(16-11-14) Diet Quality and Survival After Ovarian Cancer: Results Fromthe Women’s Health Initiative

Cynthia A. Thomson, Tracy E. Crane, Betsy C. Wertheim, Marian L. Neuhouser, Wenjun Li, Linda G. Snetselaar,
Karen M. Basen-Engquist, Yang Zhou, Melinda L. Irwin
Manuscript received January 8, 2014; revised May 16, 2014; accepted August 21, 2014.
Correspondence to: Cynthia A. Thomson, PhD, RD, Health Promotion Sciences, Canyon Ranch Center for Prevention and Health Promotion, Mel and Enid
Zuckerman College of Public Health, University of Arizona, 1295 N. Martin St, Tucson, AZ 85721 (e-mail: [email protected]).


Background 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.
Methods We identified 636 centrally adjudicated cases of ovarian cancer within the Women’s Health Initiative Observational
Study or Clinical Trials of 161 808 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.
Results 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, Ptrend = .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.
Conclusion Our results suggest that overall higher prediagnosis diet quality may protect against mortality after ovarian
cancer.

Source: JNCI J Natl Cancer Inst (2014) 106(11): dju314

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