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Forster M, Deal AM, Page A, Vohra S, Wardell AC, Pak J, Lund JL, Nyrop KA, Muss HB. Dose delay, dose reduction, and early treatment discontinuation in Black and White women receiving chemotherapy for nonmetastatic breast cancer. Oncologist 2024:oyae150. [PMID: 38913986 DOI: 10.1093/oncolo/oyae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/14/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND To describe reasons for deviations from planned chemotherapy treatments in women with nonmetastatic breast cancer that contribute to less-than-planned receipt of chemotherapy. METHODS Electronic medical records for patients receiving chemotherapy were reviewed for adverse events and treatment modifications. Log-binomial regression models were used to estimate relative risks (RRs) with 95% CIs to examine associations between chemotherapy modifications, patient characteristics, and treatment modalities. RESULTS Delays in chemotherapy initiation (7%) were for surgical complications (58%), personal reasons (16%), and other (26%; port malfunction, infections, and obtaining extra imaging). Delays during chemotherapy (38%) were for infections (20%), neutropenia (13%), and personal reasons (13%). Dose reductions (38%) were for neuropathy (36%), unknown causes (9%), anemia (9%), and neutropenia (8%). Early treatment discontinuations (23%) were for neuropathy (29%). Patients receiving paclitaxel/nab-paclitaxel (RR 2.05; 95% CI, 1.47-2.87) and an anthracycline (RR 1.89; 95% CI, 1.39-2.57) reported more dose delays during chemotherapy. Black race (RR 1.46; 95% CI, 1.07-2.00), stage 3 (RR 1.79; 95% CI, 1.09-2.93), and paclitaxel/nab-paclitaxel receipt (RR 1.39; 95% CI, 1.02-1.90) increased the likelihood of dose reduction. Both Black race (RR 2.06; 95% CI, 1.35-3.15) and receipt of paclitaxel/nab-paclitaxel (RR 1.93; 95% CI, 1.19-3.13) increased the likelihood of early discontinuation. Patients receiving anthracyclines had higher rates of hospitalizations during chemotherapy (RR: 1.79; 95% CI, 1.11-2.89). CONCLUSION Toxicities are the most common reason for treatment modifications and need close monitoring in high-risk groups for timely intervention. Dose reductions and early treatment discontinuations occurred more for Black patients and need further study.
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Affiliation(s)
- Moriah Forster
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University, Nashville, TN 37232, United States
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Annie Page
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Sanah Vohra
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Alexis C Wardell
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Joyce Pak
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Jennifer L Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
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Zhao FY, Liu JE, Fang XM, Chen L, Liang JG, Liu Y, Li RL, Chen HR. Effects of a 12-week exercise-based intervention on weight management in overweight or obese breast cancer survivors: a randomized controlled trial. Support Care Cancer 2024; 32:98. [PMID: 38200265 DOI: 10.1007/s00520-023-08300-6] [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: 09/05/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Breast cancer survivors face dual challenges: long-term sequelae of treatment and the risk of recurrent disease. Furthermore, obesity and a sedentary lifestyle can complicate both challenges. We aimed to assess the effect of a 12-week exercise-based weight-management program in overweight/obese breast cancer survivors. METHODS A two-arm, single-blinded, randomized controlled trial was conducted among 60 overweight/obese, stage 0-III breast cancer survivors. During the 12-week program, the intervention group received weekly information support, fortnightly exercise prescriptions, including aerobic and resistance exercises to perform at home, and one dietary instruction. The control group received information support about weight management and exercise. Weight, body composition, and physical fitness data were collected at baseline, postintervention, and the 3-month follow-up. RESULTS The intervention group showed significant improvements in body weight and all adiposity indices, including body mass index, waist circumference, and %body fat, in comparison with baseline (P < 0.001) and the control group (P < 0.05). Both groups showed no significant changes in fat-free mass during the 6-month period (P > 0.05). International Physical Activity Questionnaire scores and left grip strength increased significantly in the intervention group in comparison with the baseline (P < 0.01) and the control group (P < 0.05). Right grip strength, lower-body strength, and aerobic endurance showed no significant intergroup differences (P > 0.05). CONCLUSIONS A combination of exercise prescription and weight-loss interventions yielded clinically meaningful weight loss in overweight/obese breast cancer survivors. These findings may facilitate the incorporation of home-based exercise and weight management into breast cancer treatment and survivorship care.
