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Hurtado MD, Tama E, D'Andre S, Shufelt CL. The relation between excess adiposity and breast cancer in women: Clinical implications and management. Crit Rev Oncol Hematol 2024; 193:104213. [PMID: 38008197 PMCID: PMC10843740 DOI: 10.1016/j.critrevonc.2023.104213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer in women. While the combination of improved screening, earlier detection, and advances in therapeutics has resulted in lower BC mortality, BC survivors are now increasingly dying of cardiovascular disease. Cardiovascular disease in the leading cause of non-cancer related mortality among BC survivors. This situation underscores the critical need to research the role of modifiable cardiometabolic risk factors, such as excess adiposity, that will affect BC remission, long-term survivorship, and overall health and quality of life. PURPOSE First, this review summarizes the evidence on the connection between adipose tissue and BC. Then we review the data on weight trends after BC diagnosis with a focus on the effect of weight gain on BC recurrence and BC- and non-BC-related death. Finally, we provide a guide for weight management in BC survivors, considering the available data on the effect of weight loss interventions on BC.
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Affiliation(s)
- Maria D Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Jacksonville, FL, USA; Precision Medicine for Obesity Program, Mayo Clinic, Rochester, MN, USA.
| | - Elif Tama
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Jacksonville, FL, USA; Precision Medicine for Obesity Program, Mayo Clinic, Rochester, MN, USA
| | - Stacey D'Andre
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Chrisandra L Shufelt
- Center for Women's Health, Division of General Internal Medicine, Jacksonville, FL, USA
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2
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Li Z, Shen G, Shi M, Zheng Y, Guan Y, Xin Y, Wang M, Zhao F, Ren D, Zhao J. Association between high body mass index and prognosis of patients with early-stage breast cancer: A systematic review and meta-analysis. CANCER PATHOGENESIS AND THERAPY 2023; 1:205-215. [PMID: 38327841 PMCID: PMC10846319 DOI: 10.1016/j.cpt.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 02/09/2024]
Abstract
Background A high body mass index (BMI) can indicate overweight or obesity and is a crucial risk factor for breast cancer survivors. However, the association between high BMI and prognosis in early-stage breast cancer (EBC) remains unclear. We aimed to assess the effects of high BMI on the prognosis of patients with EBC. Methods The PubMed, Embase, and Cochrane Library databases and proceedings of major oncological conferences related to the effects of BMI on the prognosis of breast cancer were searched up to November 2021. Fixed- and random-effects models were used for meta-analyses. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free survival (DFS) and overall survival (OS) were extracted from the included literature. Results Twenty retrospective cohort studies with 33,836 patients with EBC were included. Overweight patients had worse DFS (HR: 1.16, 95% CI: 1.05-1.27, P = 0.002) and OS (HR: 1.20; 95% CI: 1.09-1.33, P < 0.001). Obesity also had adverse effects on DFS (HR: 1.17, 95% CI: 1.07-1.29, P = 0.001) and OS (HR: 1.30, 95% CI: 1.17-1.45, P < 0.001). Likewise, patients with high BMI had worse DFS (HR: 1.16, 95% CI: 1.08-1.26, P < 0.001) and OS (HR: 1.25, 95% CI: 1.14-1.39, P < 0.001). In subgroup analyses, overweight had adverse effects on DFS (HR: 1.11, 95% CI: 1.04-1.18, P = 0.001) and OS (HR: 1.18, 95% CI: 1.11-1.26, P < 0.001) in multivariate analyses, whereas the relationship that overweight had negative effects on DFS (HR: 1.21, 95% CI: 0.99-1.48, P = 0.058) and OS (HR: 1.39, 95% CI: 0.92-2.10, P = 0.123) was not statistically significant in univariate analysis. By contrast, obesity had adverse effects on DFS (HR: 1.21, 95% CI: 1.06-1.38, P = 0.004 and HR: 1.14, 95% CI: 1.08-1.22, P < 0.001) and OS (HR: 1.33, 95% CI: 1.15-1.54, P < 0.001 and HR: 1.23, 95% CI: 1.15-1.31, P < 0.001) in univariate and multivariate analyses, respectively. Conclusions Compared with normal weight, increased body weight (overweight, obesity, and high BMI) led to worse DFS and OS in patients with EBC. Once validated, these results should be considered in the development of prevention programs.
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Affiliation(s)
| | | | | | - Yonghui Zheng
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Yumei Guan
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Yuanfang Xin
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Miaozhou Wang
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Fuxing Zhao
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Dengfeng Ren
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
| | - Jiuda Zhao
- Breast Disease Diagnosis and Treatment Center of the Affiliated Hospital of Qinghai University and the Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China
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Chan DS, Vieira R, Abar L, Aune D, Balducci K, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Becerra‐Tomás N, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:572-599. [PMID: 36279884 PMCID: PMC10092239 DOI: 10.1002/ijc.34322] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
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Affiliation(s)
- Doris S.M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Nutrition, Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
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Denise de Lima Bezerra A, Matias de Sousa I, Silva de Souza AP, Miranda de Carvalho AL, Trussardi Fayh AP. Early nutritional intervention does not prevent long-term adverse events in women with breast cancer: A pilot study. Clin Nutr ESPEN 2023; 53:268-273. [PMID: 36657923 DOI: 10.1016/j.clnesp.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/24/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
AIM This study aims to evaluate the effect of early nutritional intervention on adverse clinical events in women with breast cancer undergoing neoadjuvant chemotherapy. DESIGN AND SETTINGS This is a randomized clinical trial performed at the beginning of neoadjuvant chemotherapy for women with breast cancer treated at an oncology referral center (Brazil) and followed until the end of radiotherapy period, at least. Registered under ClinicalTrials.gov Identifier no. RBR-3SHHXS. METHODS Participants were allocated to a control group - CG (nutritional guidance on healthy eating practices) or an intervention group - IC (nutritional guidance and individualized food plan). Chemotherapy toxicity (primary endpoint) was considered a precocious adverse clinical event and it was evaluated by self-reported gastrointestinal symptoms observed at any time during the first three cycles of treatment. Post-surgical complications, radiotherapy toxicity, and weight change were considered long-term adverse events. RESULTS 34 women (19 in the IG and 15 in the CG) were evaluated. The early nutritional intervention was associated with low gastrointestinal chemotoxicity (nausea, vomiting, and constipation, p < 0.001, p < 0.048, and p < 0.024, respectively). However, there were no statically significant differences between both groups in the presence of long-term adverse events (radiotherapy toxicity-88.2% vs 76.9%, weight loss-21.1% vs 26.7% for IC and CG respectively, p > 0.05 for both). CONCLUSION The early nutritional intervention was associated with a low frequency of precocious events, but not with long-term adverse events in women with breast cancer during treatment.
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Affiliation(s)
- Agnes Denise de Lima Bezerra
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Iasmin Matias de Sousa
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Priscilla Silva de Souza
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Lúcia Miranda de Carvalho
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Liga Norteriograndense Contra o Câncer, Natal, RN, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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Rein MS, Dadiani M, Godneva A, Bakalenik-Gavry M, Morzaev-Sulzbach D, Vachnish Y, Kolobkov D, Lotan-Pompan M, Weinberger A, Segal E, Gal-Yam EN. BREAst Cancer Personalised NuTrition (BREACPNT): dietary intervention in breast cancer survivors treated with endocrine therapy - a protocol for a randomised clinical trial. BMJ Open 2022; 12:e062498. [PMID: 36410828 PMCID: PMC9680181 DOI: 10.1136/bmjopen-2022-062498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Breast cancer survivors treated with adjuvant endocrine therapy commonly experience weight gain, which has been associated with low adherence to therapy and worse breast cancer prognosis. We aim to assess whether a personalised postprandial glucose targeting diet will be beneficial for weight management as compared with the recommended Mediterranean diet in this patient population METHODS AND ANALYSIS: The BREAst Cancer Personalised NuTrition study is a phase-2 randomised trial in hormone receptor positive patients with breast cancer, treated with adjuvant endocrine therapy. The study objective is to assess whether dietary intervention intended to improve postprandial glycaemic response to meals results in better weight and glycaemic control in this population as compared with the standard recommended Mediterranean diet. Consenting participants will be assigned in a single blinded fashion to either of two dietary arms (Mediterranean diet or an algorithm-based personalised diet). They will be asked to provide a stool sample for microbiome analysis and will undergo continuous glucose monitoring for 2 weeks, at the initiation and termination of the intervention period. Microbiome composition data will be used to tailor personal dietary recommendations. After randomisation and provision of dietary recommendations, participants will be asked to continuously log their diet and lifestyle activities on a designated smartphone application during the 6-month intervention period, during which they will be monthly monitored by a certified dietitian. Participants' clinical records will be followed twice yearly for 5 years for treatment adherence, disease-free survival and recurrence. ETHICS AND DISSEMINATION The study has been approved by the ethics committee in the Sheba medical centre (file 5725-18-SMC, Ramat Gan, Israel) and the Weizmann Institutional Review Board (file 693-2, Rehovot, Israel). The findings of this study will be published in a peer reviewed publication. TRIAL REGISTRATION NUMBER NCT04079270.
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Affiliation(s)
- Michal Sela Rein
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Maya Dadiani
- Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
| | - Anastasia Godneva
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | | | | | - Yaeli Vachnish
- Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
| | - Dmitry Kolobkov
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Maya Lotan-Pompan
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Adina Weinberger
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
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Guo Z, Wang J, Tian X, Fang Z, Gao Y, Ping Z, Liu L. Body mass index increases the recurrence risk of breast cancer: a dose-response meta-analysis from 21 prospective cohort studies. Public Health 2022; 210:26-33. [PMID: 35868141 DOI: 10.1016/j.puhe.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/09/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of body mass index (BMI) on the recurrence risk of breast cancer. STUDY DESIGN Dose-response meta-analysis. METHODS Cohort studies that included BMI and the recurrence of breast cancer were selected through various databases including PubMed, Web of Science, the China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals (VIP), and Wanfang Data Knowledge Service Platform (WanFang) until November 30, 2021. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of literature. A two-stage random-effects meta-analysis was performed to assess the dose-response relationship between BMI and breast cancer recurrence risk. Heterogeneity between studies is assessed using I2. RESULTS The relative risk (RR) of BMI <25 kg/m2 vs BMI ≥25 kg/m2, BMI <30 kg/m2 vs BMI ≥30 kg/m2 were 1.09 (95% CI: 1.00-1.19) and 1.15 (95% CI: 1.04-1.27), suggesting that BMI had a significant effect on the recurrence risk of breast cancer, and there might be a dose-response relationship between them. A total of 21 studies were included in dose-response meta-analysis, which showed that there was a positive linear correlation between BMI and the risk of recurrence (RR = 1.02, 95% CI: 1.01-1.03). For every 1 kg/m2 increment of BMI, the risk of recurrence increased by approximately 2%. In subgroup analyses, positive linear dose-response relationships between BMI and recurrence risk were observed among Asian and study period >10 years groups. For every 1 kg/m2 increment of BMI, the risk of recurrence increased by 3.41% and 1.87%, respectively. CONCLUSIONS The recurrence risk of breast cancer increases with BMI, which is most obvious among Asian women.
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Affiliation(s)
- Z Guo
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - J Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - X Tian
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Z Fang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Y Gao
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Z Ping
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - L Liu
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
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7
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Association between weight change and breast cancer prognosis. Breast Cancer Res Treat 2022; 193:677-684. [PMID: 35435529 DOI: 10.1007/s10549-022-06592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/30/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Results of the associations between weight change after breast cancer diagnosis and prognosis were inconsistent. The modification effects of menopausal status and endocrine therapy on the associations remain poorly understood. METHODS A total of 2016 breast cancer patients were recruited between October 2008 and January 2018 and followed up until December 31, 2019 in Guangzhou. Multivariate Cox models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for progression-free survival (PFS) in association with weight change after diagnosis. RESULTS Weight loss at 2 years (HR = 1.34, 95% CI 0.87-2.06) or more than 2 years (HR = 1.95, 95% CI 1.22-3.10) after diagnosis increased risk of breast cancer progression. The adverse effect of weight loss was significantly more pronounced in post-menopausal than pre-menopausal women, particularly for weight loss at 2 years after diagnosis, with the HRs and 95% CIs of 2.41 (1.25-4.63) and 0.90 (0.49-1.64), respectively. Weight gain tended to reduce the risk of disease progression among patients with endocrine therapy but not for those with non-endocrine therapy; the significant interaction between weight gain at 2 years after diagnosis and endocrine therapy was observed (Pinteraction = 0.042). CONCLUSION Our finding suggested that weight loss was detrimental to breast cancer prognosis, particularly for post-menopausal women, while weight gain may be a potential beneficial indicator for the patients with endocrine therapy but not for those with non-endocrine therapy.
