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Li X, Zhang N, Yang J, Geng Z, Zhou J, Zhang J. Weight management personas of breast cancer patients undergoing chemotherapy in China: a multi-method study. BMC Med Inform Decis Mak 2024; 24:108. [PMID: 38664653 PMCID: PMC11044285 DOI: 10.1186/s12911-024-02515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) may be an ideal solution for breast cancer (BC) patients in China to access weight management interventions. User retention and engagement are the main challenges faced by mHealth applications. A user persona, which is a user-centered design process, can lead to the development of mHealth that is more acceptable to the needs of target users. This study aimed to investigate the variety of experiences in weight management and the behavioral preferences of BC patients receiving chemotherapy to develop users' personal information and persona development for the design and implementation of mHealth interventions. METHODS Sixteen individual semi-structured in-depth interviews were conducted with BC patients receiving chemotherapy. We employed the thematic analysis method to analyze the interview transcripts in NVivo 11 software. The themes obtained from the analysis were used as the subdomains of personas. A proforma was designed to extract each participant's experience in each subdomain. Patients who exhibited similar experience in subdomains were grouped into a persona using affinity diagrams. The personas were named according to their prominent features. A questionnaire survey was conducted to validate the personas and to test whether the personas that were generated from the qualitative interview data were applicable to the Chinese population with BC. RESULTS Four themes were identified as subdomains of weight management personas: the perception of weight management while undergoing chemotherapy, symptoms and emotional disturbance, changes in diet and exercise, and health literacy and information seeking. Five personas were ultimately obtained: (1) positive weight controllers, (2) patients who were inactive due to fatigue, (3) young patients who avoided communication, (4) overweight patients with treatment priority, and (5) patients who engaged in irregular exercise. Finally, the quantitative study showed that 51.58% of patients chose one of these five personas to represent themselves in weight management. None of the patient reported selecting options that were not explicitly outlined in the questionnaire and provided personalized descriptions of their weight management characteristics. CONCLUSIONS The selected personas were developed from in-depth interviews on biopsychosocial areas. They highlight different weight management patterns in Chinese BC patients and provide implications for both the design of mHealth systems and traditional interventions.
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Affiliation(s)
- Xinyu Li
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Nan Zhang
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juan Yang
- Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhaohui Geng
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Zhou
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jinyu Zhang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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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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Puklin LS, Li F, Cartmel B, Zhao J, Sanft T, Lisevick A, Winer EP, Lustberg M, Spiegelman D, Sharifi M, Irwin ML, Ferrucci LM. Post-diagnosis weight trajectories and mortality among women with breast cancer. NPJ Breast Cancer 2023; 9:98. [PMID: 38042922 PMCID: PMC10693588 DOI: 10.1038/s41523-023-00603-5] [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: 05/10/2023] [Accepted: 11/16/2023] [Indexed: 12/04/2023] Open
Abstract
Weight gain after breast cancer diagnosis is associated with adverse health outcomes. Yet, few studies have characterized post-diagnosis weight change in the modern treatment era or populations most at risk for weight changes. Among women diagnosed with stages I-III breast cancer in the Smilow Care Network (2013-2019; N = 5441), we abstracted demographic and clinical characteristics from electronic health records and survival data from tumor registries. We assessed if baseline characteristics modified weight trajectories with nonlinear multilevel mixed-effect models. We evaluated body mass index (BMI) at diagnosis and weight change 1-year post-diagnosis in relation to all-cause and breast cancer-specific mortality with Cox proportional hazard models. Women had 34.4 ± 25.5 weight measurements over 3.2 ± 1.8 years of follow-up. Weight gain was associated with ER/PR-, HER2+ tumors, BMI ≤ 18.5 kg/m2, and age ≤ 45 years (+4.90 kg (standard error [SE] = 0.59), +3.24 kg (SE = 0.34), and +1.75 kg (SE = 0.10), respectively). Weight loss was associated with BMI ≥ 35 kg/m2 and age ≥ 70 years (-4.50 kg (SE = 0.08) and -4.34 kg (SE = 0.08), respectively). Large weight loss (≥10%), moderate weight loss (5-10%), and moderate weight gain (5-10%) 1-year after diagnosis were associated with higher all-cause mortality (hazard ratio [HR] = 2.93, 95% confidence interval [CI] = 2.28-3.75, HR = 1.32, 95% CI = 1.02-1.70 and HR = 1.39, 95% CI = 1.04-1.85, respectively). BMI ≥ 35 kg/m2 or BMI ≤ 18.5 kg/m2 at diagnosis were also associated with higher all-cause mortality. Weight change after a breast cancer diagnosis differed by demographic and clinical characteristics highlighting subgroups at-risk for weight change during a 5-year period post-diagnosis. Monitoring and interventions for weight management early in clinical care are important.