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Affiliation(s)
- Fu-Yun Zhao
- School of Nursing, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, China
| | - Jun-E Liu
- School of Nursing, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, China.
| | - Xiao-Ming Fang
- Department of Breast Surgery, Yantai Yuhuangding Hospital, Shandong, China
| | - Lu Chen
- School of Nursing, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, China
| | - Jia-Gui Liang
- School of Nursing, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, China
| | - Yu Liu
- School of Nursing, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, China
| | - Ruo-Lin Li
- School of Nursing, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, China
| | - Hai-Rong Chen
- School of Nursing, Capital Medical University, No. 10, Xitoutiao, You An Men Wai, Fengtai District, Beijing, China
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Uhelski ACR, Blackford AL, Sheng JY, Snyder C, Lehman J, Visvanathan K, Lim D, Stearns V, Smith KL. Factors associated with weight gain in pre- and post-menopausal women receiving adjuvant endocrine therapy for breast cancer. J Cancer Surviv 2023:10.1007/s11764-023-01408-y. [PMID: 37261654 DOI: 10.1007/s11764-023-01408-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Weight gain after breast cancer poses health risks. We aimed to identify factors associated with weight gain during adjuvant endocrine therapy (AET). METHODS Women initiating AET enrolled in a prospective cohort. Participants completed FACT-ES plus PROMIS pain interference, depression, anxiety, fatigue, sleep disturbance and physical function measures at baseline, 3, 6, 12, 24, 36, 48 and 60 months. Treatment-emergent symptoms were defined as changes in scores in the direction indicative of worsening symptoms that exceeded the minimal important difference at 3 and/or 6 months compared to baseline. We used logistic regression to evaluate associations of clinicodemographic features and treatment-emergent symptoms with clinically significant weight gain over 60 months (defined as ≥ 5% compared to baseline) in pre- and post-menopausal participants. RESULTS Of 309 participants, 99 (32%) were pre-menopausal. The 60 months cumulative incidence of clinically significant weight gain was greater in pre- than post-menopausal participants (67% vs 43%, p < 0.001). Among pre-menopausal participants, treatment-emergent pain interference (OR 2.49), aromatase inhibitor receipt (OR 2.8), mastectomy, (OR 2.06) and White race (OR 7.13) were associated with weight gain. Among post-menopausal participants, treatment-emergent endocrine symptoms (OR 2.86), higher stage (OR 2.25) and White race (OR 2.29) were associated with weight gain while treatment-emergent physical function decline (OR 0.30) was associated with lower likelihood of weight gain. CONCLUSIONS Weight gain during AET is common, especially for pre-menopausal women. Clinicodemographic features and early treatment-emergent symptoms may identify at risk individuals. IMPLICATIONS FOR CANCER SURVIVORS Patients at risk for weight gain can be identified early during AET. CLINICAL TRIALS GOV IDENTIFIER NCT01937052, registered September 3, 2013.
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Affiliation(s)
- Anna-Carson Rimer Uhelski
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Hematology/Oncology Fellowship Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jennifer Y Sheng
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Lehman
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kala Visvanathan
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cancer Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Lim
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Division of Statistics, Collaborative Inc., WCG, Washington, DC, USA
| | - Vered Stearns
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Under Armour Breast Health Innovation Center, The Skip Viragh Outpatient Cancer, Building 201 North Broadway Viragh 10th floor, Room 10291, Baltimore, MD, 21287, USA.