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Donzella SM, Lind KE, Skiba MB, Farland LV, Thomson CA, Werts SJ, Bell ML, LeBlanc E, Weitlauf JC, Hery CMB, Naughton MJ, Mortimer J, Crane TE. The relationship between sleep and weight change among women diagnosed with breast cancer participating in the Women's Health Initiative. Breast Cancer Res Treat 2022; 192:423-433. [PMID: 35006483 DOI: 10.1007/s10549-021-06486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Short and long sleep duration and poor sleep quality are risk factors for weight gain and cancer mortality. The purpose of this study is to investigate the relationship between sleep and weight change among postmenopausal breast cancer survivors. METHODS Women participating in the Women's Health Initiative who were diagnosed with incident breast cancer between year one and year three were included. Self-reported sleep duration was categorized as ≤ 5 h (short), 6 h, 7-8 h (optimal), and ≥ 9 h (long). Self-reported sleep quality was categorized as poor, average, and above average. Post-diagnosis weight change was the difference of weight closest to, but preceding diagnosis, and year 3 weight. We used linear regression to evaluate sleep duration and sleep quality associations with post-diagnosis weight change adjusted for potential confounders. RESULTS Among 1156 participants, 63% were weight stable after diagnosis; average weight gain post cancer diagnosis was 3.2 kg. Six percent of women reported sleeping ≤ 5 h, 26% reported 6 h, 64% reported 7-8 h, and 4% reported ≥ 9 h. There were no differences in adjusted estimates of weight change among participants with short duration (0.37 kg; 95% CI - 0.88, 1.63), or long duration (- 0.56 kg; 95% CI - 2.03, 0.90) compared to optimal duration, nor was there a difference among poor quality (- 0.51 kg; 95% CI - 1.42, 0.41) compared to above average quality. CONCLUSION Among postmenopausal breast cancer survivors, sleep duration and quality were not associated with weight change after breast cancer diagnosis. Future studies should consider capturing change in adiposity and to expand beyond self-reported sleep.
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Affiliation(s)
- Sidney M Donzella
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, USA
| | - Kimberly E Lind
- Department of Health Promotion Sciences, University of Arizona, Tucson, USA
| | - Meghan B Skiba
- Division of Oncological Sciences, Oregon Health & Science University, Portland, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, University of Arizona, Tucson, USA
- University of Arizona Cancer Center, Tucson, USA
| | - Samantha J Werts
- Department of Health Promotion Sciences, University of Arizona, Tucson, USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, USA
- University of Arizona Cancer Center, Tucson, USA
| | - Erin LeBlanc
- Center for Health Research, Kaiser Permanente, Oakland, USA
| | - Julie C Weitlauf
- Veterans Affairs Palo Alto Health Care System, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, USA
| | | | | | - Joanne Mortimer
- Department of Medical Oncology & Therapeutics Research, The City of Hope, Duarte, USA
| | - Tracy E Crane
- University of Arizona Cancer Center, Tucson, USA.
- College of Nursing, University of Arizona, Tucson, USA.
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9
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Kwon MR, Ko ES, Park MS, Jeong WK, Hwang NY, Kim JH, Lee JE, Kim SW, Yu JH, Han BK, Ko EY, Choi JS, Park KW. Impact of Skeletal Muscle Loss and Visceral Obesity Measured Using Serial CT on the Prognosis of Operable Breast Cancers in Asian Patients. Korean J Radiol 2022; 23:159-171. [PMID: 35029082 PMCID: PMC8814696 DOI: 10.3348/kjr.2020.1475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 10/01/2021] [Accepted: 10/16/2021] [Indexed: 11/15/2022] Open
Abstract
Objective This study aimed to investigate the impact of baseline values and temporal changes in body composition parameters, including skeletal muscle index (SMI) and visceral adipose tissue area (VAT), measured using serial computed tomography (CT) imaging on the prognosis of operable breast cancers in Asian patients. Materials and Methods This study retrospectively included 627 Asian female (mean age ± standard deviation [SD], 53.6 ± 8.3 years) who underwent surgery for stage I–III breast cancer between January 2011 and September 2012. Body composition parameters, including SMI and VAT, were semi-automatically calculated on baseline abdominal CT at the time of diagnosis and follow-up CT for post-treatment surveillance. Serial changes in SMI and VAT were calculated as the delta values. Multivariable Cox regression analysis was used to evaluate the association of baseline and delta SMI and VAT values with disease-free survival. Results Among 627 patients, 56 patients (9.2%) had breast cancer recurrence after a median of 40.5 months. The mean value ± SD of the baseline SMI and baseline VAT were 43.7 ± 5.8 cm2/m2 and 72.0 ± 46.0 cm2, respectively. The mean value of the delta SMI was -0.9 cm2/m2 and the delta VAT was 0.5 cm2. The baseline SMI and VAT were not significantly associated with disease-free survival (adjusted hazard ratio [HR], 0.983; 95% confidence interval [CI], 0.937–1.031; p = 0.475 and adjusted HR, 1.001; 95% CI, 0.995–1.006; p = 0.751, respectively). The delta SMI and VAT were also not significantly associated with disease-free survival (adjusted HR, 0.894; 95% CI, 0.766–1.043; p = 0.155 and adjusted HR, 1.001; 95% CI, 0.989–1.014; p = 0.848, respectively). Conclusion Our study revealed that baseline and early temporal changes in SMI and VAT were not independent prognostic factors regarding disease-free survival in Asian patients undergoing surgery for breast cancer.
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Affiliation(s)
- Mi-Ri Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Min Su Park
- Department of Information and Statistics, Chungnam National University, Daejeon, Korea
| | - Woo Kyoung Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Na Young Hwang
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Han Yu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Soo Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ko Woon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Di Meglio A, Soldato D, Presti D, Vaz-Luis I. Lifestyle and quality of life in patients with early-stage breast cancer receiving adjuvant endocrine therapy. Curr Opin Oncol 2021; 33:553-573. [PMID: 34456250 DOI: 10.1097/cco.0000000000000781] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW A comprehensive approach to survivorship care for women with early-stage, hormone-receptor positive breast cancer should systematically include the proactive assessment and adequate management of endocrine therapy-associated symptoms, in order to assure optimal balance between preserving quality of life (QOL) and maximizing treatment adherence. We reviewed the recent literature focused on lifestyle factors, including physical activity, diet and nutrition, weight management, smoke, and alcohol behavior, and their link with symptomatology and QOL among women receiving adjuvant endocrine therapy. RECENT FINDINGS Recent studies confirm the safety, feasibility, and effectiveness of lifestyle interventions in mitigating several common endocrine therapy-related effects, including musculoskeletal pain, fatigue, and insomnia, and in improving physical and emotional wellbeing as well as overall health-related QOL among women with early-stage breast cancer. SUMMARY Healthy lifestyle behaviors have the potential to modulate the downstream impact of endocrine therapy and improve QOL among women with early-stage breast cancer. Considerations for real-world clinical care implementation emerged, including a need to evaluate the long-term uptake of healthy behaviors and facilitate the postintervention maintenance of an improved lifestyle. Some facilitators to health promotion in breast cancer survivors were also suggested, such as individualized and one-to-one supervised programs, and digital solutions providing real-time feedback, building on personalized, direct patient engagement.
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Affiliation(s)
- Antonio Di Meglio
- Molecular predictors and new targets in oncology, INSERM Unit 981, Gustave Roussy, Villejuif
| | - Davide Soldato
- Molecular predictors and new targets in oncology, INSERM Unit 981, Gustave Roussy, Villejuif.,Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova
| | - Daniele Presti
- Molecular predictors and new targets in oncology, INSERM Unit 981, Gustave Roussy, Villejuif.,Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Ines Vaz-Luis
- Molecular predictors and new targets in oncology, INSERM Unit 981, Gustave Roussy, Villejuif
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11
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Grupińska J, Budzyń M, Maćkowiak K, Brzeziński JJ, Kycler W, Leporowska E, Gryszczyńska B, Kasprzak MP, Iskra M, Formanowicz D. Beneficial Effects of Oral Nutritional Supplements on Body Composition and Biochemical Parameters in Women with Breast Cancer Undergoing Postoperative Chemotherapy: A Propensity Score Matching Analysis. Nutrients 2021; 13:nu13103549. [PMID: 34684550 PMCID: PMC8540954 DOI: 10.3390/nu13103549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/06/2023] Open
Abstract
Aim: Recently, more attention has been paid to the role of nutritional intervention in preventing the side effects of chemotherapy in oncology patients. Therefore, the aim of the present study was to analyze the effects of oral nutritional supplements on the body composition and biochemical parameters in women with breast cancer receiving postoperative adjuvant chemotherapy. Patients and Methods: The study involved women diagnosed with breast cancer who underwent surgical treatment and were qualified for chemotherapy (doxorubicin and cyclophosphamide). Women were divided into two groups, depending on whether oral nutritional supplements were used during chemotherapy. Anthropometric and biochemical parameters were analyzed twice in all patients: before and after six weeks of chemotherapy. Propensity score (PS) matching was performed to select patients balanced in terms of age, BMI, and clinicopathological features of the tumor. Statistical comparisons were conducted in a propensity-matched cohort of patients. Results: The value of BMI was maintained constant in the supplemented women older than 56 years after six weeks of chemotherapy. Regardless of age in the supplemented women, a significant increase in muscle mass, fat free mass (FFM), and fat free mass index (FFMI) was demonstrated. An increase in fat mass (FM) including visceral fat was observed only in the non-supplemented control. Regardless of age or initial FM, supplemented women exhibited a constant level of albumin. Moreover, in the supplemented women with normal initial FM, the stable values of triglycerides and HDL cholesterol were maintained after six weeks of chemotherapy. Conclusion: The present study demonstrated that oral nutritional supplements could improve body composition and prevent hypoalbuminemia and lipid abnormalities in women with breast cancer undergoing chemotherapy.
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Affiliation(s)
- Joanna Grupińska
- Chair and Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (M.B.); (K.M.); (B.G.); (M.P.K.); (M.I.); (D.F.)
- Hospital Pharmacy, Greater Poland Cancer Centre, 61-866 Poznań, Poland
- Correspondence: ; Tel.: +48-61-854-7701
| | - Magdalena Budzyń
- Chair and Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (M.B.); (K.M.); (B.G.); (M.P.K.); (M.I.); (D.F.)
| | - Kalina Maćkowiak
- Chair and Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (M.B.); (K.M.); (B.G.); (M.P.K.); (M.I.); (D.F.)
| | - Jacek Jakub Brzeziński
- Department of Oncological Surgery of Gastrointestinal Diseases, Greater Poland Cancer Centre, 61-866 Poznań, Poland; (J.J.B.); (W.K.)
| | - Witold Kycler
- Department of Oncological Surgery of Gastrointestinal Diseases, Greater Poland Cancer Centre, 61-866 Poznań, Poland; (J.J.B.); (W.K.)
| | - Ewa Leporowska
- Department of Laboratory Diagnostics, Greater Poland Cancer Centre, 61-866 Poznań, Poland;
| | - Bogna Gryszczyńska
- Chair and Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (M.B.); (K.M.); (B.G.); (M.P.K.); (M.I.); (D.F.)
| | - Magdalena Paulina Kasprzak
- Chair and Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (M.B.); (K.M.); (B.G.); (M.P.K.); (M.I.); (D.F.)
| | - Maria Iskra
- Chair and Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (M.B.); (K.M.); (B.G.); (M.P.K.); (M.I.); (D.F.)
| | - Dorota Formanowicz
- Chair and Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (M.B.); (K.M.); (B.G.); (M.P.K.); (M.I.); (D.F.)
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12
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Evidence-based tailored nutrition educational intervention improves adherence to dietary guidelines, anthropometric measures and serum metabolic biomarkers in early-stage breast cancer patients: A prospective interventional study. Breast 2021; 60:6-14. [PMID: 34454324 PMCID: PMC8399332 DOI: 10.1016/j.breast.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The impact of the adherence to dietary guidelines of early-stage breast cancer (EBC) patients on body composition changes during treatment is not entirely defined. This study aimed to evaluate the role of an evidence-based nutrition educational intervention, according to adherence to dietary guidelines, in EBC patients. METHODS This prospective study included EBC patients, candidates for neoadjuvant/adjuvant therapy. Patients received an evidence-based tailored nutrition educational intervention. The adherence to dietary guidelines, anthropometric and dietary assessments, and blood glucose and lipid profile tests were evaluated at baseline and after a 12-months nutritional intervention. RESULTS Two hundred and forty-three patients were enrolled. At baseline, 38.3% and 23.9% of patients were overweight and obese, weight gain ≥5% (compared to 6-months before enrollment) and central obesity were observed in 47.3% and 52.7% of patients, respectively. Adherence to dietary guidelines was low (median Med-Diet score: 6 [IQR 4-8]). After the nutritional intervention (median follow-up: 22 months [range 12-45]), adherence to dietary guidelines significantly increased (median Med-Diet score: 12 [IQR 8-13]), p < 0.0001). High adherence to dietary guidelines (defines as Med-Diet score ≥10) significantly correlated with: 1) overall weight loss ≥5% (21.8% vs. 2.5%, p = 0.003); 2) median BMI drop (from 25.6 kg/m2 to 24.4 kg/m2, p = 0.003); 3) lower prevalence of central obesity (38.2% vs. 7.2%, p = 0.01); 4) improvement in blood glucose levels and lipid profile. CONCLUSION This study suggests that an evidence-based tailored nutrition educational intervention during treatment for EBC significantly increases overall adherence to dietary guidelines, and it improves both anthropometric measures and serum metabolic biomarkers in patients with high adherence.
