, assistant professor and obstetrics and gynecology physician at Carilion Clinic, and Samantha Harden, associate professor at Virginia Tech and VTCSOM obstetrics and gynecology and family and community medicine affiliate.
Brow, who earned a Master of Public Health before medical school, said one of her main professional goals is to find ways to incorporate her passion for public health into medical practice.
“I’ve always been interested in how to close the gap between research and its actual impact on the community, what is known as implementation science,” Brow said. “I’ve also had an interest in women’s health, so being able to merge these two interests was a match made in heaven.”
Endometrial cancer occurs when malignant cells form in the lining of the uterus. The most common risk factors for the disease are obesity and diabetes.
“This is why I’m really interested in a health promotion program — because these risk factors are modifiable. Since there are no support groups for endometrial cancer survivors in this region, my overarching research goal was to determine how we could create a successful program involving survivors from the ground up,” Brow said.
In order to really understand the target population, Brow used both quantitative and qualitative analysis. She started with a survey sent to 335 eligible survivors who were treated at Carilion Clinic asking questions about demographics, quality of life, physical activity, and their knowledge about endometrial cancer and obesity.
“From the 70 survey respondents, we learned there was a pretty significant relationship between a person’s body mass index and the confidence they reported for being able to participate in physical activity,” Brow said. “Also, fewer than 20 percent of the respondents were able to identify the American Cancer Society guidelines for endometrial cancer.”
Brow followed up with a virtual focus group for survey respondents who indicated an interest. Using a technique called brainwriting pre-mortem, focus group participants were asked to silently share written ideas about why a weight-loss program would fail.
“This approach allows us to identify barriers before it dies — hence its namesake. Katie was dedicated to contacting these participants, creating clarity on the process, and following up to ensure we could gather as much data as possible to ensure that the program was developed for endometrial cancer survivors, by endometrial cancer survivors” Harden said.
Qualitative data from the focus group was analyzed using the RE-AIM Framework, which helps guide the planning and evaluation of programs according to five key dimensions: reach, effectiveness, adoption, implementation, and maintenance.
“We wanted to really understand why prior efforts were unsuccessful for them,” Brow said. “Participants wanted a program that focused less on weight loss and more on healthy lifestyles. They wanted program facilitators to have strong knowledge about endometrial cancer and an understanding of how difficult it is to adopt long-term, sustainable lifestyle changes.”
One of the barriers identified from the focus group analysis was not a lot of interest in weight-loss programs because many of the women had not been successful in these types of interventions. Other barriers were transportation issues, cost, and safety of a group activity during the height of the COVID-19 pandemic.
“What was most exciting to the participants was having a community to talk with other survivors. By far the biggest thing that we saw was enthusiasm for a program geared just for endometrial cancer survivors,” Brow said.
That’s where another VTCSOM student has taken a role in the project. Brandon Ganjineh, a third-year student, helped adapt an existing healthy lifestyle intervention, FitEx, to meet the needs of endometrial cancer survivors.
“It’s really nice to bring Brandon in,” Brow said. “I wanted to be part of something that was sustainable, and I believe I’ve achieved that.”
A pilot feasibility study with six endometrial cancer survivors proved to be successful.
“It was incredible to see how many people’s habits could be changed in that short time span,” Ganjineh said. “An upcoming trial will include more participants. Seeing them excited about being active with their friends and families is the best part of the work that we do.”
Brow has presented her project at two national conferences and is working on a manuscript for publication. She offers high praise for her two mentors.
“I’ve been very fortunate to have learned from both of them,” she said. “They encouraged me to pursue my interests and have really challenged me to be a better researcher.”
Brow and other members of the Class of 2023 will be VTCSOM’s 10th graduating class when commencement exercises are held May 6.