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Affiliation(s)
- Leah S Puklin
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA.
| | - Fangyong Li
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Brenda Cartmel
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| | - Julian Zhao
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Alexa Lisevick
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
- Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Eric P Winer
- Yale Cancer Center, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Maryam Lustberg
- Yale Cancer Center, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Donna Spiegelman
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| | - Mona Sharifi
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Melinda L Irwin
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| | - Leah M Ferrucci
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
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Ee C, Cave A, Vaddiparthi V, Naidoo D, Boyages J. Factors associated with weight gain after breast cancer: Results from a community-based survey of Australian women. Breast 2023:S0960-9776(23)00012-7. [PMID: 36710237 DOI: 10.1016/j.breast.2023.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Weight gain after breast cancer is common. The aim of this study was to determine factors associated with weight gain after breast cancer in Australian women. METHODS A cross-sectional online survey was conducted between November 2017 and January 2018. Women living in Australia who self-identified as having breast cancer or ductal carcinoma in-situ were eligible. We created stepwise linear and logistic regression models to evaluate predictors for absolute and clinically significant (≥5%) weight gain respectively. RESULTS Data from 276 women were analysed. Most were Caucasian and 92% had been diagnosed with Stage 0-III breast cancer. Absolute weight gain was associated with hot flushes, being in the menopausal transition at diagnosis, being less physically active than at diagnosis, lower eating self-efficacy when watching television or using a computer, and higher self-efficacy when anxious or nervous (F-ratio = 3.26, R2-adjusted = 0.16, p < .001). Clinically significant weight gain was associated with tamoxifen use (OR 2.7), being less physically active than at diagnosis (OR 3.1), and lower eating self-efficacy when watching television or using a computer (OR 0.82) (Chi-square 64.94, df = 16, p < .001). Weight gain was not associated with chemotherapy, radiotherapy, aromatase inhibitor use, number of lymph nodes removed, or body mass index at diagnosis. CONCLUSIONS Interventions to prevent weight gain after breast cancer, particularly aiming to maintain physical activity, should be targeted at women receiving tamoxifen. The role of eating self-efficacy, especially attentive eating, in managing weight after breast cancer should be explored.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia; Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia; LivingRoom, Chris O' Brien Lifehouse Cancer Centre, PO Box M33, Missenden Rd, Camperdown, Sydney, New South Wales, Australia; Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
| | - Adele Cave
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia
| | - Vaishnavi Vaddiparthi
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia
| | - Dhevaksha Naidoo
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia
| | - John Boyages
- ICON Cancer Centre, Sydney Adventist Hospital, 185 Fox Valley Road, Wahroonga, Sydney, New South Wales, Australia; Faculty of Health and ANU College of Health & Medicine, Canberra, Australian Capital Territory, Australia
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Abstract
BACKGROUND Elevated body mass index (BMI) in breast cancer survivors (BCS) is associated with cancer recurrence and poorer treatment response. Guidelines recommend 5%-10% weight loss for overweight or obese BCS. OBJECTIVES To assess effectiveness of lifestyle interventions for female BCS on weight loss, BMI, body composition, health-related quality of life (HRQoL), physical functioning, psychosocial measures, biomarkers. DESIGN Systematic review of reviews and meta-analyses. SETTING All clinical settings. PARTICIPANTS Adult female BCS (active treatment or post-treatment). METHODS Medline, Embase, CINAHL, PsycINFO, Cochrane Library (including Database of Abstracts of Reviews of Effects) were searched for systematic reviews published in English between 1990 and 2022, with weight, BMI or body fat as primary outcome. Narrative reviews, editorials, letters, conference abstracts were excluded. Review quality was assessed using the Joanna Briggs Institute quality assessment tool. RESULTS 17 reviews were included. Twelve reported significant reductions in one or more anthropometric outcomes: weight -1.36 kg (95% CI:-2.51 to -0.21) to -3.8 kg (95% CI: -5.6 to -1.9); BMI -0.89 kg/m2 (95% CI: -0.15 to -0.28) to -3.59 kg/m2 (95% CI: -6.29 to 0.89) or body fat -1.6% (95% CI: -2.31 to -0.88) to -2.6% (95% CI not reported). Significant reductions in two or more anthropometric outcomes were reported in 7/12 reviews, with effective interventions comprising aerobic exercise/aerobic exercise plus resistance training (n=5), or diet and exercise with or without counselling (n=2). Significant improvements were also reported for HRQoL (8/11 reviews), mental health (4/7) and physical functioning (2/3). Group interventions comprising aerobic exercise or aerobic exercise plus resistance training were most likely to improve outcomes. CONCLUSIONS Lifestyle interventions can significantly improve outcomes for BCS. Multimodal interventions are likely to have the greatest impact in reducing weight, BMI and body fat. Further research must define the optimal combination, intensity and duration of effective interventions. PROSPERO REGISTRATION NUMBER CRD42021283481.