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13
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Orban E, Jung AY, Möhl A, Behrens S, Becher H, Obi N, Chang-Claude J. Changes in alcohol consumption, body weight and physical activity among breast cancer survivors and population-based unaffected women in a prospective study. Cancer Epidemiol 2020; 70:101852. [PMID: 33221667 DOI: 10.1016/j.canep.2020.101852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND It is unclear whether a breast cancer diagnosis affects health behaviour changes that occur with ageing. We aimed to compare long-term changes of alcohol consumption, body weight, and physical activity in women with breast cancer and in age-matched unaffected women. METHODS We used data from 1,925 women with breast cancer and 3,473 unaffected women aged 50-74 years enrolled in the population-based case-control study MARIE (Mamma Carcinoma Risk Factor Investigation) in 2002-2005, who also completed the follow-up in 2014-2016. Multinomial logistic regression was applied to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for the associations between breast cancer status and categories of change in alcohol consumption, weight and physical activity. RESULTS After 11.6 years of follow-up, breast cancer survivors had significantly lower odds than unaffected women of increasing alcohol consumption from ≤10 to >10 g/day (adjusted OR 0.48, 95 % CI 0.35-0.65), but were more likely to experience a major weight change of ≥10 % compared to having stable weight (±<5 %) (OR for increase and decrease 1.32, 95 % CI 1.03-1.70 and 1.36, 95 % CI 1.05-1.77, resp.) and to decrease transport physical activity to below 2.5 h/week compared to maintaining the activity level (OR 1.61, 95 % CI 1.26-2.04). No significant group difference was found for changes in recreational physical activity. CONCLUSION Our data indicate that some long-term health behaviour changes can be attributed to a breast cancer diagnosis rather than ageing, suggesting that long-term medical care of breast cancer survivors could pay greater attention to weight control and sufficient physical activity.
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Affiliation(s)
- Ester Orban
- Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany
| | - Audrey Y Jung
- Department of Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Annika Möhl
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany
| | - Sabine Behrens
- Department of Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany
| | - Jenny Chang-Claude
- Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany; Department of Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
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14
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The impact of body size changes on recurrence risk depends on age and estrogen receptor status in primary breast cancer. Cancer Causes Control 2019; 30:1157-1170. [PMID: 31515643 DOI: 10.1007/s10552-019-01227-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/30/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the prognostic impact of body size changes during the first postoperative year in breast cancer. METHODS A cohort of 1,317 primary breast cancer patients included in Sweden (2002-2014) underwent body size measurements at the preoperative and 1-year visits (n = 1,178). Landmark survival analyses were used to investigate how postoperative weight gain or loss (> 5%) or change in waist-hip ratio (WHR) categories (≤ 0.85 or > 0.85) impact prognosis. RESULTS Median age at inclusion was 61 years and body mass index 25.1 kg/m2. After a median follow-up of 5.0 years from inclusion, 165 recurrences and 77 deaths occurred. Weight gain (17.0%) conferred over twofold recurrence risk only in patients < 50 years (Pinteraction = 0.033). Weight loss (8.6%) was only associated with a poor prognosis in patients ≥ 70 years, but not after restriction analysis. Weight change did not impact prognosis in patients 50 to < 70 years. Changes between WHR categories were associated with differential recurrence risk depending on estrogen receptor (ER) status (Pinteraction = 0.007), with higher recurrence risk in patients with ER+ tumors and lower recurrence risk with ER- tumors. CONCLUSION Both changes in terms of weight and WHR category yielded independent prognostic information. Further research is imperative before recommending weight loss for all overweight breast cancer patients.
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15
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Ekenga CC, Wang X, Pérez M, Schootman M, Jeffe DB. A Prospective Study of Weight Gain in Women Diagnosed with Early-Stage Invasive Breast Cancer, Ductal Carcinoma In Situ, and Women Without Breast Cancer. J Womens Health (Larchmt) 2019; 29:524-533. [PMID: 31460829 DOI: 10.1089/jwh.2018.7638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Weight gain after breast cancer has been associated with recurrence and mortality. We therefore examined factors associated with ≥5% weight gain over 2-year follow-up of a cohort of newly diagnosed early-stage invasive breast cancer (EIBC) and ductal carcinoma in situ (DCIS) patients and age-matched controls without a breast cancer history. Materials and Methods: We interviewed participants 4-6 weeks after definitive surgical treatment (patients) or a negative/benign screening mammogram (controls). Multivariable logistic regression models were used to identify socioeconomic, psychosocial, and treatment factors associated with ≥5% weight gain over 2-year follow-up. Results: Overall, 88 (24%) of 362 EIBC patients, 31 (17%) of 178 DCIS patients, and 82 (15%) of 541 controls had ≥5% weight gain during follow-up. EIBC patients were more likely to experience ≥5% weight gain than DCIS patients (Odds ratio [OR] = 2.16; 95% confidence interval [95% CI] = 1.19-3.95) and controls (OR = 1.76; 95% CI = 1.23-2.51). Among EIBC patients, older patients (OR = 0.96; 95% CI = 0.93-0.99), patients who underwent endocrine therapy (OR = 0.43; 95% CI = 0.19-0.95), smokers (OR = 0.35; 95% CI = 0.14-0.86), and African Americans (OR = 0.23; 95% CI = 0.09-0.58) were less likely to have ≥5% weight gain than their respective counterparts. Among DCIS patients, older patients (OR = 0.94; 95% CI = 0.89-0.99) were less likely to have ≥5% weight gain. Among controls, smokers were more likely to have ≥5% weight gain (OR = 3.03; 95% CI = 1.49-6.17). Conclusions: EIBC patients were more likely than DCIS patients and controls to experience ≥5% weight gain over follow-up. Studies are necessary to elucidate mechanisms of weight gain in early-stage breast cancer survivors.
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Affiliation(s)
| | - Xiaoyan Wang
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Maria Pérez
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Mario Schootman
- Department of Clinical Analytics and Insight, Center for Clinical Excellence, SSM Health, St. Louis, Missouri
| | - Donna B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Da Silva Ribeiro-Sousa MA, Mastelaro I, Maris Peria F, Angotti Carrara H, Moreira de Andrade J, Freire de Carvalho Cunha S. Weight Gain during Systemic Oncologic Therapy for Breast Cancer: Changes in Food Intake and Physical Activity. REVISTA BRASILEIRA DE CANCEROLOGIA 2019. [DOI: 10.32635/2176-9745.rbc.2019v65n2.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Introduction: Weight gain frequently occurs during treatment for breast cancer. Objective: To evaluate changes in dietary intake and physical activity in the weight evolution of women on systemic oncologic treatment for breast cancer. Method: The prospective and comparative study included 89 women submitted to systemic oncologic treatment for breast cancer, grouped according to the occurrence of weight gain in relation to body weight documented before beginning treatment. Patients were classified as 1) Group with weight gain (those with an increase in body weight greater than or equal to 2% over pre-treatment weight); 2) Group without weight gain (those who maintained or lost weight during treatment). We calculated body mass index (BMI) of patients and analyzed their body composition by bioelectrical impedance (BIA). Changes in food intake, gastrointestinal symptoms, and physical activity level, as well as reductions in muscle and fat mass, were documented. Results: Tumor staging (p=0.24), use of antineoplastic drugs (p=0.23) and intention of treatment (p=0.61) were no different between the weight gain group (n=36) and no weight gain group (n=53). No difference was found in anthropometric and BIA data between the groups during oncologic treatment. Frequency of gastrointestinal symptoms was not different between the groups. However, increased food intake and bed rest, and a decrease in physical activity level were more frequent among women who gained weight during therapy. Conclusions: Weight gain in women undergoing systemic oncologic therapy for breast cancer may be, at least in part, caused by higher energy intake and lower physical activity.
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Affiliation(s)
- Marco Aurélio Da Silva Ribeiro-Sousa
- Division of Medical Nutrition, Department of Internal Medicine, Ribeirão Preto Medical School, São Paulo University. Ribeirão Preto (SP), Brazil
| | - Isabelle Mastelaro
- Division Medical Nutrition, Department of Internal Medicine, Ribeirão Preto Medical School, São Paulo University. Ribeirão Preto (SP), Brazil
| | - Fernanda Maris Peria
- Division of Clinical Oncology, Department of Internal Medicine, Ribeirão Preto Medical School, São Paulo University. Ribeirão Preto (SP), Brazil
| | - Hélio Angotti Carrara
- Mastology/Oncology Division, Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, São Paulo University. Ribeirão Preto (SP), Brazil
| | - Jurandyr Moreira de Andrade
- Mastology/Oncology Division, Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, São Paulo University. Ribeirão Preto (SP), Brazil
| | - Selma Freire de Carvalho Cunha
- Division of Medical Nutrition, Department of Internal Medicine, Ribeirão Preto Medical School, São Paulo University. Ribeirão Preto (SP), Brazil
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17
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van den Berg MMGA, Kok DE, Visser M, de Vries JHM, de Kruif JTCM, de Vries Y, Posthuma L, Sommeijer DW, Timmer-Bonte A, Los M, van Laarhoven HWM, Kampman E, Winkels RM. Changes in body composition during and after adjuvant or neo-adjuvant chemotherapy in women with breast cancer stage I-IIIB compared with changes over a similar timeframe in women without cancer. Support Care Cancer 2019; 28:1685-1693. [PMID: 31290019 PMCID: PMC7036066 DOI: 10.1007/s00520-019-04951-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023]
Abstract
Purpose Body weight and body composition may change during and after adjuvant or neo-adjuvant chemotherapy for breast cancer. However, most studies did not include a comparison group of women without cancer, thus could not assess whether observed changes differed from age-related fluctuations in body weight and body composition over time. We assessed changes in body composition during and after chemotherapy in breast cancer patients compared with age-matched women not diagnosed with cancer. Methods We recruited 181 patients with stage I–IIIb breast cancer and 180 women without cancer. In patients, we assessed body composition using a dual-energy X-ray scan before start of chemotherapy (T1), shortly after chemotherapy (T2), and 6 months after chemotherapy (T3); for the comparison group, the corresponding time points were recruitment (T1) and 6 (T2) and 12 (T3) months. Results Fifteen percent of patients and 8% of the comparison group gained at least 5% in body weight between T1 and T3. Among the comparison group, no statistically significant changes in body weight, or body composition were observed over time. Body weight of patients significantly increased from baseline (72.1 kg ± 0.4 kg) to T2 (73.3 kg ± 0.4 kg), but decreased to 73.0 kg ± 0.4 kg after chemotherapy (T3). Lean mass of patients significantly increased from 43.1 kg ± 0.5 kg at baseline to 44.0 kg ± 0.5 kg at T2, but returned to 43.1 kg ± 0.5 kg at T3. There were no differential changes in fat mass over time between patients and the comparison group. Conclusions Changes in body weight and body composition during and after chemotherapy for early stage breast cancer were modest, and did not differ substantially from changes in body weight and body composition among women without cancer.
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Affiliation(s)
- M M G A van den Berg
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - D E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - M Visser
- Department of Health Sciences, Faculty of Science, the Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - J H M de Vries
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - J Th C M de Kruif
- Department of Health Sciences, Faculty of Science, the Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Y de Vries
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - L Posthuma
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - D W Sommeijer
- Flevoziekenhuis, Almere, the Netherlands.,Academisch Medisch Centrum, Amsterdam, the Netherlands
| | | | - M Los
- St Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | | | - E Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands. .,Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA. .,Wageningen University & Research, Wageningen, Netherlands.