| | - Karen Lisa Smith
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- AstraZeneca, Gaithersburg, MD, USA
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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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Nyrop KA, O'Hare EA, Teal R, Stein K, Muss HB, Charlot M. Person-centered communication about weight and weight management: Focus group discussions in a diverse sample of women with nonmetastatic breast cancer and obesity. Cancer 2021; 127:4266-4276. [PMID: 34374079 PMCID: PMC9907558 DOI: 10.1002/cncr.33843] [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: 05/26/2021] [Revised: 07/12/2021] [Accepted: 07/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Women with obesity are at higher risk for high-grade and/or advanced-stage breast cancer in comparison with women without obesity. Many women with a high body mass index (BMI) at breast cancer diagnosis experience further weight gain during and after treatment. This study investigated Black and White patient perspectives on conversations with their oncologists about weight and weight management. METHODS Focus groups using a virtual platform (Zoom) were conducted with women after primary treatment for stage I to III breast cancer who were 21 years or older and had a BMI ≥ 30 kg/m2 : 2 with Black women (n = 12) and 2 with White women (n = 14). RESULTS Participants asked that their oncologists be "transparent" about weight gain as a potential side effect of their cancer treatment and how excess weight might affect their prognosis and survival. They asked to be "seen as an individual" to facilitate both person-centered and culturally appropriate conversations about behavioral changes needed for weight management. Participants urged clinicians to take the lead in initiating conversations about weight to underscore its importance in cancer care and survivorship. They welcomed actionable recommendations about nutrition and exercise from either the oncology clinician or a specialist. Participants offered specific suggestions on how clinicians could initiate weight-related conversations, beginning with questions eliciting patients' perspectives on their weight and lifestyle. CONCLUSIONS Many women with early-stage breast cancer and obesity have concerns about weight and weight gain and urge their oncologists to use an active and personalized approach in recommending and supporting efforts at weight management. LAY SUMMARY Focus group discussions with Black and White women with early-stage breast cancer and obesity have elicited patient perspectives on conversations with their oncologists about weight and weight management. Many patients have concerns about weight and weight gain and urge their oncologists to use an active and personalized approach in recommending and supporting efforts at weight management.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin A O'Hare
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn Stein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marjory Charlot
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Fukui J, White K, Frankland TB, Oshiro C, Wilkens L. Weight changes according to treatment in a diverse cohort of breast cancer patients. BMC Cancer 2021; 21:1005. [PMID: 34496789 PMCID: PMC8425001 DOI: 10.1186/s12885-021-08740-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Weight changes are common among breast cancer patients. The majority of studies to date have focused on weight gain after a breast cancer diagnosis and its implications on health in survivors. Fewer studies have examined weight loss and its related characteristics. Weight changes have been reported to be influenced by several factors such as age, treatment, stage and pre-diagnostic weight. We evaluated weight changes during key treatment time points in early stage breast cancer patients. METHODS We characterized 389 female patients diagnosed in Hawaii with early stage breast cancer from 2003 to 2017 in the Multiethnic Cohort (MEC) linked with Kaiser Permanente Hawaii electronic medical record data. We evaluated weight changes from surgery to 4 years post-diagnosis with six time points along a patient's treatment trajectory (chemotherapy, radiation, endocrine, or surgery alone) and annually thereafter, adjusting for age, race/ethnicity and initial body mass index (BMI). RESULTS We found key time points of significant weight change for breast cancer patients according to their adjuvant treatment. In patients who had surgery alone (S), surgery-radiation (SR), or surgery-endocrine therapy (SE), the majority of patients had stable weight, although this consistently decreased over time. However, the percentages of patients with weight loss and weight gain during this time steadily increased up to 4 years after initial surgery. Weight loss was more common than weight gain by about 2 fold in these treatment groups. For patients with surgery-chemotherapy (SC), there was significant weight loss seen within the first 3 months after surgery, during the time when patients receive chemotherapy. And this weight loss persisted until year 4. Weight gain was less commonly seen in this treatment group. CONCLUSIONS We identified key time points during breast cancer treatment that may provide a therapeutic window to positively influence outcomes. Tailored weight management interventions should be utilized to promote overall health and long term survivorship.