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Affiliation(s)
- Blossom Lake
- Breast Surgery, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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6
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Management of Breast Cancer Survivors by Gynecologists. Clin Obstet Gynecol 2022; 65:494-509. [PMID: 35708967 DOI: 10.1097/grf.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast cancer patients commonly present to their OBGYN during the process of diagnosis and treatment of breast cancer both for specific gynecologic needs and for primary care follow up. These patients require counseling on contraception, hormone use, and fertility at diagnosis. During treatment and survivorship, patients will face a variety of side effects from treatments leading to vasomotor symptoms, vulvovaginal discomfort, sexual dysfunction, osteoporosis, and vaginal bleeding. This chapters aims to enlighten providers on the unique range of issues a gynecologist may face when caring for breast cancer patients.
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Zullig LL, Sung AD, Khouri MG, Jazowski S, Shah NP, Sitlinger A, Blalock DV, Whitney C, Kikuchi R, Bosworth HB, Crowley MJ, Goldstein KM, Klem I, Oeffinger KC, Dent S. Cardiometabolic Comorbidities in Cancer Survivors. JACC CardioOncol 2022; 4:149-165. [PMID: 35818559 PMCID: PMC9270612 DOI: 10.1016/j.jaccao.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 12/28/2022] Open
Abstract
There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or chronic lymphocytic leukemia, who will receive cancer therapy for many years. Current clinical practice guidelines focus on lifestyle interventions, such as exercise and healthy eating habits, but generally do not address management strategies for clinicians or strategies to increase adherence to medications. We discuss 3 cardiometabolic comorbidities among cancer survivors and present the prevalence of comorbidities prior to a cancer diagnosis, treatment of comorbidities during cancer therapy, and management considerations of comorbidities in long-term cancer survivors or those on chronic cancer therapy. Approaches to support medication adherence and potential methods to enhance a team approach to optimize care of the individual with cancer across the continuum of disease are discussed. Cancer survivors are at increased risk for several chronic conditions, including hypertension, dyslipidemia, and diabetes. Determining optimal management of comorbidities for patients with cancer is critical. A multidisciplinary care approach is recommended throughout the continuum of active cancer treatment and survivorship. Survivorship research should focus on medication adherence and coordination of care.