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18
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Springfield S, Odoms-Young A, Tussing-Humphreys LM, Freels S, Stolley MR. A Step toward Understanding Diet Quality in Urban African-American Breast Cancer Survivors: A Cross-sectional Analysis of Baseline Data from the Moving Forward Study. Nutr Cancer 2019; 71:61-76. [PMID: 30775929 PMCID: PMC6527422 DOI: 10.1080/01635581.2018.1557217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/27/2018] [Accepted: 11/06/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Little is known about the dietary behaviors of African-American breast cancer survivors (AABCS). We sought to describe dietary intake and quality in AABCS and examine associations with demographic, social, lifestyle, and body composition factors to potentially inform the development of effective dietary interventions. METHODS Baseline data from a prospective weight loss trial of 210 AABCS were assessed. A food frequency questionnaire was used to evaluate dietary intake and diet quality via the Healthy Eating Index 2010 (HEI-2010) and Alternative Healthy Eating Index 2010 (AHEI-2010). Linear regression analysis was conducted to determine the most influential variables on diet quality. RESULTS Mean HEI- and AHEI-2010 total scores were 65.11 and 56.83 indicating that diet quality needs improvement. Women were the least adherent to recommendations for intake of whole grains, dairy, sodium, empty calories, sugary beverages, red/processed meats, and trans-fat. Increased self-efficacy for healthy eating behaviors, more years of education (AHEI only), negative smoking status, smaller waist circumference, and increased physical activity (HEI only) were significantly associated with higher diet quality scores. CONCLUSION Our findings suggest the diet quality of AABCS needs improvement. Intervention programs may achieve higher diet quality in AABCS by focusing on increasing self-efficacy for healthy eating behaviors.
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Affiliation(s)
- Sparkle Springfield
- Stanford Prevention Research Center, School of Medicine, 3300 Hillview Ave (MC 5411), Palo Alto, CA 94304, US
| | - Angela Odoms-Young
- Department of Kinesiology and Nutrition, 646 Applied Health Sciences Building, 1919 West Taylor Street (MC 517), Chicago, IL 60612, US
- University of Illinois Cancer Center, 486 Westside Research Office Bldg., 1747 West Roosevelt Road (MC 275), Chicago, IL 60608, US
- School of Public Health, Division of Epidemiology and Biostatistics, 953 SPHP1, 1603 W Taylor St (MC 923), Chicago, IL 60612, US
| | - Lisa M. Tussing-Humphreys
- University of Illinois Cancer Center, 486 Westside Research Office Bldg., 1747 West Roosevelt Road (MC 275), Chicago, IL 60608, US
- School of Public Health, Division of Epidemiology and Biostatistics, 953 SPHP1, 1603 W Taylor St (MC 923), Chicago, IL 60612, US
| | - Sally Freels
- School of Public Health, Division of Epidemiology and Biostatistics, 953 SPHP1, 1603 W Taylor St (MC 923), Chicago, IL 60612, US
| | - Melinda R. Stolley
- Medical College of Wisconsin, Department of Medicine, 8701 Watertown Plank Road, Milwaukee, WI 53226, US
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Kus T, Cinkir HY, Aktas G, Abali H. Hepatosteatosis may predict late recurrence of breast cancer: A single-center observational study. Curr Probl Cancer 2019; 43:100461. [PMID: 30686567 DOI: 10.1016/j.currproblcancer.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022]
Abstract
AIM The positive energy balance and insulin resistance caused by weight gain, physical inactivity, poor dietary quality are linked to a decreased breast cancer (BC)-specific survival. The aim of the present study was to assess whether or not hepatosteatosis, which reflect underlying insulin resistance, has a predictive value on recurrence in patients with nonmetastatic BC. MATERIAL METHOD All diagnosed nonmetastatic BC patients between 2005 and 2016 were included in this retrospective analysis. Patients' medical characteristics included for analysis were age, menopausal status, presence of obesity, diabetes, dyslipidemia, and tumor features. Liver parenchyma was evaluated by ultrasonography, and then patients divided into 2 groups according to final follow-up findings; group 1: without hepatosteatosis or presence of grade 1 steatosis; group 2: presence of grades 2 and 3 hepatosteatosis. Survival distributions were estimated with the Kaplan-Meier method and compared between groups with the log-rank statistic. RESULTS Four hundred twenty-four patients included in this study. The median follow-up period of all patients was 6.7 years (range, 0.6-13 years). The mean age was 48.2 ± 0.5 years. Of total, 154 (36.3%) patients experienced recurrence. In total, 171 (40.6%) patients had grades 2 and 3 hepatosteatosis, and the remaining had no, or grade 1 hepatosteatosis during last follow-up or at recurrence. The clinicopathologic characteristics of the participants were well balanced between the 2 groups. Younger age (odds ratio [OR]: 2.19; 95% confidence interval [CI]: 1.3-3.8, P = 0.005), and higher tumor stage (OR: 7.52; 95% CI: 1.2-48.5, P = 0.035 for stage Ia vs stage IIIC) were associated with recurrence of BC during the entire follow-up in multivariate analysis. Hepatosteatosis predicted late recurrence after 5 years in nonmetastatic BC after adjusted for age, diabetes, tumor stage, grade, and luminal type (OR: 2.45; 95% CI: 1.1-5.6, P = 0.034) and the hazard ratio was 0.40 (95% CI: 0.18-0.88, P = 0.023 adjusted value) for relapse-free survival after 5 years. CONCLUSION Higher degree of hepatosteatosis may predict recurrence after 5 years in BC survivors.
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Affiliation(s)
- Tulay Kus
- Adıyaman University, Training and Research Hospital, Clinics of Medical Oncology, Adıyaman, Turkey.
| | - Havva Yesil Cinkir
- Gaziantep University, School of Medicine, Department of Medical Oncology, Gaziantep, Turkey
| | - Gokmen Aktas
- Kahramanmaras Sütçü İmam University, School of Medicine, Department of Medical Oncology, Kahramanmaraş, Turkey
| | - Huseyin Abali
- King Hamad Hematology-Oncology Center, Department of Medical Oncology, Bahrain
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20
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Trestini I, Carbognin L, Monteverdi S, Zanelli S, De Toma A, Bonaiuto C, Nortilli R, Fiorio E, Pilotto S, Di Maio M, Gasbarrini A, Scambia G, Tortora G, Bria E. Clinical implication of changes in body composition and weight in patients with early-stage and metastatic breast cancer. Crit Rev Oncol Hematol 2018; 129:54-66. [DOI: 10.1016/j.critrevonc.2018.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 02/08/2023] Open
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21
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de Kruif JTCM, Scholtens MB, van der Rijt J, de Boer MR, van den Berg MMGA, de Vries YC, Winkels RM, Visser M, Kampman E, Westerman MJ. Perceptions of Dutch health care professionals on weight gain during chemotherapy in women with breast cancer. Support Care Cancer 2018; 27:601-607. [PMID: 30022349 PMCID: PMC6325997 DOI: 10.1007/s00520-018-4347-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Abstract
Purpose Dutch Health care professionals (HCPs) provide little information concerning health risks associated with weight gain during chemotherapy for breast cancer. Women with breast cancer have specified the need for more information on nutrition and physical activity to deal with weight gain. The aims of this study were to assess the perceptions of Dutch HCPs on weight gain during chemotherapy and in addition evaluate whether and what kind of information on dietary intake and physical activity HCPs provide to prevent/treat weight gain during (neo)adjuvant chemotherapy. Methods A qualitative study was conducted using semi-structured interviews with 34 HCPs involved in breast cancer care: general practitioners, oncologists, specialized nurses, and dieticians. Results To date, little information about nutrition, physical activity, and weight gain is given during chemotherapy because it is not part of most HCPs’ training, it is not included in the guidelines and it is not the best time to bring up information in the opinion of HCPs. Weight gain was perceived as just a matter of a few kilos and not an important health issue during treatment. All HCPs felt it is better that women themselves addressed their weight gain after chemotherapy. Conclusion More knowledge about health risks associated with chemotherapy-induced weight gain and how to combat these issues needs to be made readily available to the HCPs and should become part of their training. Existing patient guidelines should include information on how to prevent and/or reduce weight gain through self-management of nutrition intake and physical activity during and post chemotherapy.
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Affiliation(s)
- J Th C M de Kruif
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - M B Scholtens
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J van der Rijt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M R de Boer
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Y C de Vries
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - R M Winkels
- Penn State Cancer Institute, Department of Public Health Sciences, Penn State University, Hershey, PA, USA
| | - M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - E Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - M J Westerman
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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22
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Mutschler NS, Scholz C, Friedl TW, Zwingers T, Fasching PA, Beckmann MW, Fehm T, Mohrmann S, Salmen J, Ziegler C, Jäger B, Widschwendter P, de Gregorio N, Schochter F, Mahner S, Harbeck N, Weissenbacher T, Jückstock J, Janni W, Rack B. Prognostic Impact of Weight Change During Adjuvant Chemotherapy in Patients With High-Risk Early Breast Cancer: Results From the ADEBAR Study. Clin Breast Cancer 2018; 18:175-183. [DOI: 10.1016/j.clbc.2018.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/23/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
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23
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Flanagan MR, Tang MTC, Baglia ML, Porter PL, Malone KE, Li CI. Relationship Between Anthropometric Factors and Risk of Second Breast Cancer Among Women With a History of Ductal Carcinoma In Situ. JNCI Cancer Spectr 2018; 2:pky020. [PMID: 31360852 PMCID: PMC6649731 DOI: 10.1093/jncics/pky020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Women with ductal carcinoma in situ (DCIS) have an elevated risk of a second breast cancer, but few data are available regarding the impact of modifiable lifestyle factors on this risk. METHODS In a population-based case-control patient study of women with a history of DCIS in western Washington diagnosed between 1996 and 2013, 497 patients diagnosed with DCIS and a second ipsilateral or contralateral invasive or in situ breast cancer were enrolled. There were 965 matched control patients with one DCIS diagnosis. Associations between anthropometric factors and risk of an invasive or in situ second breast cancer event were evaluated using conditional logistic regression. Statistical tests were two-sided. RESULTS Obesity (body mass index [BMI] ≥ 30 kg/m2) at initial DCIS diagnosis was associated with a 1.6-fold (95% confidence interval [CI] = 1.2 to 2.2) increased risk of any second breast cancer and a 2.2-fold increased risk of a contralateral second breast cancer (95% CI = 1.4 to 3.3) compared with normal weight women (BMI < 25 kg/m2). BMI and weight, both at initial DCIS diagnosis and at the time of the second breast cancer diagnosis, were positively associated with risk of any second and second invasive breast cancers (odds ratio = 1.01-1.04, all P ≤ .03). CONCLUSIONS Although additional confirmatory studies are needed, obesity appears to be an important contributor to the risk of second breast cancers within the growing population of women with DCIS. This has potential clinical relevance with respect to identifying which women with a history of DCIS may require more careful monitoring and who may benefit from lifestyle modifications.
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Affiliation(s)
- Meghan R Flanagan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mei-Tzu C Tang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Michelle L Baglia
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Peggy L Porter
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kathleen E Malone
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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24
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Raghavendra A, Sinha AK, Valle-Goffin J, Shen Y, Tripathy D, Barcenas CH. Determinants of Weight Gain During Adjuvant Endocrine Therapy and Association of Such Weight Gain With Recurrence in Long-term Breast Cancer Survivors. Clin Breast Cancer 2018; 18:e7-e13. [PMID: 29239836 PMCID: PMC5937690 DOI: 10.1016/j.clbc.2017.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/26/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Weight gain is a negative prognostic factor in breast cancer (BC) patients. The risk factors for weight gain during adjuvant endocrine therapy (ET) and the extent to which such weight gain is associated with disease recurrence remain unclear. PATIENTS AND METHODS We retrospectively identified a cohort of women with a diagnosis of stage I-III, hormone receptor-positive, human epidermal growth factor receptor 2-negative BC from January 1997 to August 2008, who had received initial treatment at the MD Anderson Cancer Center, had completed 5 years of ET, and had remained free of locoregional or distant relapse or contralateral BC for ≥ 5 years after diagnosis. The weight change at the end of 5 years of ET was measured as the percentage of the change in weight from the start of ET, with a weight gain of > 5% considered clinically significant. Multivariable logistic regression and Cox proportional hazards models were used to assess the determinants of such weight gain and the risk of recurrence after 5 years. RESULTS Of 1282 long-term BC survivors, 432 (33.7%) had a weight gain of > 5% after 5 years of ET. Women who were premenopausal at diagnosis were 1.40 times more likely than women who were postmenopausal at diagnosis to have a weight gain of > 5%. Asian women had the lowest risk of gaining weight. The recurrence risks of patients who had gained weight and those who had not were not significantly different. CONCLUSION Premenopausal BC patients had an increased risk of weight gain after 5 years of ET; however, BC patients with a weight gain of > 5% did not have an increased risk of disease recurrence.
