Welcome from the IOM National Cancer Policy Forum
Patricia Ganz, University of California, Los Angeles (UCLA), National Cancer Policy Forum Vice Chair

Workshop Introduction and Overview
Wendy Demark-Wahnefried, University of Alabama at Birmingham, Workshop Planning Committee Chair

Session 1: Role of Obesity and Weight Gain in the Promotion of Various Cancers
Moderator: Rachel Ballard-Barbash, National Cancer Institute (NCI)

Overview of the role of obesity in cancer risk and progression

–   Susan Gapstur, American Cancer Society

Evidence for the role of obesity in breast cancer progression

–   Pamela Goodwin, Mount Sinai Hospital, University of Toronto

Evidence for the role of obesity in prostate cancer progression

–   Elizabeth A. Platz, Johns Hopkins Bloomberg School of Public Health

Obesity, energy balance, and colorectal cancer survivorship

–   Jeffrey Meyerhardt, Dana-Farber Cancer Institute

The impact of weight loss on cancer incidence and mortality

–   Bruce M. Wolfe, Oregon Health & Science University

Correlations of obesity, comorbidity, and treatment:
Implications for survival analysis and interpretation

–   Rachel Ballard-Barbash, NCI

Panel Discussion
Questions:

•  What is the current state of the evidence? What are the evidence gaps?

•  Is the evidence strong enough to recommend weight loss for individuals who are overweight or obese and who are either newly diagnosed with cancer or long-term cancer survivors?

•  Would such an approach be recommended for all survivors or a subset of individuals diagnosed with specific cancers? If the latter, which cancers are those?

•  What is the downside of recommending weight loss to cancer survivors who are overweight or obese given the high incidence of comorbidity in this population?

•  What are the methodological issues for closing the evidence gaps?

•  How do we adjust data on obesity for other factors such as physical activity and diet?

Overview of mechanisms

–   Nathan Berger, Case Western Reserve University School of Medicine

Increased risk of cancer in obesity and type 2 diabetes

–   Derek LeRoith, Mount Sinai School of Medicine

Growth factor and energy sensing pathways

–   John DiGiovanni, University of Texas at Austin

Hormonal factors in obesity and breast cancer

–   Angela Brodie, University of Maryland

Obesity and breast inflammation: Implications for carcinogenesis

–   Andrew Dannenberg, Weill Medical College of Cornell University

Obesity, stem cells, and cancer

–   Madhuri Kakarala, University of Michigan

Signaling pathway crosstalk/Systems biology

–   Nathan Berger, Case Western Reserve University School of Medicine

Panel Discussion
Questions:

•  What is the evidence to support a role for the various potential mechanisms underpinning the obesity–cancer link?

•  What are the most pressing unanswered questions about mechanistic pathways?

•  What mechanisms are the most viable targets for pharmacologic or other interventions?

•  Are multipronged approaches feasible? Should the focus be on combination therapies and interventions?

•  How easy is it to measure the intermediate biomarkers that have been suggested?

Break

Session 3: Dissecting the Obesity–Cancer Link—Is It Obesity? Energy Balance? Physical Activity?
Moderator: Wendy Demark-Wahnefried, University of Alabama at Birmingham

Overview

–   Wendy Demark-Wahnefried

Mechanistic insights from animal models

–   Stephen Hursting, University of Texas at Austin

Clinical evidence

–   Jennifer Ligibel, Dana-Farber Cancer Center

Panel Discussion
Questions:

•  What is the ultimate driver of the obesity–cancer link?

•  Are the relationships between physical activity and energy restriction in cancer similar to those in other diseases such as cardiovascular disease, or does cancer represent a different model?

•  What model systems and research methodologies could help us sort out the various contributions to the obesity–cancer link?

•  What is needed for effective clinical studies?

•  If we are able to discern the factors most influential in cancer promotion, would that necessarily change medical practice?

•  How might we best break the obesity–cancer link?

Wrap-up, Day 1

Adjourn Day 1

Session 4: Tying It All Together
Moderator: Pamela Goodwin, University of Toronto

Overview of weight loss interventions for obese adults

–   Thomas Wadden, University of Pennsylvania

Physical activity interventions in cancer survivors: What works?

–   Kerry Courneya, University of Alberta

Evidence from diet and weight loss studies for cancer survivors: What works?

–   Cheryl Rock, University of California, San Diego

Interventions in cancer survivors; issues and challenges in this population

–   Anne McTiernan, University of Washington

When do we have enough evidence to intervene in cancer patients?

–   Patricia Ganz, UCLA

Panel Discussion
Opening statements by:
Kate Murphy, Fight Colorectal Cancer
Diana Dyer, CancerRD.com

Questions:

•  When is there enough evidence to warrant intervention?

•  What interventions are effective? What is the evidence?

•  When is the teachable moment?

•  What are the mechanics of intervention: Who, when, where, how, and what?

•  Which interventions are likely to be the most cost-effective?

•  What barriers stand in the way of broad dissemination on interventions?

Lunch Break

Session 5: Reactions and Panel Discussion—What Are the Policy and Research Implications?
Moderators: Martin Murphy, CEO Roundtable on Cancer and Patricia Ganz, UCLA

Lori Minasian, Division of Cancer Prevention, NCI
Linda Nebeling, Division of Cancer Control and Population Sciences, NCI
Jo Anne Zujewski, Division of Cancer Treatment and Diagnosis, NCI
Edward Partridge, American Cancer Society and University of Alabama at Birmingham
Dean Brenner, American Society of Clinical Oncology and University of Michigan

Questions:

•  What are the research needs and goals to advance understanding of this topic?

•  What resources and infrastructures are needed to accomplish the research goals?

•  What is needed for effective interdisciplinary research in this area?

•  What policy changes do you suggest to reduce obesity-related cancer incidence and mortality?

•  What are the obstacles to implementing such policy changes? How could those obstacles be overcome?

•  How can we work with other medical fields to accomplish common goals?

Closing Remarks—Wendy Demark-Wahnefried

Adjourn