Barriers to integrating obesity management into cancer survivorship care: Results from a single-institution survey.

Abstract

e13783 Background: Cancer survivors with obesity are at increased risk of cancer recurrence, cancer-related mortality, and secondary cancer development. Evidence-based obesity treatments such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and bariatric surgery reduce these risks yet remain profoundly underutilized in survivorship care. We surveyed oncology clinicians to characterize barriers to adoption and identify potential implementation solutions. Methods: We conducted a cross-sectional, anonymous web-based survey of oncology clinicians at a single academic institution, purposively sampling across specialties to ensure broad representation, including surgical oncologists, medical oncologists, and advanced practice practitioners. Likert-scale items assessed clinician knowledge, comfort with counseling and referral, and perceived patient awareness, while short-answer items elicited barriers to integrating GLP-1RAs and bariatric surgery in survivorship care. Quantitative responses were summarized using descriptive statistics, and qualitative responses were reviewed to identify common themes. Results: Twenty-eight clinicians completed the survey (76% response rate). Respondents reported low utilization of these therapies, with 84% reporting they never or only sometimes discussed bariatric surgery or GLP-1RAs with patients, and 63% reporting they had never referred a patient for either therapy. Respondents also described substantial knowledge and confidence gaps: 79% reported low understanding of the oncologic benefits of these treatments, 84% reported low confidence discussing them in practice, and 76% perceived that cancer survivors with obesity were not at all or only slightly aware of their benefits. Despite these gaps, 79% of respondents agreed that bariatric surgery and GLP-1RAs should be a standard component of survivorship care. Reported barriers included unclear referral pathways (71%), limited knowledge of eligibility criteria (54%), and lack of support or resources (46%). Across candidate implementation strategies, 40-60% of respondents rated clarified referral pathways, decision support, and enhanced education/training as “highly helpful.” Conclusions: Oncology clinicians endorsed GLP-1RAs and bariatric surgery as an important component of survivorship care, but reported low utilization driven by knowledge gaps and system-level barriers. These findings highlight the need for multi-level, multi-component implementation strategies to support the integration of evidence-based obesity treatment into cancer survivorship care.