Effect of multimodal rehabilitation on anthropometric parameters in ovarian cancer surgical patients

Objective: To evaluate the effect of multimodal rehabilitation on anthropometric changes following radical surgery for earlystage ovarian cancer (OC).

Material and methods. This prospective randomized controlled trial included 94 patients with stage I–II OC and borderline ovarian tumors, who were randomized into a multimodal “active” rehabilitation group (Group 1, n=47) and a “passive” rehabilitation group (Group 2, n=47). The control group consisted of 80 women without gynecologic malignancies. The multimo­ dal “active” rehabilitation program included dietary management, prescribed physical exercise, lifestyle modification, nutritional and pharmacological support. Body weight, body mass index (BMI), waist circumference, hip circumference, and waist-to-hip ratio were assessed preoperatively, as well as at 1 week; 1, 3, 6, 12, 24, and 36 months.

Results. At baseline, over 50% of patients in Groups 1 and 2 were overweight or obese. After 36 months, a significant reduction in body weight and BMI was observed in Group 1 (from 27.66±4.15 to 22.28±6.73 kg/m²; p=0.0362). The proportion of Group 1 patients with normal BMI increased from 40.4% to 71.4%. In contrast, Group 2 exhibited an increase in BMI (from 26.90±2.62 to 27.81±3.06 kg/m²; p=0.0015) and a decrease in the proportion of patients with normal BMI to 16.7%. Significant differences were also found in the waist-to-hip ratio dynamics: in Group 1, the ratio decreased from 0.89±0.05 to 0.79±0.10 (p=0.0037), indicating a shift from the “risky” to the “good” waist-to-hip ratio and reduction in abdominal obesity. In Group 2, the waist-to-hip ratio increased to 0.96±0.07.

Conclusion. The multimodal “active” rehabilitation program demonstrates high efficacy in weight correction and improvement of anthropometric parameters after early-stage OC surgery. Unlike “passive” postoperative management, which is associated with progressive weight gain and deterioration of anthropometric parameters, long-term application of this multimodal approach not only reduces body weight but also achieves a clinically significant reduction in abdominal obesity.

1. Tanha K., Mottaghi A., Nojomi M., et al. Investigation on factors associated with ovarian cancer: an umbrella review of systematic review and meta-analyses. J Ovarian Res. 2021; 14 (1): 153. https://doi.org/10.1186/s13048-021-00911-z.

2. Kuper H., Cramer D.W., Titus-Ernstoff L. Risk of ovarian cancer in the United States in relation to anthropometric measures: does the association depend on menopausal status? Cancer Causes Control. 2002; 13 (5): 455–63. https://doi.org/10.1023/a:1015751105039.

3. Reeves G.K., Pirie K., Beral V., et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ. 2007; 335 (7630): 1134. https://doi.org/10.1136/bmj.39367.495995.AE.

4. Tworoger S.S., Eliassen A.H., Missmer S.A., et al. Birthweight and body size throughout life in relation to sex hormones and prolactin concentrations in premenopausal women. Cancer Epidemiol Biomarkers Prev. 2006; 15 (12): 2494–501. https://doi.org/10.1158/1055-9965.EPI-06-0671.

5. Liu Z., Zhang T.T., Zhao J.J., et al. The association between overweight, obesity and ovarian cancer: a meta-analysis. Jpn J Clin Oncol. 2015; 45 (12): 1107–15. https://doi.org/10.1093/jjco/hyv150.

6. Staley S.A., Tucker R., Clark L.H. The role of obesity in the development and management of gynecologic cancer. Obstet Gynecol Surv. 2020; 75 (5): 308–16. https://doi.org/10.1097/OGX.0000000000000779.

7. Wichmann I.A., Cuello M.A. Obesity and gynecological cancers: a toxic relationship. Int J Gynecol Obstet. 2021; 155 (S1): 123–34. https://doi.org/10.1002/ijgo.13870.

8. Erondu C.O., Alberg A.J., Bandera E.V., et al. The association between body mass index and presenting symptoms in African American women with ovarian cancer. J Womens Health. 2016; 25 (6): 571–8. https://doi.org/10.1089/jwh.2015.5359.

9. Bedogni G., Tiribelli C., Bellentani S. Body mass index: from Quételet to evidence-based medicine. Available at: https://www.giorgiobedogni.it/archivio/testi/bmi/pbmi.html (accessed 14.06.2025).

