Prediagnosis Diet Improves Survival in Black Women With Deadly Ovarian Cancer

Moderate prediagnosis adherence to dietary guidelines may be associated with improved survival among Black women with high-grade serous ovarian cancer (HGSOC), the most lethal epithelial ovarian cancer (EOC) histotype, according to a study published in JAMA Network Open.¹

Among patients with ovarian cancer, the 5-year relative survival rate is 51% overall and 42% among Black women, which is lower than other racial and ethnic group.² Consequently, it is “imperative,” noted researchers, to identify ways to improve ovarian cancer survival, especially for Black women.¹

Although a healthy dietary pattern is recommended for cancer prevention and survivorship, there is limited research evaluating its role in ovarian cancer survival. The existing evidence has yielded inconsistent findings and primarily analyzed predominately White populations. Therefore, the researchers examined the association of adherence to dietary recommendations with survival among Black women with EOC.

Moderate prediagnosis adherence to dietary guidelines was associated with improved survival rates among Black women with high-grade serous ovarian cancer (HGSOC). | Image Credit: nadianb - stock.adobe.com

They used data from the African American Cancer Epidemiology Study (AACES), a multisite, population-based study of ovarian cancer risk and survival in Black women diagnosed between December 2010 and December 2015, with follow-up until October 2022. The data were analyzed from March 2023 to June 2024.

At baseline, researchers collected data via telephone survey on medical history, lifestyle, reproductive, and sociodemographic factors. Clinical characteristics, such as first-line treatment regimen and debulking status, were obtained from medical records. Additionally, diet information was gathered through the Block 2005 Food Frequency Questionnaire (FFQ), which covers the consumption of 110 foods and beverages during the year before diagnosis.

They assessed dietary recommendation adherence using the Healthy Eating Index-2020 (HEI-2020) and the Alternative Healthy Eating Index-2010 (AHEI-2010). HEI-2020 includes 13 components separated into adequacy and moderation categories, with scores ranging from 0 to 100, where higher scores indicate greater guideline adherence.³ AHEI-2010 has 11 food and nutrient components, including fruits, vegetables, and whole grains, with scores ranging from 0 to 110⁴; higher scores indicate better dietary quality.

Overall survival was the main study outcome.¹ The researchers ascertained vital status and date of death annually through multiple sources, including cancer registries, patient contact, and the National Death Index. Additionally, to avoid immortal time bias, they calculated survival time as the number of days from the interview date to either the date of death or last contact (October 2022).

The study population consisted of 483 patients, with a mean (SD) age of 58.1 (10.5) years at EOC diagnosis. The mean (SD) HEI-2020 score was 67.9 (9.5), and their mean (SD) AHEI-2010 score was 53.1 (10.2). Lower scores were more common among those with less education, current smokers, and those who did not use dietary supplements. Also, lower HEI-2020 scores were associated with higher total energy intake and younger age, while lower AHEI-2010 scores correlated with not meeting physical activity guidelines.

Based on HEI-2020 scores, the study population consumed close to the recommended amounts of total protein foods, seafood, plant proteins, refined grains, and greens and beans. However, sodium intake was high, while dairy and whole grain consumption were much lower than recommended.

Similarly, AHEI-2010 scores showed that polyunsaturated fatty acid intake was near the recommended level, but whole grain, fruit, and long-chain (n-3) fat consumption was much lower than recommended. Conversely, there was excessive consumption of fruit juices, sugar-sweetened beverages, and trans fats.

The researchers recorded 310 deaths during a median follow-up of 4.3 years (IQR, 2.0-8.2). The multivariable model showed no significant difference in overall mortality based on index scores. However, patients in the highest adherence quartile (quartile 4) to the HEI-2020 (HR, 0.78; 95% CI, 0.56-1.08) and AHEI-2010 (HR, 0.83; 95% CI, 0.89-1.16) guidelines had decreased mortality compared with those in the lowest quartile.

Among the study population, 325 patients (67.3%) had HGSOC. Those with higher prediagnosis dietary pattern scores in this subpopulation exhibited significantly better overall survival. In the multivariable-adjusted models, patients in the second quartile of HEI-2020 scores had reduced mortality (HR, 0.63; 95% CI, 0.44-0.92) than those in the lowest quartile.

Decreased mortality was also observed in quartiles 3 (HR, 0.67; 95% CI, 0.46-0.97) and 4 (HR, 0.63; 95% CI, 0.44-0.91) of HEI-2020 scores compared with quartile 1. Consequently, each 10-point increase in patients’ HEI-2020 scores corresponded to a decrease in mortality (HR, 0.86; 95% CI, 0.75-1.00). Similar trends were seen with AHEI-2010 scores for patients with HGSOC in quartiles 2 (HR, 0.62; 95% CI, 0.43-0.89) and 4 (HR, 0.67; 95% CI, 0.45-0.98) compared with those in quartile 1.

The researchers acknowledged their limitations, including that the study population only represented patients who survived 10 months or more after an ovarian cancer diagnosis. Therefore, their findings cannot be generalized to those with the most fatal cancers who die shortly after diagnosis. Despite their limitations, the researchers expressed confidence in their findings.

“Our study adds much-needed evidence to the gap of knowledge regarding modifiable lifestyle factors associated with ovarian cancer survival among Black women,” the authors concluded. “This is particularly important given that Black women have worse survival after an ovarian cancer diagnosis compared with other racial and ethnic groups.”

References

1. Armidie TA, Bandera EV, Johnson CE, et al. Diet and survival in Black women with epithelial ovarian cancer. JAMA Netw Open. 2024;7(10):e2440279. doi:10.1001/jamanetworkopen.2024.40279
2. Cancer facts & figures 2024. American Cancer Society. Accessed October 22, 2024. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2024/2024-cancer-facts-and-figures-acs.pdf
3. Healthy Eating Index (HEI). Food and Nutrition Service. Updated September 14, 2023. Accessed October 22, 2024. https://www.fns.usda.gov/cnpp/healthy-eating-index-hei
4. Al-Ibrahim AA, Jackson RT. Healthy eating index versus alternate healthy index in relation to diabetes status and health markers in U.S. adults: NHANES 2007-2010. Nutr J. 2019;18(1):26. doi:10.1186/s12937-019-0450-6