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Affiliation(s)
- Leah L. Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Address for correspondence: Dr Leah Zullig, Duke University, 411 West Chapel Hill Street, Suite 600, Durham, North Carolina 27701, USA. @LeahZullig
| | - Anthony D. Sung
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michel G. Khouri
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shelley Jazowski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nishant P. Shah
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrea Sitlinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dan V. Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Colette Whitney
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Cascades East–Oregon Health and Science University, Klamath Falls, Oregon, USA
| | - Robin Kikuchi
- Keck School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Hayden B. Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Matthew J. Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M. Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Igor Klem
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin C. Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Susan Dent
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Krok-Schoen JL, Pennell ML, Saquib N, Naughton M, Zhang X, Shadyab AH, Kroenke CH, Bea JW, Peterson LL, Crane T, Wactawski-Wende J, Paskett ED. Correlates of physical activity among older breast cancer survivors: Findings from the Women's Health Initiative LILAC study. J Geriatr Oncol 2022; 13:143-151. [PMID: 34893462 PMCID: PMC9346622 DOI: 10.1016/j.jgo.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/09/2021] [Accepted: 11/29/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Physical activity can attenuate cancer-related declines in physical functioning, improve emotional well-being, and prolong survival among older (≥65 years) breast cancer survivors. However, factors associated with physical activity among older breast cancer survivors are not well-understood. MATERIALS AND METHODS Participants were enrolled in the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study. Descriptive statistics, multiple linear regression, and relative risk [RR] regression were used to assess the association of demographic, clinical, physical and psychosocial variables with the total duration of and participation in physical activity among postmenopausal breast cancer survivors. Age-specific correlates (65-74 years vs. 75-84 years vs. ≥85 years) of physical activity were also examined. RESULTS The majority of participants (n = 3710, mean age = 78.8 ± 5.9) were white (90.7%) and had in situ/localized breast cancer (78.9%). Women who had higher education (RR = 1.47 for graduate/professional school versus high school or less, 95% CI: 1.32, 1.63), higher self-rated health (RR = 1.04 for 10 point increase, 95% CI:1.02, 1.07), higher physical functioning (RR = 1.03 for 5 point increase, 95% CI: 1.02, 1.04), and higher social support (RR = 1.41 for social support all of the time versus none of the time, 95% CI: 1.01, 1.96), were more likely to engage in any physical activity. Similar results were observed for duration of physical activity. Among women aged <75, radiation therapy, but not chemotherapy, was associated with longer duration of total physical activity (adjusted difference = 19.7 min/week, 95% CI: 6.1, 33.3), but was not associated with duration among older women. The association between pain and duration of moderate/strenuous activity also differed with age: among women aged <75, those with moderate pain averaged fewer minutes of moderate/strenuous physical activity than those with no pain (adjusted difference:-14.4 min/week, 95% CI:-28.5, -0.1). However, among women aged ≥85, those with moderate pain averaged more minutes of moderate/strenuous physical activity per week than those with no pain (adjusted difference:16.6 min/week; 95% CI:2.9, 30.3). DISCUSSION Multiple factors were associated with physical activity among older breast cancer survivors in the WHI. Future physical activity interventions should focus on age-related (e.g., comorbidities) and treatment-related factors (e.g., radiation) as well as certain subgroups, such as women with higher symptom burden.
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Affiliation(s)
- Jessica L. Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10 Ave., 306 Atwell Hall, Columbus, OH 43210, USA,Corresponding author at: Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10th Ave., 306 Atwell Hall, Columbus, OH 43210, USA. (J.L. Krok-Schoen)
| | - Michael L. Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, 246 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman Alrajhi University, PO Box 777, Bukariyah, Qassim 51941, Saudi Arabia
| | - Michelle Naughton
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, 1590 N. High St., Columbus, OH 43210, USA
| | - Xiaochen Zhang
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, 1590 N. High St., Columbus, OH 43210, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Candyce H. Kroenke
