Acceptability of bariatric surgery in people with endometrial cancer and atypical hyperplasia: A qualitative study

In young individuals with obesity, infertility, and endometrial cancer, significant, sustained weight loss through bariatric surgery may result in a durable oncologic and reproductive response. However, it is not known whether bariatric surgery is acceptable to this patient population. We performed a qualitative study to understand the acceptability of bariatric surgery in young individuals with obesity and endometrial cancer or atypical hyperplasia. All participants were of reproductive age with body mass index [BMI] ≥ 35 and grade 1 endometrial cancer or atypical hyperplasia. Semi-structured interviews were used to explore participant perception of their weight, fertility, and the possibility of bariatric surgery as part of the treatment strategy for their endometrial cancer/atypical hyperplasia. Thematic saturation was reached after 14 interviews. Fourteen participants with a median age of 34 years (range 27–38) and BMI of 42 (33–64) were interviewed. Participants were reluctant to accept bariatric surgery as a treatment option due to 1) lack of knowledge about the procedure, 2) stigma attached to bariatric surgery, and 3) fear of the risks associated with bariatric surgery. Their perception towards their weight, fertility, and cancer diagnosis was characterized by concepts of ‘helplessness’, ‘isolation’, ‘frustration’, and ‘guilt’. We observed a significant gap in participant understanding of the complex interplay between their cancer, infertility, and obesity. More support and resources are required, with patient-oriented counseling focused on the implication of their weight on their cancer diagnosis and fertility, before presenting bariatric surgery as a treatment option. •Bariatric surgery improves oncologic and reproductive outcomes in individuals with obesity and endometrial cancer•Participants are reluctant to accept bariatric surgery due to a lack of knowledge, stigma, and fear of the surgical risks.•Patient-oriented counseling needs to focus on the implication of weight on cancer and fertility, and take place early.