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Affiliation(s)
- Akshara Raghavendra
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Arup K Sinha
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Biostatistics, The University of Texas School of Public Health, Houston, TX
| | | | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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25
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Liu LN, Lin YC, Miaskowski C, Chen SC, Chen ML. Association between changes in body fat and disease progression after breast cancer surgery is moderated by menopausal status. BMC Cancer 2017; 17:863. [PMID: 29254480 PMCID: PMC5735658 DOI: 10.1186/s12885-017-3869-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/29/2017] [Indexed: 01/17/2023] Open
Abstract
Background Obesity is linked to poor disease outcomes in breast cancer patients. However, this link was mostly based on body weight or BMI rather than body-fat. The purpose of this study was to evaluate the relationship between body-fat gain and disease progression in Taiwanese women after breast cancer surgery and how this relationship is influenced by menopausal status. Methods Body fat percentage was measured 1 day before and 6 months after surgery in 131 women with stages 0–III breast cancer. Disease outcomes (metastasis and death) were assessed by chart review and telephone contact 7 to 8 years after diagnosis. These data were analyzed by multivariate Cox proportional hazard model analysis. Results The percentage of women with over 5% gain in body-fat was 56% for premenopausal and 42% for postmenopausal. Rates of distant metastasis and all-cause mortality were 17.6 and 9.9%, respectively over the follow-up period. Distant metastases were predicted in postmenopausal but not premenopausal women with breast cancer by increased body fat percentage (HR = 1.3, p = 0.035), after controlling other potential covariates, including disease severity, estrogen receptor expression, progesterone receptors expression, age, and exercise habit before diagnosis. Survival was not significantly associated with body-fat percentage gains. Conclusions Our results suggest that increased body fat percentage 6 months after breast surgery is an important predictor of distant metastasis in postmenopausal Taiwanese women with breast cancer. Clinicians may need to measure patients’ body fat periodically. Our findings should be validated in studies with a longer follow-up time.
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Affiliation(s)
- Li-Ni Liu
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yung-Chang Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, USA
| | - Shin-Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Mei-Ling Chen
- Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. .,School of Nursing, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan, Republic of China. .,Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
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26
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Thomson ZO, Reeves MM. Can weight gain be prevented in women receiving treatment for breast cancer? A systematic review of intervention studies. Obes Rev 2017; 18:1364-1373. [PMID: 28875575 DOI: 10.1111/obr.12591] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/15/2017] [Accepted: 06/26/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity and weight gain have been associated with poor disease-specific and health-related outcomes in women with breast cancer. OBJECTIVES This review aimed to evaluate the effectiveness of weight gain prevention interventions among women with breast cancer. METHODS Completed and ongoing trials evaluating a behaviourally based dietary intervention with or without physical activity and with a focus on weight gain prevention during treatment for breast cancer were reviewed. Weight change and body composition data were extracted. Within-group weight change of ±1 kg and between-group (intervention versus control) weight difference of ≥2 kg were defined as successful weight gain prevention. RESULTS Five completed trials (seven intervention arms) and five ongoing trials were identified. Completed trials exclusively recruited premenopausal or premenopausal and postmenopausal women. Within-group weight gain was prevented in two intervention arms, two arms achieved weight loss and three arms reported weight gain. Of the five comparisons with control groups, two reported significant differences in weight change between groups. Ongoing trials will provide further evidence on longer-term outcomes, cost-effectiveness and blood markers. CONCLUSION This small but growing number of studies provides preliminary and promising evidence that weight gain can be prevented in women with breast cancer undergoing chemotherapy.
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Affiliation(s)
- Z O Thomson
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - M M Reeves
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
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27
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Schvartsman G, Gutierrez-Barrera AM, Song J, Ueno NT, Peterson SK, Arun B. Association between weight gain during adjuvant chemotherapy for early-stage breast cancer and survival outcomes. Cancer Med 2017; 6:2515-2522. [PMID: 29024537 PMCID: PMC5673950 DOI: 10.1002/cam4.1207] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/10/2017] [Accepted: 08/25/2017] [Indexed: 12/13/2022] Open
Abstract
Obese and overweight women have an increased risk of breast cancer and worse outcomes at the time of diagnosis. Women tend to gain weight after breast cancer diagnosis and during chemotherapy for early‐stage disease, which may in turn increase risk for worse outcomes. We examined if weight gained during adjuvant chemotherapy was associated with worse survival outcomes. We queried our database for data on patients who received adjuvant third‐generation chemotherapy for early‐stage breast cancer. Univariate and multivariate analyses by Cox regression were performed for survival outcomes across three categories according to BMI variation from start to end of chemotherapy: >0.5 kg/m2 loss or gain and stable BMI (±0.5 kg/m2). We included 1998 patients in this study. Women over 50 years old and postmenopausal were more likely to lose weight during adjuvant chemotherapy, whereas women under 30 years old gained more weight (P < 0.001). At 1 year postchemotherapy, patients tended to return to their original weight (ρ = −0.3, P < 0.001). On multivariate analysis, BMI increase of >0.5 kg/m2 compared to maintaining BMI was marginally associated with increased locoregional recurrence risk (HR: 2.53; 95% CI, 1.18–5.45; P = 0.017), adjusting for grade, stage, and radiation delivery. Weight variation during adjuvant chemotherapy for early‐stage breast cancer may occur as both weight gain and weight loss in a balanced manner. Furthermore, this variation seems to be transient in nature and does not appear to significantly influence recurrence rates and overall survival.
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Affiliation(s)
- Gustavo Schvartsman
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan K Peterson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,MD Anderson Cancer Center, Houston, Texas
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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28
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Winkels RM, Sturgeon KM, Kallan MJ, Dean LT, Zhang Z, Evangelisti M, Brown JC, Sarwer DB, Troxel AB, Denlinger C, Laudermilk M, Fornash A, DeMichele A, Chodosh LA, Schmitz KH. The women in steady exercise research (WISER) survivor trial: The innovative transdisciplinary design of a randomized controlled trial of exercise and weight-loss interventions among breast cancer survivors with lymphedema. Contemp Clin Trials 2017; 61:63-72. [PMID: 28739540 PMCID: PMC5817634 DOI: 10.1016/j.cct.2017.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/05/2017] [Accepted: 07/20/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Breast cancer survivors face dual challenges: long term sequelae of treatment, and risk of recurrent disease. Obesity and a sedentary lifestyle complicate both challenges. The WISER Survivor trial assessed the effects of exercise and/or weight-loss on lymphedema, biomarkers of breast cancer recurrence, and quality of life. We report on the innovative transdisciplinary design of this trial and report attrition rates. METHODS This one year trial randomized breast cancer survivors who had a BMI of ≥25kg/m2, were sedentary and had breast-cancer-related-lymphedema to 1) exercise (weight training and aerobic exercise) 2) weight-loss 3) exercise and weight-loss 4) or control group. Innovative aspects included: adaptation of a community-based weight training program to a largely home-based program; use of a commercial meal replacement system as part of the lifestyle modification weight-loss program; inclusion of measures of cost-effectiveness to enable economic evaluations; and alignment with a parallel mouse model for breast cancer recurrence to enable transdisciplinary research. In this model, mice bearing dormant residual tumor cells, which spontaneously relapse, were placed on a high-fat diet. Overweight animals were randomly assigned to exercise, calorie restriction, both, or control group and followed for cancer recurrence. The animal model will guide mechanistic biomarkers to be tested in the human trial. RESULTS & DISCUSSION 351 participants were randomized; 13 experienced breast cancer recurrence during the trial. Of the 338 participants without recurrence, 83% completed the trial. The WISER Survivor trial will show the effects of exercise and weight-loss on lymphedema outcomes, biomarkers of recurrence and quality of life. NCT ClinicalTrials.gov registration #: NCT01515124.
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Affiliation(s)
- Renate M Winkels
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, United States
| | - Kathleen M Sturgeon
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, United States
| | - Michael J Kallan
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Zi Zhang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Margaret Evangelisti
- Center for Human Phenomic Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Justin C Brown
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, United States
| | - David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Andrea B Troxel
- Department of Population Health, New York University School of Medicine, New York City, NY, United States
| | - Crystal Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Centre, Philadelphia, PA, United States
| | | | - Anna Fornash
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Angela DeMichele
- Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lewis A Chodosh
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, United States.
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Wu R, Liu T, Yang P, Liu X, Liu F, Wang Y, Xiong H, Yu S, Huang X, Zhuang L. Association of 15-hydroxyprostaglandin dehydrogenate and poor prognosis of obese breast cancer patients. Oncotarget 2017; 8:22842-22853. [PMID: 28206964 PMCID: PMC5410267 DOI: 10.18632/oncotarget.15280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/27/2017] [Indexed: 01/04/2023] Open
Abstract
In order to explore the new mechanism that obesity worsens the prognosis of breast cancer, we reanalyzed the data about gene expression of normal, overweight, and obese breast cancer patients to explore potential genes and validate its function by clinical and experimental data. The fold change of 15-hydroxyprostaglandin dehydrogenate (HPGD) gene which displayed declining trend with BMI increase was 0.46 in obese versus normal weight patients. HPGD protein was highest expressed in normal weight group and lowest expressed in obese group. The rate of positive lymph nodes was 67% in low expression of HPGD group and 35% in high expression of HPGD group. The recurrence-free survival (RFS) rate and overall survival (OS) rate of 5 years had significant difference between low expression of HPGD group and high expression of HPGD group. Obesity dramatically decreased the RFS rate and OS rate of 5 years. Down regulation of HPGD expression could increase the migration and proliferation ability of breast cancer cell line MCF-7. Taken together, our results indicate that low expression of HPGD may be a reason for poor prognosis of obese breast cancer patients.
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Affiliation(s)
- Ruxing Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Liu
- Department of Pediatrics, Aflac Cancer Center and Blood Disorders Service, Emory University School of Medicine, Atlanta, GA, USA
| | - Peiwen Yang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiyou Liu
- Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Liu
- Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huihua Xiong
- Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiying Yu
- Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyuan Huang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Zhuang
- Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Vance V, Campbell S, Mccargar L, Mourtzakis M, Hanning R. The Voice of Experience: Diet and Weight Change in Women with Breast Cancer Associate with Psychosocial and Treatment-Related Challenges. CAN J DIET PRACT RES 2017; 78:74-80. [PMID: 28145730 DOI: 10.3148/cjdpr-2016-034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE This study investigated relationships between psychosocial and treatment-related factors, diet, and weight change in women treated with chemotherapy for early-stage breast cancer. METHODS Comprehensive qualitative interviews were conducted with 28 women who were within 12 months of completing chemotherapy treatment. RESULTS Changes in food intake and eating patterns were universal over the course of chemotherapy, with broad variability in treatment effects and associated dietary responses linked to weight change. Increased appetite, food cravings, and intake of energy-dense comfort foods were more common among women who gained weight during treatment (n = 11). Changes in taste, nausea, and emotional distress were central in promoting these dietary responses. Women who lost weight during treatment (n = 6) tended to report more severe and persistent side effects of treatment leading to poor appetite and lower food intake, and they were more likely to live alone. CONCLUSIONS While the etiology of weight change in this population is complex, this study suggests that changes in food intake related to treatment and psychosocial challenges may play an important role for some women. These findings may help to identify women who are most at risk of weight change during treatment and may inform the development of tailored dietary interventions.
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Affiliation(s)
- Vivienne Vance
- a Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON
| | - Sharon Campbell
- b School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Linda Mccargar
- c Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB
| | | | - Rhona Hanning
- b School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
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Min YH, Lee JW, Chung IY, Ahn SH. Longitudinal patterns and associated factors of postdiagnosis weight changes in Korean breast cancer survivors with normal body mass index. Support Care Cancer 2017; 25:2549-2558. [PMID: 28378159 DOI: 10.1007/s00520-017-3664-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 03/06/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to describe longitudinal patterns of weight changes from diagnosis to within 5 years after diagnosis and investigate factors associated with short- and long-term weight changes among Korean breast cancer survivors with initially normal body mass index (BMI). METHODS Body weights at diagnosis for 1546 breast cancer survivors were compared with those at 12, 24, 36, 48, and 60 months after diagnosis. Absolute weight change (kg) and relative weight changes (%) were analyzed. Logistic regression was used to identify factors associated with short-term (1 year) and long-term (5 years) weight changes. RESULTS A significant decrease in mean weight was predominant at 12 months postdiagnosis. In subgroup analysis, the younger age group showed significant weight gains after 36 months. The older age group and chemotherapy (CT) group showed significant weight losses after 24 months. About 40% of weight gainers and 60% of weight losers at 12 months returned to their initial weight by 60 months postdiagnosis. CT and lower educational levels were associated with short-term weight loss and gain, respectively. For long-term changes, age at diagnosis was the sole associated factor. CONCLUSIONS Korean breast cancer survivors treated with CT mainly experienced postdiagnosis weight loss rather than weight gain. Short-term weight change was independently associated with chemotherapy and educational level. However, long-term weight change was associated with age at diagnosis. Breast cancer survivors with normal BMI may be categorized according to the time-dependent risk for postdiagnosis weight change.