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Jennifer W. Bea
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1515 N. Campbell Ave, Tucson, AZ 85724, USA
| | - Lindsay L. Peterson
- Division of Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Tracy Crane
- Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 410 Kimball Tower, Buffalo, NY 14214, USA
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, 1590 N. High St., Columbus, OH 43210, USA
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Terranova CO, Winkler EAH, Healy GN, Demark-Wahnefried W, Eakin EG, Reeves MM. Dietary and physical activity changes and adherence to WCRF/AICR cancer prevention recommendations following a remotely delivered weight loss intervention for female breast cancer survivors: The Living Well after Breast Cancer randomized controlled trial. J Acad Nutr Diet 2022; 122:1644-1664.e7. [PMID: 35182789 DOI: 10.1016/j.jand.2022.02.009] [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: 11/29/2021] [Revised: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Diet, exercise, and weight management are key in improving outcomes for breast cancer survivors, with international recommendations for cancer survivors relating to these behaviors. However, few behavioral interventions have reported outcomes aligned specifically with these recommendations. OBJECTIVE To evaluate a remotely delivered weight loss intervention versus usual care for female breast cancer survivors, on changes in multiple diet and physical activity behaviors. DESIGN A randomized controlled trial with assessments at study baseline, 6-, 12- and 18 months (i.e., mid-intervention, post-intervention, and non-contact follow-up). PARTICIPANTS/SETTING Participants were recruited between October 2012 and December 2014 through hospitals in Brisbane (Australia) and the state-based cancer registry. Eligible participants (female, 18-75 years, BMI 25-45 kg/m2, diagnosed with stage I-III breast cancer in previous two years) were randomly allocated to intervention (n=79) or usual care (n=80). INTERVENTION Participants randomized to the intervention group received 22 counseling telephone calls targeting diet and physical activity aimed at achieving 5-10% weight loss, and optional text messages, over 12 months. Usual care participants received their standard medical care and brief feedback following each assessment, which was similar to that provided to intervention participants with the exception that usual care participants' results were not compared to national and study recommendations. MAIN OUTCOME MEASURES Dietary intake (24-hour recalls); physical activity (hip-worn Actigraph); sitting time (thigh-worn activPAL3); and, adherence to World Cancer Research Fund/American Cancer Research Institute (WCRF/AICR) recommendations for cancer survivors (0-7 score) were measured at each assessment, with data collected between November 2012 and October 2016. STATISTICAL ANALYSES PERFORMED Intervention effects were assessed by linear mixed models, accounting for repeated measures and baseline values. Significance was set at P<0.05. RESULTS At baseline, participants were (mean±SD) aged 55±9 years, with a BMI of 31.4±5.0 kg/m2, 10.7±5.0 months post-diagnosis, and primarily non-minority. At baseline, only 8% (n=12) of participants met ≥5/7 WCRF/AICR recommendations (mean±SD WCRF/AICR adherence score: 3.8±1.0). At 12 months, significant intervention effects were observed in walking/running ( +21 mins/week; 95%CI: 4, 38) and WCRF/AICR adherence scores (+0.3 points; 95%CI: 0.0, 0.6) only. At 18 months, significant intervention effects were observed for energy intake (-229 kcal/day energy; 95%CI: -373, -84), total fat (-10 g/day; 95%CI: -18, -2), and saturated fat (-5 g/day; 95%CI: -9, -1), and were sustained for WCRF/AICR adherence scores (+0.5 points; 95%CI: 0.2, 0.8). CONCLUSIONS This remotely delivered weight loss intervention led to sustained improvements in WCRF/AICR adherence scores, and some improvements in diet and physical activity. These findings provide support for the health benefit of programs targeting lifestyle behaviors in line with cancer survivor recommendations, and the potential for dissemination of such programs following treatment for early-stage female breast cancer.
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Affiliation(s)
- C O Terranova
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - E A H Winkler
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - G N Healy
- School of Public Health, The University of Queensland, Brisbane, Australia; Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - W Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - E G Eakin
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - M M Reeves
- School of Public Health, The University of Queensland, Brisbane, Australia
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10