10. Zierle-Ghosh A., Jan A. Physiology, body mass index In: Treasure Island (FL): StatPearls Publishing; 2023 Nov 5. 11. Carlos Poston W.S., Foreyt J.P. Body mass index: uses and limitations. Strength Conditioning J. 2002; 24 (4): 15–7. https://doi.org/10.1519/00126548-200208000-00004.

11. Mitka M. Obesity’s role in heart disease requires apples and Pears comparison. JAMA. 2005; 294 (24): 3071–2. https://doi.org/10.1001/jama.294.24.3071.

12. Folsom A.R., Kushi L.H., Anderson K.E., et al. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women’s Health Study. Arch Intern Med. 2000; 160 (14): 2117–28. https://doi.org/10.1001/archinte.160.14.2117.

13. Canoy D. Distribution of body fat and risk of coronary heart disease in men and women. Curr Opin Cardiol. 2008; 23 (6): 591–8. https://doi.org/10.1097/HCO.0b013e328313133a.

14. Blinov D.V., Solopova A.G., Achkasov E.E., et al. Patterns of the indicators of quality of life in rehabilitation after surgical treatment of female reproductive system tumors of various localization. Oncogynecology. 2023; 2: 56–68 (in Russ.).

15. Blinov D.V., Solopova A.G., Achkasov E.E., et al. Strengthening rehabilitation for patients with ovarian tumors: current approaches and future directions. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2023; 16 (2): 303–16 (in Russ.). https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.196.

16. Blinov D.V., Solopova A.G., Achkasov E.E., et al. Algorithm for the provision of comprehensive psychotherapeutic support to women experiencing neuropsychiatric symptoms during rehabilitation following the treatment of malignant neoplasms of the reproductive system. Epilepsia i paroksizmal'nye sostoania / Epilepsy and Paroxysmal Conditions. 2023; 15 (3): 232–45 (in Russ.). https://doi.

17. Liu Y., Yang J., Hilliard T.S., et al. Host obesity alters the ovarian tumor immune microenvironment and impacts response to standard of care chemotherapy. J Exp Clin Cancer Res. 2023; 42 (1): 165. https://doi.org/10.1186/s13046-023-02740-y.

18. Stelten S., Schofield C., Hartman Y.A., et al. Association between energy balance-related factors and clinical outcomes in patients with ovarian cancer: a systematic review and meta-analysis. Cancers. 2022; 14 (19): 4567. https://doi.org/10.3390/cancers14194567.

19. Kenkhuis M.F., Stelten S., Hartman Y.A., et al. Effects of a combined exercise and dietary intervention on body composition, physical functioning and fatigue in patients with ovarian cancer: results of the PADOVA trial. Br J Cancer. 2024; 131 (1): 101–9. https://doi.org/10.1038/s41416-024-02694-8.

20. Silberman J.N., Benjamin A., Solk P., et al. Fit4Surgery: a pilot randomized controlled trial to assess the feasibility of prehabilitation prior to debulking surgery for ovarian cancer. Gynecol Oncol. 2025; 199: 116–23. https://doi.org/10.1016/j.ygyno.2025.06.020.

21. Davis E.W., Attwood K., Prunier J., et al. The association of body composition phenotypes before chemotherapy with epithelial ovarian cancer mortality. J Natl Cancer Inst. 2024; 116 (9): 1513–24. https://doi.org/10.1093/jnci/djae112.

22. Skírnisdóttir I., Sorbe B. Prognostic impact of body mass index and effect of overweight and obesity on surgical and adjuvant treatment in early-stage epithelial ovarian cancer. Int J Gynecol Cancer. 2008; 18 (2): 345–51. https://doi.org/10.1111/j.1525-1438. 2007.01013.x.

23. Matthews K.S., Straughn J.M. Jr., Kemper M.K., et al. The effect of obesity on survival in patients with ovarian cancer. Gynecol Oncol. 2009; 112 (2): 389–93. https://doi.org/10.1016/j.ygyno.2008.10.016.

24. Cai B., Li K., Li G. Impact of obesity on major surgical outcomes in ovarian cancer: a meta-analysis. Front Oncol. 2022; 12: 841306. https://doi.org/10.3389/fonc.2022.841306.

25. Tan R., White C., Chen Y., et al. Impact of body mass index, diabetes, and tumor mutational burden in ovarian, fallopian tube, and primary peritoneal carcinoma with BRCA1/2 alteration on poly(ADP-ribose) polymerase inhibitors. J Clin Oncol. 2025; 43 (16 Suppl.): 5585.