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Affiliation(s)
- Yul Ha Min
- College of Nursing, Gachon University, Incheon, South Korea
| | - Jong Won Lee
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - Il Yong Chung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sei Hyun Ahn
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Melisko ME, Gradishar WJ, Moy B. Issues in Breast Cancer Survivorship: Optimal Care, Bone Health, and Lifestyle Modifications. Am Soc Clin Oncol Educ Book 2017; 35:e22-9. [PMID: 27249727 DOI: 10.1200/edbk_159203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There are an estimated 3.1 million survivors of breast cancer in the United States. The predominant reasons for this substantially large population are that breast cancer is the most common noncutaneous malignancy among women and that 5-year survival rates after breast cancer treatment are approximately 90%. These patients have many medical considerations, including the need to monitor for disease recurrence and to manage complications of their previous cancer treatments. Most patients remain at risk indefinitely for local and systemic recurrences of their breast cancers and have an increased risk of developing contralateral new primary breast cancers. Therefore, optimizing care for this patient population is critical to the overall health care landscape in the United States. Here, we summarize survivorship care delivery and its challenges, the optimization of bone health in breast cancer survivors, and opportunities for risk reduction through lifestyle modifications.
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Affiliation(s)
- Michelle E Melisko
- From the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Massachusetts General Hospital Cancer Center, Boston, MA
| | - William J Gradishar
- From the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Massachusetts General Hospital Cancer Center, Boston, MA
| | - Beverly Moy
- From the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Massachusetts General Hospital Cancer Center, Boston, MA
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Meyerhardt JA, Kroenke CH, Prado CM, Kwan ML, Castillo A, Weltzien E, Cespedes Feliciano EM, Xiao J, Caan BJ. Association of Weight Change after Colorectal Cancer Diagnosis and Outcomes in the Kaiser Permanente Northern California Population. Cancer Epidemiol Biomarkers Prev 2016; 26:30-37. [PMID: 27986654 DOI: 10.1158/1055-9965.epi-16-0145] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Higher body mass index (BMI) is associated with incident colorectal cancer but not consistently with colorectal cancer survival. Whether weight gain or loss is associated with colorectal cancer survival is largely unknown. METHODS We identified 2,781 patients from Kaiser Permanente Northern California diagnosed with stages I-III colorectal cancer between 2006 and 2011 with weight and height measurements within 3 months of diagnosis and approximately 18 months after diagnosis. We evaluated associations between weight change and colorectal cancer-specific and overall mortality, adjusted for sociodemographics, disease severity, and treatment. RESULTS After completion of treatment and recovery from stage I-III colorectal cancer, loss of at least 10% of baseline weight was associated with significantly worse colorectal cancer-specific mortality (HR 3.20; 95% confidence interval [CI], 2.33-4.39; Ptrend < 0.0001) and overall mortality (HR 3.27; 95% CI, 2.56-4.18; Ptrend < 0.0001). For every 5% loss of baseline weight, there was a 41% increased risk of colorectal cancer-specific mortality (95% CI, 29%-56%). Weight gain was not significantly associated with colorectal cancer-specific mortality (Ptrend = 0.54) or overall mortality (Ptrend = 0.27). The associations were largely unchanged after restricting analyses to exclude patients who died within 6 months and 12 months of the second weight measurement. No significant interactions were demonstrated for weight loss or gain by gender, stage, primary tumor location, or baseline BMI. CONCLUSIONS Weight loss after diagnosis was associated with worse colorectal cancer-specific mortality and overall mortality. Reverse causation does not appear to explain our findings. IMPACT Understanding mechanistic underpinnings for the association of weight to worse mortality is important to improving patient outcomes. Cancer Epidemiol Biomarkers Prev; 26(1); 30-37. ©2016 AACR SEE ALL THE ARTICLES IN THIS CEBP FOCUS SECTION, "THE OBESITY PARADOX IN CANCER EVIDENCE AND NEW DIRECTIONS".
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Affiliation(s)
| | - Candyce H Kroenke
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Marilyn L Kwan
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Adrienne Castillo
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Erin Weltzien
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | | | - Jingjie Xiao
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bette J Caan
- Kaiser Permanente Northern California Division of Research, Oakland, California
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Bea JW, Blew RM, Going SB, Hsu CH, Lee MC, Lee VR, Caan BJ, Kwan ML, Lohman TG. Dual energy X-ray absorptiometry spine scans to determine abdominal fat in postmenopausal women. Am J Hum Biol 2016; 28:918-926. [PMID: 27416964 DOI: 10.1002/ajhb.22892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/06/2016] [Accepted: 06/18/2016] [Indexed: 11/09/2022] Open
Abstract
Body composition may be a better predictor of chronic disease risk than body mass index (BMI) in older populations. OBJECTIVES We sought to validate spine fat fraction (%) from dual energy X-ray absorptiometry (DXA) spine scans as a proxy for total abdominal fat. METHODS Total body DXA scan abdominal fat regions of interest (ROI) that have been previously validated by magnetic resonance imaging were assessed among healthy, postmenopausal women who also had antero-posterior spine scans (n = 103). ROIs were (1) lumbar vertebrae L2-L4 and (2) L2-Iliac Crest (L2-IC), manually selected by two independent raters, and (3) trunk, auto-selected by DXA software. Intra-class correlation coefficients evaluated intra and inter-rater reliability on a random subset (N = 25). Linear regression models, validated by bootstrapping, assessed the relationship between spine fat fraction (%) and total abdominal fat (%) ROIs. RESULTS Mean age, BMI, and total body fat were 66.1 ± 4.8 y, 25.8 ± 3.8 kg/m2 and 40.0 ± 6.6%, respectively. There were no significant differences within or between raters. Linear regression models adjusted for several participant and scan characteristics were equivalent to using only BMI and spine fat fraction. The model predicted L2-L4 (Adj. R2 : 0.83) and L2-IC (Adj. R2 : 0.84) abdominal fat (%) well; the adjusted R2 for trunk fat (%) was 0.78. Model validation demonstrated minimal over-fitting (Adj. R2 : 0.82, 0.83, and 0.77 for L2-L4, L2-IC, and trunk fat, respectively). CONCLUSIONS The strong correlation between spine fat fraction and DXA abdominal fat measures make it suitable for further development in postmenopausal chronic disease risk prediction models. Am. J. Hum. Biol. 28:918-926, 2016. © 2016Wiley Periodicals, Inc.
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Affiliation(s)
- J W Bea
- Department of Medicine, University of Arizona Cancer Center, Tucson, Arizona, 85724-5024.,Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - R M Blew
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - S B Going
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - C-H Hsu
- University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, 85724
| | - M C Lee
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - V R Lee
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - B J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, 94612
| | - M L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, 94612
| | - T G Lohman
- Department of Physiology, University of Arizona, Tucson, Arizona, 85721
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Koo HY, Seo YG, Cho MH, Kim MJ, Choi HC. Weight Change and Associated Factors in Long-Term Breast Cancer Survivors. PLoS One 2016; 11:e0159098. [PMID: 27391162 PMCID: PMC4938573 DOI: 10.1371/journal.pone.0159098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/27/2016] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Weight gain often occurs after breast cancer diagnosis and significantly impacts the general health of cancer survivors. While the number of breast cancer survivors is increasing, few studies have reported data on weight change beyond 5 years post-diagnosis. We investigated weight change and associated factors in long-term survivors of breast cancer. PATIENTS AND METHODS Medical records were reviewed on 1363 breast cancer patients and a total of 822 women who had survived beyond 5 years since diagnosis were included in the final analysis. The association between demographic, anthropometric, lifestyle, cancer related factors (including time since diagnosis, treatment modality, pathologic stage, and hormone receptor status), and weight-change over 5 years were examined. RESULTS During an average 8.2 years of follow-up time, mean weight gain was 0.32kg (p = 0.017). 175 (21.3%) patients had gained more than 5% of their weight at diagnosis and their average gain was 5.55kg. Body mass index (BMI) at diagnosis, age at diagnosis, aromatase inhibitor (AI) use, heavy drinking, and type of surgery were associated with relative weight gain (≥5%) in univariate analysis (all p-values<0.05). Patients who were non-obese at diagnosis showed weight gain, while those who were obese at diagnosis lost weight (0.78kg,-1.11kg, respectively, p<0.001). In multivariate analysis, the non-obese group showed odds ratio of 2.7 (p = 0.001) relative to the obese group. Younger age group (age 18-54 years) showed odds ratio of 1.9 (p = 0.021) relative to the older age group (age 55-75 years), and patients who did not use AI showed odds ratio of 2.2 (p = 0.006) relative to women who did. CONCLUSION Long-term breast cancer survivors who were non-obese at diagnosis are more likely to gain weight than obese survivors. Younger survivors and survivors who have never used AI are also likely to gain weight.
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Affiliation(s)
- Hye-Yeon Koo
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Gyun Seo
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi-Hee Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min-Jung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho-Chun Choi
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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Karatas F, Erdem GU, Sahin S, Aytekin A, Yuce D, Sever AR, Babacan T, Ates O, Ozisik Y, Altundag K. Obesity is an independent prognostic factor of decreased pathological complete response to neoadjuvant chemotherapy in breast cancer patients. Breast 2016; 32:237-244. [PMID: 27318645 DOI: 10.1016/j.breast.2016.05.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The relation between higher body mass index (BMI) and pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer (BC) is a controversial issue according to the data of Western and Asian patients. The aim of this study is to evaluate BMI and pCR to NAC and discuss the importance of pCR outcomes in Turkish BC patients as a bridging country between Europe and Asia. PATIENTS AND METHODS Of the 4423 BC patients diagnosed between the years 1994 and 2015 in Hacettepe University Cancer Institute, 295 female patients with stage II and III BC were enrolled in the study. Three different group divisions were done according to patients' BMI as normal or underweight (N/U) patients (BMI <25 kg/m2), overweight (OW) patients (BMI = 25-29.9 kg/m2) and obese (OB) patients (BMI ≥30 kg/m2). BC subtypes were defined as luminal-like (ER/PR-positive and HER2-negative), HER2/luminal (ER/PR-positive and HER2-positive), HER2-type (ER/PR-negative and HER2-positive), and triple-negative (TNBC; ER/PR- and HER2-negative). The analysis of overall survival (OS) and recurrence-free survival (RFS) was performed according to Kaplan-Meier method. The Log-rank test was used to compare the subgroup analysis and logistic regression analysis to determine the independent prognostic factors. RESULTS In this study, a total number of 93 (31.5%) patients were N/U, 107 (36.3%) patients were OW and 95 (32.2%) patients were OB. Among groups, except for the age, no baseline clinicopathological differences were found. In 70 (23.7%) patients, pCR was achieved. pCR rates in N/U, OW and OB were 31.2%, 22.4%, and 17.9% respectively, showing a considerable trend towards significance (P = 0.09 in chi-square test). In the multivariate logistic regression analysis, obesity was an independent adverse prognostic feature on pCR to NAC compared to N/U patients (OR, 0.34; 95% CI, 0.13 to 0.85, P = 0.02). The recurrence rates were slightly increased with the increase of BMI (N/U = 24.7%, OW = 29.0% and OB = 40%; P = 0.06 respectively). Median RFS was significantly higher in N/U group compared to OB patients (150 vs. 76 months respectively, P = 0.03) and was also higher in pCR group compared to non-pCR patients (151 vs. 77 months P = 0.004). Median OS was significantly higher in N/U patients compared to OB patients (N/U = not reached, OW = 211 and OB = 114 months; P = 0.01) and was also higher in pCR group compared to non-pCR patients (not reached vs. 211 months P = 0.04). In Cox regression analysis; pCR, histopathological grade and TNBC were found as independent prognostic factors on OS (HR, 0.29; 95% CI, 0.11 to 0.79, P = 0.015, HR, 2.09; 95% CI, 1.14 to 3.83, P = 0.017, HR, 1.95; 95% CI, 1.01 to 3.77, P = 0.046, respectively). CONCLUSION It was observed that obesity was an important independent prognostic factor which has an adverse effect on pCR. Moreover it causes decreasing RFS and OS in BC patients who had received NAC. The probability of inefficient treatment in obese patients should be considered.