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Wang S, Yang T, Qiang W, Zhao Z, Shen A, Zhang F. Benefits of weight loss programs for breast cancer survivors: a systematic reviews and meta-analysis of randomized controlled trials. Support Care Cancer 2022; 30:3745-3760. [PMID: 35022884 DOI: 10.1007/s00520-021-06739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/03/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Obesity and weight gain have been associated with poor disease-specific and health-related outcomes in breast cancer survivors (BCS). But the benefits of weight loss in managing BCS have not been elucidated. OBJECTIVE To evaluate the beneficial effects of weight loss programs in randomized controlled trials on BCS. METHODS We searched English databases PubMed, the Cochrane Library, EMBASE, Scopus, Web of Science, CINAHL, and Chinese databases China National Knowledge Infrastructure (CNKI), Weipu Information Chinese Periodical Service Platform (VIP), China Biomedical Literature Service System (SinoMed), and Wanfang from the inception to January 2021 and collected randomized controlled trials (RCTs) of weight loss programs for BCS. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. The data synthesis was performed on RevMan (version 5.3), and the publication bias was calculated with STATA (version 15.1). RESULTS Ten RCTs were included in the meta-analysis. The current study showed that diet and exercise interventions resulted in significant improvements in body weight (MD = - 4.43 kg, 95%CI: - 6.23 to - 2.63, P < 0.00001), waist circumference (MD = - 2.81 cm, 95%CI: - 4.37 to - 1.26, P = 0.004), hip circumference (MD = - 3.01 cm, 95%CI: - 4.24 to - 1.77, P < 0.0001), body mass index (MD = - 1.69 kg/m2, 95%CI: - 2.16 to - 1.21, P < 0.00001), systolic blood pressure (MD = - 12.12 mmHg, 95%CI: - 18.97 to - 5.27), p = 0.0005), C-reactive protein (MD = - 1.83 mg/L, 95% CI: - 2.74 to - 0.91, p < 0.0001), body fat (MD = - 1.19 kg, 95%CI: - 1.75 to - 0.63, P < 0.001), fat mass (MD = - 2.29 kg, 95%CI: - 3.12 to - 1.46, P < 0.0001), and lean body mass (MD = - 2.15 kg, 95%CI: - 3.66 to - 0.65, P = 0.005). Alternatively, compared with the effects of control interventions, weight loss programs did not affect fat-free mass, total cholesterol, low-density leptin cholesterol, glucose, insulin, and leptin (P > 0.05). CONCLUSIONS This review summarizes the benefits of weight loss programs for BCS. The results indicated that weight loss programs could significantly improve specific anthropometric outcomes but not affect biochemical indicators. Researchers should tailor weight loss interventions to the body fat status of BCS. Evidence to support the translation of effective weight loss intervention programs into wider-scale implementation is needed to be part of routine survivorship care.
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Affiliation(s)
- Shurui Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ting Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wanmin Qiang
- Nursing Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.
| | - Zihan Zhao
- Nursing Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Aomei Shen
- Nursing Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Fangyuan Zhang
- Nursing Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
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11
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Vuong V, Rao V, Ee C. Mindfulness-based Interventions and Yoga for Managing Obesity/Overweight After Breast Cancer: A Scoping Review. Integr Cancer Ther 2022; 21:15347354221137321. [DOI: 10.1177/15347354221137321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Weight gain after breast cancer is common, and obesity after breast cancer increases breast cancer recurrence and mortality. Mindfulness-based interventions (MBIs) and yoga have been shown to be effective in managing obesity/overweight in people without breast cancer. There is a need to systematically map the extent and range of evidence on yoga and MBIs for managing obesity/overweight after breast cancer in order to aid planning and commissioning of future research. Methods We conducted a scoping review informed by methods described by Levac et al. Five electronic databases were searched for any peer-reviewed original research (including systematic reviews) that examined the role of yoga and/or MBIs for managing overweight/obesity after breast cancer. Data were extracted on study, population, intervention, comparator and outcome characteristics, and described narratively. Results: We found 18 publications representing 15 unique studies (11 clinical trials, 2 systematic reviews, and 2 observational studies). There were 10 studies on yoga, and 5 on MBIs. Of the clinical trials, only 4/11 examined a weight-related outcome as the primary outcome. The remaining trials examined lifestyle or metabolic outcomes (5/11) or unrelated outcomes such as psychological health (2/11). Gaps in the literature included small sample sizes, lack of cultural diversity amongst participants, inadequate reporting of the intervention, few lifestyle co-interventions offered, lack of active comparator groups, and inadequate safety reporting. Conclusions: There is a need for adequately-powered RCTs that adhere to reporting guidelines. The use of gold-standard methods for measuring outcomes, and active comparator groups, is also recommended.
