Abstract 5940: Impact of obesity on sexual functioning in women with gynecologic cancer pre-and post-radiotherapy
Authors: Lee Haerim , Bruner Deborah W. , Hu Yi-Juan , Bai Jinbing , Eng Tony Y. , Shelton Joseph W. , Patel Pretesh R. , Khanna Namita , Scott Isabelle , Yeager Katherine A. 
Published: June 2022

Abstract
Background: As the prevalence of obesity in women increases in the US, a better understanding of the effect of obesity on women with gynecologic cancer (GynCa) is imperative. However, whether obesity impacts sexual functioning (SF) in GynCa patients has been understudied. Limited studies have used body mass index (BMI) as the only obesity indicator, which may result in a misunderstanding of the effect of obesity on SF in GynCa patients with different body compositions. This study aimed to explore the role of obesity via two different measures in determining SF in GynCa patients pre-and post-radiotherapy (RT).
Methods: In this secondary analysis, obesity was measured pre-RT by both BMI and body fat percentage (BFP). BFP was calculated by using the Clinica Universidad de Navarra-Body Adiposity Estimator. SF, physical and emotional well-being were assessed pre-RT by the Female Sexual Function Index and the Functional Assessment of Cancer Therapy-General. At 6 months post-RT, SF was reassessed. Generalized linear models (GLM) and generalized linear mixed models (GLMM) with a log-link were implemented to identify the effect of obesity (using BMI and BFP) on SF pre-and post-RT. Regression-based mediation analysis was used to identify mediating effects of physical and emotional well-being between obesity and SF.
Results: Among 54 (24 cervical and 30 endometrial) patients, 48% were Black, 52% were married or in a domestic partnership, and 59% were treated with surgery and/or chemotherapy pre-RT (i.e. prior treatment). Less patients were classified as being obese when obesity was measured by BMI (48%) compared to BFP (61%). Patients with endometrial cancer and prior treatment history were more likely to be obese and reported better SF. Unadjusted GLM showed that patients with obesity had better SF than those without obesity pre-RT regardless of obesity measures (BMI p = .018; BFP p = .016). However, we found no association between obesity (both BMI-and BFP-based obesity) and SF pre-RT after adjusting for cancer type and prior treatment history. GLMM showed that BFP-based obesity had a negative effect on the improvement in SF from pre-RT to post-RT (p = .013) after adjusting for cancer type and prior treatment history. Patients without BFP-based obesity showed a significant improvement post-RT (p = .019), but those with obesity (per BFP) showed no changes in SF post-RT (p = .949) compared to pre-RT. BMI-based obesity did not affect the changes in SF post-RT. We found no mediation effects of physical and emotional well-being between obesity and SF.
Conclusions: Obesity may play a negative role in SF improvement in GynCa patients post-RT. More rigorous research and clinical attention to obesity measurement are necessary to determine the association between obesity and SF in GynCa patients and thus lead to the discovery of new interventions for this long-neglected topic of SF in GynCa patients, particularly for those who are obese.
Citation Format: Haerim Lee, Deborah W. Bruner, Yi-Juan Hu, Jinbing Bai, Tony Y. Eng, Joseph W. Shelton, Pretesh R. Patel, Namita Khanna, Isabelle Scott, Katherine A. Yeager. Impact of obesity on sexual functioning in women with gynecologic cancer pre-and post-radiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5940.