Diet Quality and Survival After Ovarian Cancer: Results From the Women's Health Initiative

• Published in: JNCI : Journal of the National Cancer Institute Vol. 106; no. 11; p. dju314
• Main Authors: THOMSON, Cynthia A, CRANE, Tracy E, WERTHEIM, Betsy C, NEUHOUSER, Marian L, WENJUN LI, SNETSELAAR, Linda G, BASEN-ENGQUIST, Karen M, YANG ZHOU, IRWIN, Melinda L
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 01-11-2014
• Subjects: Adiposity; Aged; Aged, 80 and over; Biological and medical sciences; Body Mass Index; Diabetes Complications - mortality; Feeding Behavior; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Middle Aged; Motor Activity; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; Odds Ratio; Ovarian Neoplasms - mortality; Ovarian Neoplasms - pathology; Predictive Value of Tests; Proportional Hazards Models; Risk Factors; Surveys and Questionnaires; Tumors; United States - epidemiology; Waist Circumference; Women's Health; Human; Nutrition; Health; Ovary cancer; Malignant tumor; Survival; Feeding; Female genital diseases; Ovarian diseases; Cancerology; Diet; Quality; Adult; Female; Woman; Cancer
• ISSN: 0027-8874; 1460-2105; 1460-2105
• DOI: 10.1093/jnci/dju314

Survival after an ovarian cancer diagnosis is poor. Given the high mortality in these patients, efforts to identify modifiable lifestyle behaviors that could influence survival are needed. Earlier evidence suggests a protective role for vegetables, but no prior studies have evaluated overall dietary quality and ovarian cancer survival. The purpose of this analysis was to evaluate the role of prediagnosis diet quality in ovarian cancer survival.
We identified 636 centrally adjudicated cases of ovarian cancer within the Women's Health Initiative Observational Study or Clinical Trials of 161808 postmenopausal women followed from 1995 to 2012. Dietary quality was assessed for the Healthy Eating Index (2005) using a food frequency questionnaire, covariables were obtained from standardized questionnaires, and adiposity was measured by clinic-based measurements of height, weight, and waist circumference. The association between diet quality and mortality was analyzed using Cox proportional hazards regression, adjusted for potential confounders, and stratified by waist circumference, physical activity level, and diabetes status. Tests of statistical significance were two-sided.
Overall, higher diet quality was associated with lower all-cause mortality after ovarian cancer (hazard ratio [HR] for highest vs lowest tertile = 0.73; 95% confidence interval [CI] = 0.55 to 0.97, P(trend) = .03). The effect was strongest among women with waist circumference of 88 cm or less and with no history of diabetes (HR = 0.73, 95% CI = 0.54 to 0.98). Physical activity level did not modify the association between diet quality and survival.
Our results suggest that overall higher prediagnosis diet quality may protect against mortality after ovarian cancer.