Association of Protein Intake with Recurrence and Survival Following Primary Treatment of Ovarian Cancer

Elizabeth A Johnston; Torukiri I Ibiebele; Michael L Friedlander; Peter T Grant; Jolieke C van der Pols; Penelope M Webb; Ovarian cancer Prognosis And Lifestyle (OPAL) Study Group

doi:10.1016/j.ajcnut.2023.05.002

Association of Protein Intake with Recurrence and Survival Following Primary Treatment of Ovarian Cancer

Am J Clin Nutr. 2023 Jul;118(1):50-58. doi: 10.1016/j.ajcnut.2023.05.002. Epub 2023 May 3.

Authors

Elizabeth A Johnston¹, Torukiri I Ibiebele², Michael L Friedlander³, Peter T Grant⁴, Jolieke C van der Pols⁵, Penelope M Webb²; Ovarian cancer Prognosis And Lifestyle (OPAL) Study Group

Affiliations

¹ QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia; Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia; Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia. Electronic address: elizabethjohnston@cancerqld.org.au.
² QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia.
³ University of New South Wales Clinical School, Prince of Wales Hospital, Randwick, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia.
⁴ Department of Gynaecological Oncology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
⁵ QIMR Berghofer Medical Research Institute, Population Health Program, Herston, Queensland, Australia; Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.

PMID: 37146759
DOI: 10.1016/j.ajcnut.2023.05.002

Abstract

Background: Malnutrition is common during treatment of ovarian cancer, and 1 in 3 patients report multiple symptoms affecting food intake after primary treatment. Little is known about diet posttreatment in relation to ovarian cancer survival; however, general recommendations for cancer survivors are to maintain a higher level of protein intake to support recovery and minimize nutritional deficits.

Objectives: To investigate whether intake of protein and protein food sources following primary treatment of ovarian cancer is associated with recurrence and survival.

Methods: Intake levels of protein and protein food groups were calculated from dietary data collected ∼12 mo postdiagnosis using a validated FFQ in an Australian cohort of women with invasive epithelial ovarian cancer. Disease recurrence and survival status were abstracted from medical records (median 4.9 y follow-up). Cox proportional hazards regression was used to calculate adjusted HRs and 95% CIs for protein intake and progression-free and overall survival.

Results: Among 591 women who were progression-free at 12 mo follow-up, 329 (56%) subsequently experienced cancer recurrence and 231 (39%) died. A higher level of protein intake was associated with better progression-free survival (>1-1.5 compared with ≤1 g/kg body weight, HR_adjusted: 0.69, 95% CI: 0.48, 1.00; >1.5 compared with ≤1 g/kg, HR_adjusted: 0.61, 95% CI: 0.41, 0.90; >20% compared with ≤20% total EI from protein, HR_adjusted: 0.77, 95% CI: 0.61, 0.96). There was no evidence for better progression-free survival with any particular protein food sources. There was a suggestion of better overall survival among those with higher total intakes of animal-based protein foods, particularly dairy products (HR: 0.71; 95% CI: 0.51, 0.99 for highest compared with lowest tertiles of total dairy intake).

Conclusions: After primary treatment of ovarian cancer, a higher level of protein intake may benefit progression-free survival. Ovarian cancer survivors should avoid dietary practices that limit intake of protein-rich foods.

Keywords: cancer survivors; cohort studies; diet; malnutrition; nutrition; ovarian cancer; protein intake; survival analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Dairy Products
Diet
Female
Humans
Neoplasm Recurrence, Local*
Ovarian Neoplasms* / diagnosis
Surveys and Questionnaires