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Affiliation(s)
- Jami Fukui
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813 USA
| | - Kami White
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813 USA
| | - Timothy B. Frankland
- Kaiser Permanente, Center for Integrated Health Care Research, 501 Alakawa St. Suite 201, Honolulu, HI 96817 USA
| | - Caryn Oshiro
- Kaiser Permanente, Center for Integrated Health Care Research, 501 Alakawa St. Suite 201, Honolulu, HI 96817 USA
| | - Lynne Wilkens
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813 USA
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Okumatsu K, Yamauchi H, Kotake R, Gosho M, Nakata Y. Association between Endocrine Therapy and Weight Gain after Breast Cancer Diagnosis among Japanese Patients: A Retrospective Cohort Study. ACTA ACUST UNITED AC 2021; 9:medsci9030050. [PMID: 34287341 PMCID: PMC8293471 DOI: 10.3390/medsci9030050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to investigate the association between endocrine therapy and weight gain with a history of breast cancer. METHODS This was a retrospective cohort study. Recruited patients consisted of those receiving endocrine therapy and those not receiving endocrine therapy. Weight at diagnosis was collected from medical records, and current body mass was measured using a digital scale (time since diagnosis was 4.0 ± 1.9 years). Moreover, we measured current physical activity using an accelerometer and dietary intake using a validated questionnaire. The primary analysis was a t-test for the body-mass change after diagnosis between the two groups. RESULTS We recruited 300 patients and collected data from 292. Mean weight gain after diagnosis was 1.3 ± 3.9 kg, and the change in body mass of patients taking endocrine therapy (1.3 ± 4.0 kg) was not significantly different from that of patients not taking endocrine therapy (1.4 ± 3.8 kg, p = 0.92). There was no association of endocrine therapy, physical activity, and dietary intake with a 5% weight gain after adjusting confounding factors (e.g., breast cancer stage and chemotherapy). CONCLUSIONS Caution is required with generalization because of sampling bias and ethnic differences.
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Affiliation(s)
- Koki Okumatsu
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan;
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St. Luke’s International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo 104-8560, Japan; (H.Y.); (R.K.)
| | - Rina Kotake
- Department of Breast Surgical Oncology, St. Luke’s International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo 104-8560, Japan; (H.Y.); (R.K.)
| | - Masahiko Gosho
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan;
| | - Yoshio Nakata
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan
- Correspondence: ; Tel.: +81-29-853-3957
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Nyrop KA, Damone EM, Deal AM, Carey LA, Lorentsen M, Shachar SS, Williams GW, Brenizer AT, Wheless A, Muss HB. Obesity, comorbidities, and treatment selection in Black and White women with early breast cancer. Cancer 2020; 127:922-930. [PMID: 33284988 DOI: 10.1002/cncr.33288] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study investigates obesity and comorbidity in Black and White women with early breast cancer (stages I-III) and their potential impact on treatment decisions for patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) tumors. METHODS In this retrospective chart review, comparisons of frequencies for Black and White patients were calculated with the Fisher exact test. Log binomial regression was used to estimate prevalence ratios (PRs) with 95% confidence intervals for total and individual comorbidities, and multivariable modeling was used to estimate PRs adjusted for age and body mass index (BMI). RESULTS In a sample of 548 patients, 26% were Black, and 74% were White. Sixty-two percent of Black patients and 32% of White patients were obese (BMI ≥ 30 kg/m2 ; P < .0001). Seventy-five percent of Black patients and 87% of White patients had HR+ tumors (P = .001). Significant intergroup differences were seen for 2 or more total comorbidities (62% of Blacks vs 47% of Whites; P = .001), 2 or more obesity-related comorbidities (33% vs 10%; P < .0001), hypertension (60% vs 32%; P < .0001), diabetes mellitus (23% vs 6%; P < .0001), hypercholesterolemia or hyperlipidemia (28% vs 18%; P = .02), and hypothyroidism (4% vs 11%; P = .012). In women with HR+/HER2- tumors, there were no intergroup differences in treatment decisions regarding the type of surgery, chemotherapy regimen, radiation, or endocrine treatment despite significant differences in the prevalence of obesity and comorbidities. CONCLUSIONS This study documents significant disparities between Black and White women with early breast cancer with regard to high rates of obesity, overall comorbidities, and obesity-related comorbidities, and it highlights the prevalence of competing risks that may complicate outcomes in breast cancer.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily M Damone
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Lorentsen
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Grant W Williams
