The impact of weight gain during adjuvant chemotherapy on survival in breast cancer

Energy balance in cancer survivors at risk of weight gain: a review

PURPOSE

The study of energy balance [i.e., energy intake (EI) and energy expenditure (EE)] is a powerful tool for understanding body weight regulation and may contribute to our understanding of rapid weight gain risk in certain cancer survivors post-diagnosis. The purpose of this review was to summarize studies that assessed longitudinal, prospective changes in components of energy balance from diagnosis/start of treatment to any duration of follow-up in cancer survivors with prior evidence of weight gain (breast, prostate, thyroid, gynecologic, testicular, and acute lymphoblastic leukemia) RESULTS: The available literature suggests that energy balance components may be altered in cancer survivors who have a heightened risk of weight gain post-diagnosis. The evidence for EI was overall inconsistent. Conversely, decreases in resting and physical activity EE during the active phases of treatment (e.g., chemotherapy, hypothyroid state) were commonly noted, which then slowly rebounded towards baseline levels at the end of treatment and during follow-up assessments. Much of this evidence is based on data collected from breast cancer survivors, which highlights a paucity of data currently available on other cancer types.

CONCLUSIONS

While there is growing acknowledgement that weight management interventions in cancer survivors are needed, it is important to recognize that changes in both behavioral (EI, physical activity EE) and passive (resting EE, thermic effect of food) components of energy balance may occur post-diagnosis. This information can help to inform weight management interventions which often entail modifications in diet and/or physical activity.

Weight Changes in Women Receiving Chemotherapy for Non-Metastatic Breast Cancer in Saudi Arabia

Background Women with breast cancer (BC) commonly experience weight gain during chemotherapy, although there is conflicting evidence regarding the contributing factors. This study aimed to evaluate body weight changes among women undergoing chemotherapy for non-metastatic BC during the first year after diagnosis, and to determine whether baseline body weight and/or hemoglobin concentration values were associated with weight changes during chemotherapy. Methods This retrospective study evaluated patients who were treated at the King Abdulaziz University Hospital (Saudi Arabia) during 2010-2019. A total of 228 women were included based on the following criteria: new diagnosed BC, age of 18-80 years, non-metastatic disease, and initial chemotherapy treatment for BC. The patients' baseline characteristics, including body weight during the first chemotherapy cycle, were collected from their electronic medical records. Each patient's weight was then followed at each hospital visit until the last chemotherapy cycle. In addition, data were collected regarding tumor status, menopausal status, chemotherapy regimen, hemoglobin concentration, recurrence status, and death. Results The mean patient age was 53.37±10.9 years and 55.7% of the patients were pre-menopausal. The vast majority of patients underwent surgery (96.9%) and most patients received adjuvant chemotherapy (63.6%) or adjuvant radiotherapy (68.9%). The mean number of chemotherapy cycles was 6.29±1.74 (taxane-based: 1.67±1.36 cycles, anthracycline-based: 2.61±1.81 cycles). At the end of chemotherapy, the body weight changes were classified as increased (41.7% of patients, mean increase: 3.39 kg), decreased (35.5% of patients, mean decrease: -4.12 kg), or stable (22.8%). Factors that predicted weight gain after chemotherapy included younger age at diagnosis (p<0.029), pre-menopausal status (p<0.003), and a high number of taxane-based chemotherapy cycles (p<0.029). Conclusions Chemotherapy for BC did not lead to significant changes in body weight among women in Saudi Arabia. Weight gain in this setting was significantly associated with younger age, pre-menopausal status, and a high number of taxane-based chemotherapy cycles.

Herbal Decoction Divya-Peedantak-Kwath Alleviates Allodynia and Hyperalgesia in Mice Model of Chemotherapy-Induced Peripheral Neuropathy via Modulation in Cytokine Response

The widely used cancer treatment, chemotherapy, causes severe long-term neuropathic pain in 30–40% cases, the condition clinically known as chemotherapy-induced peripheral neuropathy (CIPN). Approved conventional analgesics are sometimes ineffective, while others like opioids have undesirable side effects like addiction, seizures, and respiratory malfunctioning. Tricyclic antidepressants and anticonvulsants, although exhibit anti-allodynic effects in neuropathy, also have unpleasant side effects. Thus, alternative medicines are being explored for CIPN treatment. Despite scattered reports on different extracts from different plants having potential anti-allodynic effects against CIPN, no established medicine or formulation of herbal origin exists. In this study, efficacy of an herbal decoction, formulated based on ancient medicinal principles and protocols for treating neuropathic pain, Divya-Peedantak-Kwath (DPK), has been evaluated in a paclitaxel (PTX)-induced peripheral neuropathic mouse model. We observed that DPK has prominent anti-allodynic and anti-hyperalgesic effects and acts as a nociceptive modulator for CIPN. With exhibited antioxidative effects, DPK restored the redox potential of the sciatic nerves to the normal. On histopathological evaluation, DPK prevented the PTX-induced lesions in the sciatic nerve, in a dose-dependent manner. It also prevented inflammation by modulating the levels of pro-inflammatory cytokines involved in CIPN pathogenesis. Our observations evinced that DPK can alleviate CIPN by attenuating oxidative stress and concomitant neuroinflammation through immune modulation.

Impact of chemotherapy on perceptions related to food intake in women with breast cancer: A prospective study

Breast cancer (BC) treatment includes mostly chemotherapy (CT), which can cause side effects like nausea, taste changes, early satiety, slow gastric emptying and xerostomia. In this way, the individual’s relationship with food may change during the treatment. The aim of this study was to evaluate the impact of chemotherapy on perceptions related to food intake of women with BC. Fifty-five women with BC were followed, and data were collected at three periods during first-line CT: beginning (T0), intermediate (T1) and end (T2). A visual analogue scale (VAS) (0 to 10 cm) for hunger, appetite for various food categories and meal enjoyment was investigated. The frequency and intensity of side effects were evaluated using a 4 cm scale. The results showed a higher prevalence of taste changes in T1 (p = 0.044) and more nausea in T1 and T2 (p = 0.018). Furthermore, the intensity of nausea was higher in T2 (p = 0.01) than in the other periods. We observed moderate hunger in T0, T1 and T2 (p = 0.113), but the overall appetite increased between T0 and T2 (p = 0.003). Meal enjoyment was reduced from T0 to T1and returned back to the initial value in T2 (p = 0.021). The appetite for salty (p = 0.004) and spicy (p = 0.03) foods was increased in T1. There was an increase of body weight (p = 0.008), body mass index (BMI) (p = 0.009) and waist circumference (WC) (p = 0.03) during CT. CT changes food hedonism, increasing the overall appetite and the appetite for salty and spicy foods. Moreover, we observed the negative impact of CT on meal enjoyment and an increase in side effects and anthropometric parameters.