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Affiliation(s)
- Fatih Karatas
- Diskapi Yildirim Beyazit Education and Training Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Gokmen Umut Erdem
- Ankara Numune Education and Training Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Suleyman Sahin
- Diskapi Yildirim Beyazit Education and Training Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Aydin Aytekin
- Gazi University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Deniz Yuce
- Hacettepe University Faculty of Medicine, Department of Preventive Oncology, Ankara, Turkey
| | - Ali R Sever
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Taner Babacan
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Ozturk Ates
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Yavuz Ozisik
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Kadri Altundag
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey.
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Nelson SH, Marinac CR, Patterson RE, Nechuta SJ, Flatt SW, Caan BJ, Kwan ML, Poole EM, Chen WY, Shu XO, Pierce JP. Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors. Breast Cancer Res Treat 2016; 155:551-7. [PMID: 26861056 DOI: 10.1007/s10549-016-3694-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/29/2016] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to examine post-diagnosis BMI, very low physical activity, and comorbidities, as predictors of breast cancer-specific and all-cause mortality. Data from three female US breast cancer survivor cohorts were harmonized in the After Breast Cancer Pooling Project (n = 9513). Delayed entry Cox proportional hazards models were used to examine the impact of three post-diagnosis lifestyle factors: body mass index (BMI), select comorbidities (diabetes only, hypertension only, or both), and very low physical activity (defined as physical activity <1.5 MET h/week) in individual models and together in multivariate models for breast cancer and all-cause mortality. For breast cancer mortality, the individual lifestyle models demonstrated a significant association with very low physical activity but not with the selected comorbidities or BMI. In the model that included all three lifestyle variables, very low physical activity was associated with a 22 % increased risk of breast cancer mortality (HR 1.22, 95 % CI 1.05, 1.42). For all-cause mortality, the three individual models demonstrated significant associations for all three lifestyle predictors. In the combined model, the strength and significance of the association of comorbidities (both hypertension and diabetes versus neither: HR 2.16, 95 % CI 1.79, 2.60) and very low physical activity (HR 1.35, 95 % CI 1.22, 1.51) remained unchanged, but the association with obesity was completely attenuated. These data indicate that after active treatment, very low physical activity, consistent with a sedentary lifestyle (and comorbidities for all-cause mortality), may account for the increased risk of mortality, with higher BMI, that is seen in other studies.
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Affiliation(s)
- Sandahl H Nelson
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Catherine R Marinac
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Ruth E Patterson
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Sarah J Nechuta
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shirley W Flatt
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA
| | - Bette J Caan
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Elizabeth M Poole
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xiao-ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John P Pierce
- Cancer Prevention and Control Program, Division of Population Science, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, 92093-0901, USA.
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
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Nechuta S, Chen WY, Cai H, Poole EM, Kwan ML, Flatt SW, Patterson RE, Pierce JP, Caan BJ, Ou Shu X. A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor-positive breast cancer prognosis. Int J Cancer 2015; 138:2088-97. [PMID: 26606746 DOI: 10.1002/ijc.29940] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023]
Abstract
Lifestyle factors have been well studied in relation to breast cancer prognosis overall; however, associations of lifestyle and late outcomes (>5 years after diagnosis) have been much less studied, and no studies have focused on estrogen receptor-positive (ER+) breast cancer survivors, who may have high risk of late recurrence and mortality. We utilized a large prospective pooling study to evaluate the associations of lifestyle factors with late recurrence and all-cause mortality among 6,295 5-year ER+ Stage I-III breast cancer survivors. Pooled and harmonized data were available on clinical factors and lifestyle factors (pre- to post-diagnosis weight change, body mass index (BMI) (kg/m(2)), recreational physical activity, alcohol intake and smoking history), measured on average 2.1 years after diagnosis. Updated information for weight only was available. Study heterogeneity was evaluated by the Q-statistic. Multivariable Cox regression models were stratified by study. Adjusting for clinical factors and potential confounders, ≥ 10% weight gain and obesity (BMI, 30-34.99 and ≥ 35) were associated with increased risk of late recurrence (hazard ratios (95% confidence intervals): 1.24 (1.00-1.53), 1.40 (1.05-1.86) and 1.41 (1.02-1.93), respectively). Daily alcohol intake was associated with late recurrence, 1.28 (1.01-1.62). Physical activity was inversely associated with late all-cause mortality (0.81 (0.71-0.93) and 0.71 (0.61-0.82) for 4.9 to <17.4 and ≥ 17.4 metabolic equivalent-hr/week). A U-shaped association was observed for late all-cause mortality and BMI using updated weight (1.42 (1.15-1.74) and 1.40 (1.09-1.81), <21.5 and ≥ 35, respectively). Smoking was associated with increased risk of late outcomes. In this large prospective pooling project, modifiable lifestyle factors were associated with late outcomes among long-term ER+ breast cancer survivors.
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Affiliation(s)
- Sarah Nechuta
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center; and Vanderbilt-Ingram Cancer Center, Vanderbilt School of Medicine, Nashville, TN
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center; and Vanderbilt-Ingram Cancer Center, Vanderbilt School of Medicine, Nashville, TN
| | - Elizabeth M Poole
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Shirley W Flatt
- Cancer Prevention Program, Moores UCSD Cancer Center, University of California, San Diego, CA
| | - Ruth E Patterson
- Cancer Prevention Program, Moores UCSD Cancer Center, University of California, San Diego, CA
| | - John P Pierce
- Cancer Prevention Program, Moores UCSD Cancer Center, University of California, San Diego, CA
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Xiao Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center; and Vanderbilt-Ingram Cancer Center, Vanderbilt School of Medicine, Nashville, TN
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Abstract
Adjuvant chemotherapy continues to play an important role in breast cancer management. Exposure to chemotherapy can lead to a variety of early and late long-term toxicities, including ovarian failure (with resultant infertility and sexual dysfunction), bone loss, weight gain, neurotoxicity, neurocognitive changes, cardiac toxicity and secondary malignancy. Although chemotherapy effects may vary in medical severity, all effects have the potential to lead to a decrease in quality of life and a decrement on overall health status. Improved understanding of the etiology and management of chemotherapy-related toxicity may allow optimization of patient selection for treatment and ameliorate the concerns of patients who are considering embarking on a chemotherapy program. This article presents an overview of relevant early and late long-term toxicities, with a focus on recent advances and clinical management.
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Affiliation(s)
- Erica L Mayer
- From the Breast Oncology Center, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA
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Playdon MC, Bracken MB, Sanft TB, Ligibel JA, Harrigan M, Irwin ML. Weight Gain After Breast Cancer Diagnosis and All-Cause Mortality: Systematic Review and Meta-Analysis. J Natl Cancer Inst 2015; 107:djv275. [PMID: 26424778 DOI: 10.1093/jnci/djv275] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/28/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Overweight and obesity are associated with breast cancer mortality. However, the relationship between postdiagnosis weight gain and mortality is unclear. We conducted a systematic review and meta-analysis of weight gain after breast cancer diagnosis and breast cancer-specific, all-cause mortality and recurrence outcomes. METHODS Electronic databases identified articles up through December 2014, including: PubMed (1966-present), EMBASE (1974-present), CINAHL (1982-present), and Web of Science. Language and publication status were unrestricted. Cohort studies and clinical trials measuring weight change after diagnosis and all-cause/breast cancer-specific mortality or recurrence were considered. Participants were women age 18 years or older with stage I-IIIC breast cancer. Fixed effects analysis summarized the association between weight gain (≥5.0% body weight) and all-cause mortality; all tests were two-sided. RESULTS Twelve studies (n = 23 832) were included. Weight gain (≥5.0%) compared with maintenance (<±5.0%) was associated with increased all-cause mortality (hazard ratio [HR] = 1.12, 95% confidence interval [CI] = 1.03 to 1.22, P = .01, I(2) = 55.0%). Higher risk of mortality was apparent for weight gain ≥10.0% (HR = 1.23, 95% CI = 1.09 to 1.39, P < .001); 5% to 10.0% weight gain was not associated with all-cause mortality (P = .40). The association was not statistically significant for those with a prediagnosis body mass index (BMI) of less than 25 kg/m(2) (HR = 1.14, 95% CI = 0.99 to 1.31, P = .07) or with a BMI of 25 kg/m(2) or higher (HR = 1.00, 95% CI = 0.86 to 1.16, P = .19). Weight gain of 10.0% or more was not associated with hazard of breast cancer-specific mortality (HR = 1.17, 95% CI = 1.00 to 1.38, P = .05). CONCLUSIONS Weight gain after diagnosis of breast cancer is associated with higher all-cause mortality rates compared with maintaining body weight. Adverse effects are greater for weight gains of 10.0% or higher.
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Affiliation(s)
- Mary C Playdon
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT (MCP, MLI, MBB, MH); Yale Cancer Center, New Haven, CT (MLI, TBS); Dana-Farber Cancer Institute, Boston, MA (JAL).
| | - Michael B Bracken
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT (MCP, MLI, MBB, MH); Yale Cancer Center, New Haven, CT (MLI, TBS); Dana-Farber Cancer Institute, Boston, MA (JAL)
| | - Tara B Sanft
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT (MCP, MLI, MBB, MH); Yale Cancer Center, New Haven, CT (MLI, TBS); Dana-Farber Cancer Institute, Boston, MA (JAL)
| | - Jennifer A Ligibel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT (MCP, MLI, MBB, MH); Yale Cancer Center, New Haven, CT (MLI, TBS); Dana-Farber Cancer Institute, Boston, MA (JAL)
| | - Maura Harrigan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT (MCP, MLI, MBB, MH); Yale Cancer Center, New Haven, CT (MLI, TBS); Dana-Farber Cancer Institute, Boston, MA (JAL)
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT (MCP, MLI, MBB, MH); Yale Cancer Center, New Haven, CT (MLI, TBS); Dana-Farber Cancer Institute, Boston, MA (JAL)
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Atalay C, Küçük Aİ. The impact of weight gain during adjuvant chemotherapy on survival in breast cancer. ULUSAL CERRAHI DERGISI 2015; 31:124-7. [PMID: 26504414 DOI: 10.5152/ucd.2015.3123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Weight gain can be detected during adjuvant chemotherapy in breast cancer patients, leading to administration of lower drug doses than planned and a decrease in long-term survival. In this study, the effect of weight gain on survival in breast cancer patients was investigated. MATERIAL AND METHODS Breast cancer patients treated with adjuvant chemotherapy between May 2002 and May 2003 were prospectively included in the study. Patients treated with neoadjuvant chemotherapy or with chemotherapy for metastatic disease were excluded from the study. Data regarding patients' demographic, clinical and pathologic characteristics and chemotherapy protocols were recorded. Patients were grouped as those with weight gain less than or more than 3 kg, and those with a body mass index of less than or more than 30. The impact of weight gain on patients' disease-free and overall survival was investigated. Log-rank test and Cox regression analyses were utilized for survival analyses. P<0.05 value was accepted as statistically significant. RESULTS Eighty-eight consecutive female patients with a median age of 46 (29-71) were included in the study. Patients received anthracycline based chemotherapy protocols. Weight gain was detected in 79 patients (89.8%), with more than 3 kg weight gain detected in 38 patients (43.2%). In a median follow-up time of 98 months (62-120), distant metastases were detected in 21 patients (23.9%), and 11 patients (12.5%) died. Mean disease-free survival of patients with a weight gain less than and more than 3 kg during chemotherapy was 89.1±3.9 and 84.7±4.2 months (p=0.007), whereas mean overall survival was 95.6±2.2 and 92.5±2.1 months (p=0.01), respectively. Mean disease-free survival of patients with a body mass index less than and more than 30 was 87.3±2.3 and 85.1±3.6 months (p=0.4), whereas mean overall survival was 94.2±2.3 and 92.1±1.1 months (p=0.35), respectively. CONCLUSION Weight gain during adjuvant chemotherapy has a negative effect on both disease-free and overall survival in patients with breast cancer.
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Affiliation(s)
- Can Atalay
- Clinic of General Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ali İmran Küçük
- Clinic of General Surgery, Derince Training and Research Hospital, Kocaeli, Turkey
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Fedele P, Orlando L, Schiavone P, Quaranta A, Lapolla AM, De Pasquale M, Ardizzone A, Bria E, Sperduti I, Calvani N, Marino A, Caliolo C, Mazzoni E, Cinieri S. BMI variation increases recurrence risk in women with early-stage breast cancer. Future Oncol 2015; 10:2459-68. [PMID: 25525854 DOI: 10.2217/fon.14.180] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS The prognostic role of BMI variation during and/or after treatments for early-stage breast cancer is still unknown. PATIENTS & METHODS The χ(2) test was conducted to explore the correlation between breast cancer recurrence and BMI changes in 520 early-stage breast cancer patients. Cox proportional hazard models were used to analyze the association of BMI changes, baseline BMI, known prognostic factors and recurrences. RESULTS BMI gain was significant determinant of recurrences (p = 0.0008). In multivariate analyses, BMI variation more than 5.71% was associated with higher rates of recurrences, as well as age less than 55 years, stage disease and molecular subtype. CONCLUSION Women who experience BMI gain after breast cancer may be at increased risk of poor outcomes.