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Addison Tucker Brenizer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amy Wheless
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Nock NL, Jiang H, Borato L, Alberts J, Dimitropoulos A. Insights to the neural response to food cues in class III compared with class I and II obese adults using a sample of endometrial cancer survivors seeking weight loss. Nutr Diabetes 2020; 10:21. [PMID: 32541652 PMCID: PMC7296040 DOI: 10.1038/s41387-020-0124-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background The rates of severe or Class III obesity (BMI ≥ 40.0 kg/m2) and endometrial cancer (EC) incidence and mortality have been increasing significantly in the United States. Adults with severe obesity are more likely to die and women with severe obesity have a higher risk of EC development and mortality than those with Class I/II obesity (BMI: 30–<40 kg/m2). However, no prior studies have evaluated the neural response to food cues by obesity severity/class in adults with or without cancer. Methods We conducted a functional magnetic resonance imaging visual food cue task in 85 obese Stage I EC survivors who were seeking weight loss in a lifestyle intervention at baseline. We evaluated the neural response to high-calorie vs. non-food images after an overnight fast (fasted state) and after eating a standardized meal (fed state), and grouped patients by obesity class (Class I/II: n = 38; Class III: n = 47). Results In the fasted state, we found increased activation in several regions including the dorsolateral prefrontal cortex (DLPFC) in Class III and Class I/II patients (whole brain cluster corrected (WBCC), p < 0.05), which was significantly higher in Class III vs. Class I/II (p < 0.05). We found decreased activation in the insula in the fasted state, which was significantly lower in Class I/II vs. Class III (p = 0.03). In the fed state, we found increased activation in the DLPFC in Class III and Class I/II (WBCC, p < 0.05). The increased activation in cognitive control/inhibition regions (DLPFC) is consistent with the summative literature; however, the decreased activation in taste information processing regions (insula) was unexpected. Conclusions Our results provide novel insights on food cue response between different classes of obesity and highlight the importance of targeting the DLPFC in weight loss interventions, particularly in severely obese patients. Additional studies examining food-related neural circuitry between different classes of obesity are needed.
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Affiliation(s)
- Nora L Nock
- Departments of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA. .,Case Comprehensive Cancer Center, Cleveland, OH, USA.
| | - Huangqi Jiang
- Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Lauren Borato
- Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jay Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
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10
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Aleixo GFP, Deal AM, Nyrop KA, Muss HB, Damone EM, Williams GR, Yu H, Shachar SS. Association of body composition with function in women with early breast cancer. Breast Cancer Res Treat 2020; 181:411-421. [PMID: 32253683 DOI: 10.1007/s10549-020-05624-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Advances in breast cancer research are making treatment options increasingly effective and reducing mortality. Body composition is an example of a prognostic tool that can help personalize breast cancer treatments and further increase their effectiveness. In this study, we examine the association of several body composition measures with comorbidities, physical function, and quality of life. METHODS This study is a cross-sectional analysis of 99 women with early breast cancer scheduled for chemotherapy. Univariate regression models were used to identify significant associations of body composition metrics with patient demographics, clinical characteristics, measures of physical function, and patient-reported outcomes (PRO)s. Multivariable modeling was used to evaluate associations adjusted for age. RESULTS Median age was 58 (range 24-83), 27% were non-white, and, 47% were obese (≥ 30 kg/m2). Increasing age was associated with lower Skeletal Muscle Density (SMD) (p = 0.0001), lower Skeletal Muscle Gauge (SMG) (p = 0.0005), and higher Visceral Adipose Tissue (VAT) (p < 0.0001). In patients with a prolonged Timed Up and Go tests (> 14 s), mean VAT was 57.87 higher (p = 0.004), SMD 5.70 lower (p = 0.04), and SMG 325.4 lower (p = 0.02). For each point of higher performance on the Short Physical Performance Battery (SPPB), VAT decreased 12.24 (p = 0.002) and SMD rose 1.22 (p = 0.02). In multivariable analysis adjusting for age, the association of TUG > 14 with higher VAT remained significant (p = 0.02). CONCLUSIONS Suboptimal body composition prior to treatment is associated poor physical function and may be an indicator of clinical importance.
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Affiliation(s)
- G F P Aleixo
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA.
- Unoeste Universidade do Oeste Paulista, Presidente Prudente, São Paulo, SP, Brazil.
