# Associations of Obesity with Function and Patient-Reported Outcomes Among Rural Advanced Cancer Patients: A Cross-Sectional Analysis of the Nurse AMIE Randomized Controlled Trial

## TL;DR

Obesity is linked to worse physical function and more fatigue in rural cancer patients, suggesting a need for better supportive care.

## Contribution

This study identifies a link between higher BMI and poorer physical outcomes in rural advanced cancer patients.

## Key findings

- Higher BMI correlates with lower objective physical function scores in rural cancer patients.
- Obese patients report significantly lower energy levels and higher fatigue compared to normal and overweight patients.

## Abstract

The relationship between obesity and physical function among rural cancer patients is not well understood. High prevalence of obesity in rural areas may have a detrimental effect on physical functioning and health-related quality of life. This analysis examined the association between obesity and subjective and objective physical function, identifying that higher obesity levels may be correlated with poorer physical function among rural cancer survivors. These findings suggest that additional supportive care may be needed to support physical function among rural advanced cancer patients experiencing obesity.

Background/Objectives: Obesity is a common comorbidity but there remains limited understanding on how higher obesity rates in rural areas may impact physical function decline and other health domains among cancer patients. This study addresses this gap by examining the association between body mass index (BMI) and physical function among a cohort of rural advanced cancer patients. Methods: This cross-sectional analysis uses baseline data from the Nurse AMIE trial (NCT04673019). Individuals were categorized as ‘normal weight’ (BMI ≤ 25 kg/m2), ‘overweight’ (BMI > 25 to 30 kg/m2), and ‘obese’ (BMI > 30 kg/m2). Objective physical function was measured by the Short Physical Performance Battery (SPPB) and subjective physical function and health domains were measured using surveys (PROMIS; SF-36). Results: Of 348 patients included, 88 (25.3%) were classified as ‘normal weight’, 107 (30.7%) as ‘overweight’, and 153 (44.0%) as ‘obese’. Average age was 64.8 years (SD = 12.2), 46% (n = 160) were female, 95% were white (n = 331), and 52% (n = 182) were Stage 4. Total SPPB scores revealed poorer functioning with higher BMI (M ± SD: BMI ≤ 25 kg/m2: 9.1 ± 2.3; BMI > 25–30 kg/m2: 8.3 ± 3.1; BMI > 30 kg/m2: 8.1 ± 2.8; p = 0.04). Similarly, scores from the SF-36 revealed subjective physical function was lower with higher BMI (BMI ≤ 25 kg/m2: 57.9 ± 29.1; BMI > 25–30 kg/m2: 53.7 ± 28.0; BMI > 30 kg/m2: 47.6 ± 27.6; p = 0.004). Participants reported lower levels of energy and greater fatigue with higher BMI (BMI ≤ 25 kg/m2: 49.8 ± 26.1; BMI > 25–30 kg/m2: 45.1 ± 24.6; BMI > 30 kg/m2: 40.7 ± 22.6; p = 0.01). Conclusions: Higher BMI is associated with poorer physical function and increased fatigue among rural advanced cancer patients, highlighting the need for supportive care related to physical function in this at-risk group.