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Affiliation(s)
- Palma Fedele
- Medical Oncology & Breast Unit, 'A Perrino' Hospital, SS 7 Appia, 72100 Brindisi, Italy
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Schmidt S, Monk JM, Robinson LE, Mourtzakis M. The integrative role of leptin, oestrogen and the insulin family in obesity-associated breast cancer: potential effects of exercise. Obes Rev 2015; 16:473-87. [PMID: 25875578 PMCID: PMC4691342 DOI: 10.1111/obr.12281] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/06/2015] [Accepted: 02/24/2015] [Indexed: 12/13/2022]
Abstract
Obesity is an established risk factor for postmenopausal breast cancer. The mechanisms through which obesity influences the development and progression of breast cancer are not fully elucidated; however, several factors such as increased oestrogen, concentrations of various members of the insulin family and inflammation that are associated with adiposity are purported to be important factors in this relationship. Emerging research has also begun to focus on the role of adipokines, (i.e. adipocyte secreted factors), in breast cancer. Leptin secretion is directly related to adiposity and is believed to promote breast cancer directly and independently, as well as through involvement with the oestrogen and insulin signalling pathways. As leptin is secreted from white adipose tissue, any intervention that reduces adiposity may be favourable. However, it is also important to consider that energy expenditure through exercise, independent of fat loss, may improve leptin regulation. The purpose of this narrative review was to explore the role of leptin in breast cancer development and progression, identify key interactions with oestrogen and the insulin family, and distinguish the potential effects of exercise on these interactions.
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Affiliation(s)
- S Schmidt
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - J M Monk
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - L E Robinson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - M Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
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Ghose A, Kundu R, Toumeh A, Hornbeck C, Mohamed I. A review of obesity, insulin resistance, and the role of exercise in breast cancer patients. Nutr Cancer 2015; 67:197-202. [PMID: 25625592 DOI: 10.1080/01635581.2015.990569] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Breast cancer, the most common female malignancy in the world, has a strong association with obesity and insulin resistance. The importance of these risk factors goes up significantly in patients already affected by this cancer as they negatively affect the prognosis, recurrence rate, and survival by various mechanisms. The literature on the role of physical activity and aerobic exercise on modifying the above risks is debatable with data both for and against it. In this article, we have reviewed the risks of obesity and insulin resistance in breast cancer patients and the controversy associated with the impact of exercise. Ultimately, we have concluded that a randomized control trial is necessary with an individualized aerobic exercise program for a minimum duration of 20 wk on breast cancer patients, who are undergoing or recently completed chemotherapy, to study its effects on insulin resistance, weight, and clinical outcome.
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Affiliation(s)
- Abhimanyu Ghose
- a Department of Hematology/Oncology , University of Cincinnati , Cincinnati , Ohio , USA
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Flores AM, Dwyer K. Shoulder impairment before breast cancer surgery. JOURNAL OF WOMEN'S HEALTH PHYSICAL THERAPY 2014; 38:118-124. [PMID: 25593563 PMCID: PMC4290873 DOI: 10.1097/jwh.0000000000000020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To compare pre- and post-operative shoulder active range of motion (AROM) values from female breast cancer survivors to population norm values for shoulder AROM; and to compare shoulder AROM differences pre- and post-surgery between female African American and White breast cancer survivors (BCA). STUDY DESIGN This pilot study used a convenience sample and longitudinal design measuring participants 2 times (T0 = baseline, after biopsy but within 2 weeks before BCA surgery; T1 = 2nd postoperative week). BACKGROUND The U.S. has the largest BCA survivor population in history and yet the mortality burden remains highest among AA BCA survivors. AAs may also have greater burden of physical and functional side effects compared to whites and the general population. METHODS AND MEASURES The data were collected from a convenience sample (n = 33; nAA = 9, nW = 24) and included data on shoulder AROM, medical chart review for pre- and co-morbid conditions, and self-reported demographics and medical history. We used t-tests to compare sample AROM means to population norms. We then compared our sample across 2 timepoints (T0 = pre-surgery; T1 = 2 weeks post-surgery) using independent samples t-tests and repeated measures analysis of variance (p < .05) to compare AA to White sub-samples AROM means. RESULTS African Americans had significantly less shoulder abduction (at T0) and flexion (at T1) than whites. However, 100% had significantly reduced AROM for all movements at T0 (prior to surgery but after biopsy) when compared to population norms. CONCLUSIONS The significant reduction in shoulder AROM after biopsy but before surgery points to a possible unmet need for early physical therapy intervention. Further research using randomized controlled trial design is recommended.
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Affiliation(s)
- Ann Marie Flores
- Department of Physical Therapy, Rehabilitation and Movement Sciences, Center for Cancer Survivorship Studies, Northeastern University, Boston, MA
| | - Kathleen Dwyer
- College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117
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Sedjo RL, Byers T, Ganz PA, Colditz GA, Demark-Wahnefried W, Wolin KY, Azrad M, Rock CL. Weight gain prior to entry into a weight-loss intervention study among overweight and obese breast cancer survivors. J Cancer Surviv 2014; 8:410-8. [PMID: 24599421 PMCID: PMC4127359 DOI: 10.1007/s11764-014-0351-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/08/2014] [Indexed: 01/03/2023]
Abstract
PURPOSE Changes in cancer therapy, in addition to changes in obesity prevalence, suggest the need for a current assessment of weight gain patterns following breast cancer diagnosis. The aim of this study was to evaluate factors associated with weight gain among breast cancer survivors prior to enrolling into a behavioral weight loss intervention. METHODS Anthropometric measures and data on weight-related factors were collected at baseline on 665 breast cancer survivors. Postdiagnosis weight gain was determined between entry into the trial and previous diagnosis up to 5 years. Multivariate logistic regression analyses were used to evaluate the association between weight gain and influencing factors. RESULTS The mean weight gain was 4.5 % body weight (standard deviation = 10.6); 44 % of women experienced ≥5 % body weight gain. The risk of weight gain was inversely associated with age (adjusted odds ratio (ORadj) = 0.97, 95 % confidence interval (95 % CI) 0.95-0.99), Hispanic ethnicity (ORadj = 0.30, 95 % CI 0.13-0.68), and overweight (ORadj = 0.11, 95 % CI 0.05-0.23) or obese (ORadj = 0.03, 95 % CI 0.02-0.07) status at diagnosis and positively associated with time elapsed since diagnosis (ORadj = 1.19/year, 95 % CI 1.04-1.36). Women prescribed aromatase inhibitors were 46 % less likely to gain weight compared to women prescribed selective estrogen-receptor modulators (ORadj = 0.54, 95 % CI 0.31-0.93). The risk of weight gain was positively associated with smoking at diagnosis (ORadj = 2.69, 95 % CI 1.12-6.49) although this was attributable to women who subsequently quit smoking. CONCLUSIONS Postdiagnosis weight gain is common and complex and influenced by age, ethnicity, weight, smoking status, time elapsed since diagnosis, and endocrine-modulating therapy. IMPLICATIONS FOR CANCER SURVIVORS Weight gain continues to be a concern following a diagnosis of breast cancer. Factors influencing this weight gain include age, ethnicity, weight, smoking status, time elapsed since diagnosis, and endocrine-modulating therapy. Effective weight management strategies are needed for this population of women.
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Affiliation(s)
- Rebecca L Sedjo
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Place, MS F519, Aurora, CO, 80045, USA,
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Associations between self-reported post-diagnosis physical activity changes, body weight changes, and psychosocial well-being in breast cancer survivors. Support Care Cancer 2014; 23:159-67. [PMID: 25022760 DOI: 10.1007/s00520-014-2346-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/29/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Decreased physical activity and weight gain post-breast cancer diagnosis are associated with negative psychosocial, health, and disease outcomes, but little is known about how these factors interact. The purpose of the present study was to conduct a preliminary examination of the association between post-diagnosis physical activity changes, weight changes, and psychosocial well-being in breast cancer survivors. METHODS We examined the association between retrospectively collected, self-reported post-diagnosis changes in physical activity and body weight and post-diagnosis fatigue, anxiety, depression, stress, self-esteem, and health-related quality of life (HRQOL) in breast cancer survivors (N = 1,348) using univariate analyses of covariance with Bonferroni's adjustment. RESULTS After adjusting for covariates, maintaining and/or increasing physical activity post-diagnosis was significantly (p < 0.05 for all), independently associated with lower fatigue, anxiety, depression and stress and higher physical self-worth, physical, social, emotional, functional and breast cancer specific well-being and overall HRQOL (effect sizes = 0.23 to 0.60). Maintaining and/or losing weight was significantly (p < 0.05), independently associated with lower fatigue and higher physical self-worth, physical and breast cancer-specific well-being, and overall HRQOL (effect sizes = .28 to 0.87). There were no significant interaction effects between physical activity and body weight changes. CONCLUSIONS This study provides preliminary data to suggest that maintaining or increasing physical activity and controlling weight post-diagnosis may be independently, positively associated with psychosocial well-being and HRQOL in breast cancer survivors. In addition, weight management effects may be larger and more outcome-specific while physical activity effects may be more general. Future research is warranted to replicate and confirm these findings.
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Larkey LK, Vega-López S, Keller C, McClain D, Ainsworth B, Ohri-Vachaspati P, Smith L, Jeong M. A biobehavioral model of weight loss associated with meditative movement practice among breast cancer survivors. Health Psychol Open 2014; 1:2055102914565495. [PMID: 28070347 PMCID: PMC5193257 DOI: 10.1177/2055102914565495] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Women with breast cancer often experience weight gain during and after treatment, significantly increasing risk for recurrence as well as all-cause mortality. Based on a growing body of evidence, meditative movement practices may be effective for weight management. First, we describe the effects of stress on factors associated with weight gain for breast cancer survivors. Then, a model is proposed that utilizes existing evidence to suggest how meditative movement supports behavioral, psychological, and neurohormonal changes that may explain weight loss. Application of the model suggests how a novel "mindful-body-wisdom" approach may work to help reduce weight for this at-risk group.
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Oshakbayev KP, Alibek K, Ponomarev IO, Uderbayev NN, Dukenbayeva BA. Weight change therapy as a potential treatment for end-stage ovarian carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:203-11. [PMID: 24847411 PMCID: PMC4025513 DOI: 10.12659/ajcr.890229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 01/27/2014] [Indexed: 12/18/2022]
Abstract
Patient: Female, 41 Final Diagnosis: Ovarian carcinoma Symptoms: Ascites • hepatomegaly • weight loss Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
| | - Kenneth Alibek
- Department of Oncology, Republican Scientific Center for Emergency Medicine, Astana, Republic of Kazakhstan
| | - Igor Olegovich Ponomarev
- Department of Oncology, Republican Scientific Center for Emergency Medicine, Astana, Republic of Kazakhstan
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Weight change and its impact on prognosis after adjuvant TAC (docetaxel-doxorubicin-cyclophosphamide) chemotherapy in Korean women with node-positive breast cancer. Med Oncol 2014; 31:849. [PMID: 24496561 DOI: 10.1007/s12032-014-0849-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
The aim of this study was to characterize weight changes and analyze their effect on prognosis after three-drug combination chemotherapy using docetaxel, doxorubicin and cyclophosphamide (TAC) chemotherapy in Korean women with breast cancer. We analyzed weight changes and the effect of these changes on relapse-free survival (RFS) in 108 patients who received adjuvant TAC chemotherapy at the Department of Surgery of St. Vincent's Hospital at the Catholic University of Korea between January 2005 and March 2010. Following chemotherapy, 59 (54.6%) patients experienced weight gain, with their weight significantly increasing compared to their weight at diagnosis (p<0.0001). However, weight gain after chemotherapy was not associated with RFS [hazard ratio (HR) 1.1; 95% confidence interval (CI) 0.4-3.0; p=0.8955]. No significant weight (at 12 months, p=0.522; at 24 months, p=0.632) and body mass index (BMI) (at 12 months, p=0.381; at 24 months, p=0.288) changes were observed compared to the weight and BMI at diagnosis, and weight change at 12 months (HR 1.9; 95% CI 0.6-6.1; p=0.2786) and 24 months (HR 2.7; 95% CI 0.9-8.4; p=0.0776) was not associated with RFS. The present study suggests that weight gain after adjuvant TAC chemotherapy is common in Korean women with breast cancer. In contrast to previous Western studies, weight gain did not appear to be sustained, and there was no relationship between weight gain and poor RFS.
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