| | - A M Deal
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA
| | - K A Nyrop
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA
| | - H B Muss
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA
| | - E M Damone
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr., Chapel Hill, NC, USA
| | - G R Williams
- Division of Hematology/Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - H Yu
- Division of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S S Shachar
- Ruth and Bruce Rappaport Faculty of Medicine at Technion, Haifa, Israel
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Nyrop KA, Deal AM, Shachar SS, Park J, Choi SK, Lee JT, O’Hare EA, Wheless A, Carey LA, Muss HB. Weight trajectories in women receiving systemic adjuvant therapy for breast cancer. Breast Cancer Res Treat 2019; 179:709-720. [DOI: 10.1007/s10549-019-05501-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/12/2019] [Indexed: 12/26/2022]
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Nyrop KA, Lee JT, Deal AM, Ki Choi S, Muss HB. Weight-Related Communications Between Oncology Clinicians and Women With Obesity at Early Breast Cancer Diagnosis: Findings From a Review of Electronic Health Records. Nutr Cancer 2019; 72:576-583. [DOI: 10.1080/01635581.2019.1645863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kirsten A. Nyrop
- Division of Hematology and Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan T. Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison M. Deal
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seul Ki Choi
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hyman B. Muss
- Division of Hematology and Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Investigating Changes in Weight and Body Composition Among Women in Adjuvant Treatment for Breast Cancer. Cancer Nurs 2019; 42:91-105. [DOI: 10.1097/ncc.0000000000000590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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14
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Ginzac A, Thivat É, Mouret-Reynier MA, Dubray-Longeras P, Van Praagh I, Passildas J, Abrial C, Kwiatkowski F, Boirie Y, Duclos M, Morio B, Gadea É, Durando X. Weight Evolution During Endocrine Therapy for Breast Cancer in Postmenopausal Patients: Effect of Initial Fat Mass Percentage and Previous Adjuvant Treatments. Clin Breast Cancer 2018; 18:e1093-e1102. [PMID: 30417829 DOI: 10.1016/j.clbc.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/11/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Weight changes during adjuvant treatment for early-stage breast cancer has been associated with a poor prognosis. The long-term evolution of body composition during adjuvant treatment for breast cancer, in particular, endocrine therapy, is not well known, and new data on this topic are required. The present study assessed the evolution of weight and body composition among 33 postmenopausal breast cancer patients receiving endocrine therapy after standard adjuvant chemotherapy that included taxanes. PATIENTS AND METHODS Dual-energy x-ray absorptiometry was used to measure the fat and lean body mass. Body water was assessed using multifrequency bioelectrical impedance analysis. The Hospital Anxiety and Depression questionnaire and the short version of the International Physical Activity Questionnaire were also administered. RESULTS During endocrine therapy, 5 of the 33 patients (15.2%) lost weight and 12 (36.4%) gained weight. The overall average gain was 2.0 ± 5.5 kg (P = .04). During this period, the fat mass, lean body mass, and body water increased. The factors linked to fat mass gain included an excess fat mass (≥ 36%) before treatment and weight loss during chemotherapy. In the overall period of adjuvant cancer treatment, 30% of the population gained > 5% of their initial weight. The average gain was the same as that during the endocrine therapy period (2.0 ± 5.4 kg; P = .031) and was characterized by an increase in total lean body mass, mainly localized in the trunk region. CONCLUSION Endocrine therapy appears as a pivotal period in weight and body composition management. Overfat and obese patients and those who lose weight during chemotherapy were more subject to weight and fat mass gain during endocrine therapy.
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Affiliation(s)
- Angeline Ginzac
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France.
| | - Émilie Thivat
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Marie-Ange Mouret-Reynier
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | | | | | - Judith Passildas
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Catherine Abrial
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Fabrice Kwiatkowski
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Yves Boirie
- Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1019, Unité de nutrition Humaine, Centre de Recherche en Nutrition Humaine Auvergne, Clermont-Ferrand, France
| | - Martine Duclos
- Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1019, Unité de nutrition Humaine, Centre de Recherche en Nutrition Humaine Auvergne, Clermont-Ferrand, France; CHU Clermont-Ferrand, Service de Médecine du Sport et des Explorations Fonctionnelles, Centre de Recherche en Nutrition Humaine, Institut National de la Recherche Agronomique, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Béatrice Morio
- Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1397, Laboratoire CarMeN, Université Lyon 1, Lyon, France
| | - Émilie Gadea
- Centre Hospitalier Emile Roux, le Puy en Velay, France
| | - Xavier Durando
- Université Clermont Auvergne, Centre Jean Perrin, Inserm, Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
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Weight gain in hormone receptor-positive (HR+) early-stage breast cancer: is it menopausal status or something else? Breast Cancer Res Treat 2017; 167:235-248. [DOI: 10.1007/s10549-017-4501-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/06/2017] [Indexed: 12/23/2022]
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