Cautionary Issues

"The increasing prevalence of obesity combined with the higher risk of several cancers among obese individuals highlight the need to optimize clinical management of obese patients with cancers."
Research report excerpt, Karolinska Institute, Stockholm, published in the journal Nature Reviews/Clinical Oncology

"Why all this is important is because a number of studies -- our own, and others -- suggest that if you are under treatment, if you significantly reduce the dose, patients have a higher risk of their cancer returning and a higher cancer mortality rate. Their survival rates are down.
"More recent surveys suggest that probably about a quarter of patients are under-treated. It's not half anymore, so the message has got out there. But it's still a big problem. My bottom line message is that patients should talk to their oncologist if they're starting chemotherapy and ask them what treatment they're going to get, if they're going to get the full treatment or not, and, if not, why not?"
Dr. Gary Lyman, co-chair, American Society of Clinical Oncology expert panel

"Sometimes even making a diagnosis of a cervical cancer, or cancer of the uterus in an obese patient can be technically difficult. Sometimes it's just hard to see those organs in an obese patient"
Dr. Wylam Faught, head, The Ottawa Hospital, cancer program

What Dr. Faught and what the other cancer specialists are saying is that difficulties abound when dealing with morbidly obese patients. Quite apart from the fact that obesity lends itself to the growth of cancers. There's the issue of detection and diagnosis; impeded by the presence of great layers of human fat in distinguishing what's happening with visceral organs. Add to that the difficulty encountered in for example, inserting breathe tubes into patients with fat-thick airways during surgery.

Radiation treatment can become hugely complicated in dealing with obese patients. Internal organs are known to shift or move, and then it becomes increasingly more difficult to accurately target the tumours. Because obese individuals have larger body surfaces, drugs then are distributed to more tissues. Add the differences in individual metabolism, and how swiftly -- or not -- the drugs are eliminated from the body in obese or heavily overweight patients and the complexities multiply.

Some patients are simply too heavy or too wide to be able to fit within CT scanners and MRI machines. Doctors dealing with the obese discover huge difficulties in visualizing and reaching the internal organs during an attempted biopsy. And so, a new review has pointed out just how difficult it is to confront the issues surrounding detection, diagnosis and treatment of cancers in the morbidly obese. It also underlines why obese people become less exposed to cancer screening opportunities.

They are less likely to receive the optimal dose of chemotherapy tailored to take into account their weight distribution and the amount of drugs required based on the type of cancer and its state. The obese are far likelier than normal-weight patients to be burdened post-surgery with complications like wound infections. Studies have determined that up to 40% of obese patients receive incorrect doses of chemotherapy, thus adding to the risk of their cancer returning.

It is estimated that over 200 million men, and almost 300 million women, representing 11 percent of adults twenty years of age and over presented as obese globally, in 2008. A whopping 62% of the adult population in Canada is considered to be overweight or obese. Alarmingly, the heaviest weight groups are growing the fastest. Leading to a situation where the proportion of those falling into the "class II obesity" status has tripled over the past three decades.

In Canada, according to specific studies, obese women are 30% to 40% less likely than their normal weight counterparts to be screened for cervical cancer. Simply put, obese women are twice more likely to cite embarrassment, fear of pain, and sensitivity to impolite criticism regarding their weight, resulting in reasons for them not to seek out regular Pap smears as a proactive measure of health awareness.

Additionally some obese patients suffer from other major health problems like heart disease. And such complexities can serve to make them less able to tolerate large doses of chemotherapy. Still, Dr. Lyman insists no evidence exists that otherwise healthy obese patients who receive full-dose chemotherapy suffer more side effects than their non-overweight peers in similar situations. "The concern that you're going to overdose the heavy patient just by using their actual weight doesn't seem to hold up in practise", he said.

Given all of the above, and for a multitude of other quality of life reasons, it makes huge good sense for health agencies to ramp up their public relations efforts to encourage people not to become overweight, let alone obese, to begin with.