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Demark-Wahnefried W, Colditz GA, Rock CL, Sedjo RL, Liu J, Wolin KY, Krontiras H, Byers T, Pakiz B, Parker BA, Naughton M, Elias A, Ganz PA. Quality of life outcomes from the Exercise and Nutrition Enhance Recovery and Good Health for You (ENERGY)-randomized weight loss trial among breast cancer survivors. Breast Cancer Res Treat 2015; 154:329-37. [PMID: 26518022 DOI: 10.1007/s10549-015-3627-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 12/20/2022]
Abstract
Obesity is a poor prognostic factor and is negatively related to quality of life (QOL) in breast cancer survivors. Exercise and Nutrition to Enhance Recovery and Good Health for You is the largest weight loss trial completed among cancer survivors. Percent losses in body weight with an intensive group-based intervention versus an attention control were 6.0 versus 1.5 % (p < 0.0001) and 3.7 versus 1.3 % (p < 0.0001) at 12 and 24 months, respectively. ENERGY also was designed to answer the research question: Does weight loss significantly improve vitality and physical function (key components of QOL)? 692 breast cancer survivors (BMI: 25-45 kg/m(2)) at 4 US sites were randomized to a year-long intensive intervention of 52 group sessions and telephone counseling contacts versus a non-intensive (control) of two in-person counseling sessions. Weight, self-reported QOL, and symptoms were measured semi-annually for two years. Significant decreases in physical function and increases in symptoms were observed among controls from baseline to 6 months, but not in the intervention arm, -3.45 (95 % Confidence Interval [CI] -6.10, -0.79, p = 0.0109) and 0.10 (95 %CI 0.04, 0.16, p = 0.0021), respectively. Improvements in vitality were seen in both arms but trended toward greater improvement in the intervention arm -2.72 (95 % CI -5.45, 0.01, p = 0.0508). These differences diminished over time; however, depressive symptoms increased in the intervention versus control arms and became significant at 24 months, -1.64 (95 % CI -3.13, -0.15, p = 0.0308). Increased QOL has been reported in shorter term diet and exercise trials among cancer survivors. These longer term data suggest that diet and exercise interventions improve some aspects of QOL, but these benefits may diminish over time.
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Affiliation(s)
- Wendy Demark-Wahnefried
- Department of Nutrition Sciences, Wallace Tumor Institute, University of Alabama at Birmingham (UAB), 1824 6th Avenue, Rm 310D, Birmingham, AL, 35294, USA.
| | - Graham A Colditz
- Department of Surgery, Washington University in St. Louis (WUSTL), St. Louis, MO, 63110, USA
| | - Cheryl L Rock
- Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, 92093-0901, USA
| | - Rebecca L Sedjo
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus (UC), Aurora, CO, 80045, USA
| | - Jingxia Liu
- Department of Surgery, WUSTL, St. Louis, MO, 63110, USA
| | | | | | - Tim Byers
- Department of Epidemiology, Colorado School of Public Health, UC, Aurora, CO, 80045, USA
| | - Bilgé Pakiz
- Department of Family Medicine and Public Health, UCSD, La Jolla, CA, 92093, USA
| | | | | | | | - Patricia A Ganz
- Department of Health Policy & Management and Medicine, Schools of Public Health and Medicine, University of California - Los Angeles, Los Angeles, CA, 90095, USA
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