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Affiliation(s)
- Vicki Vuong
- School of Medicine, Western Sydney University, NSW, Australia
| | - Vibhuti Rao
- WNICM Health Research Institute, Western Sydney University, NSW, Australia
| | - Carolyn Ee
- WNICM Health Research Institute, Western Sydney University, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
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12
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Zullig LL, Shahsahebi M, Neely B, Hyslop T, Avecilla RAV, Griffin BM, Clayton-Stiglbauer K, Coles T, Owen L, Reeve BB, Shah K, Shelby RA, Sutton L, Dinan MA, Zafar SY, Shah NP, Dent S, Oeffinger KC. Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:234. [PMID: 34794388 PMCID: PMC8600877 DOI: 10.1186/s12875-021-01569-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 01/22/2023]
Abstract
Background As treatments for cancer have improved, more people are surviving cancer. However, compared to people without a history of cancer, cancer survivors are more likely to die of cardiovascular disease (CVD). Increased risk for CVD-related mortality among cancer survivors is partially due to lack of medication adherence and problems that exist in care coordination between cancer specialists, primary care physicians, and cardiologists. Methods/Design The Onco-primary care networking to support TEAM-based care (ONE TEAM) study is an 18-month cluster-randomized controlled trial with clustering at the primary care clinic level. ONE TEAM compares the provision of the iGuide intervention to patients and primary care providers versus an education-only control. For phase 1, at the patient level, the intervention includes video vignettes and a live webinar; provider-level interventions include electronic health records-based communication and case-based webinars. Participants will be enrolled from across North Carolina one of their first visits with a cancer specialist (e.g., surgeon, radiation or medical oncologist). We use a sequential multiple assignment randomized trial (SMART) design. Outcomes (measured at the patient level) will include Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of three CVD comorbidities using laboratory testing (glycated hemoglobin [A1c], lipid profile) and blood pressure measurements; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care, PCC-Ca-36). Primary care clinics in the intervention arm will be considered non-responders if 90% or more of their participating patients do not meet the modified HEDIS quality metrics at the 6-month measurement, assessed once the first enrollee from each practice reaches the 12-month mark. Non-responders will be re-randomized to either continue to receive the iGuide 1 intervention, or to receive the iGuide 2 intervention, which includes tailored videos for participants and specialist consults with primary care providers. Discussion As the population of cancer survivors grows, ONE TEAM will contribute to closing the CVD outcomes gap among cancer survivors by optimizing and integrating cancer care and primary care teams. ONE TEAM is designed so that it will be possible for others to emulate and implement at scale. Trial registration This study (NCT04258813) was registered in clinicaltrals.gov on February 6, 2020.
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Affiliation(s)
- Leah L Zullig
- Department of Population Health Sciences, Duke University School Of Medicine, 215 Morris St, Durham, NC, 27701, USA. .,Department of Population Health Sciences, Duke University School of Medicine, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.
| | - Mohammad Shahsahebi
- Duke University Family Medicine and Community Health, 2424 Erwin Rd, Ste 601, DUMC, Box 2714, Durham, NC, 27705, USA.,Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Benjamin Neely
- Duke Cancer Institute, Duke University, 2424 Erwin Rd, Durham, NC, 27701, USA
| | - Terry Hyslop
- Department of Biostatistics, Duke University, 2424 Erwin Road, 9064 Hock Plaza, Durham, NC, 27705, USA
| | - Renee A V Avecilla
- Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Brittany M Griffin
- Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Kacey Clayton-Stiglbauer
- Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Theresa Coles
- Department of Population Health Sciences, Duke University School Of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Lynda Owen
- Duke Cancer Network, 20 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School Of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Kevin Shah
- Duke Institute for Health Innovation, Duke University Health System, 200 Morris St, Durham, NC, 27701, USA
| | - Rebecca A Shelby
- Duke Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Linda Sutton
- Duke Cancer Network, 20 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Michaela A Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - S Yousuf Zafar
- Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Nishant P Shah
- Duke Heart Center, Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Susan Dent
- Duke Cancer Institute, Duke University, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
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13
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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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14
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Pumpa KL, Dalton J, Mara JK, Zhang Y, Yip D. Identifying women at risk of weight gain after a breast cancer diagnosis: Results from a cohort of Australian women. Health Promot J Austr 2021; 33:138-147. [PMID: 33638874 DOI: 10.1002/hpja.474] [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: 06/03/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
ISSUES ADDRESSED This study aimed to identify risk factors associated with weight gain post a diagnosis of breast cancer in a cohort of Australian women. METHODS In this retrospective clinical audit, objectively measured weight, age and menopause status, treatment type/s, grade, stage, oestrogen receptor and progesterone receptor (PR) status were extracted for 73 breast cancer patients from an ongoing breast cancer treatment quality assurance project. Weight gain or loss was classified as a body mass increase or decrease of ≥5% of weight at diagnosis. RESULTS When compared to weight at diagnosis, 57% of patients maintained, 22% gained, and 21% lost weight at 24 months post-diagnosis. Factors associated with weight gain were a diagnosis of grade II (P < .001) or grade III (P < .001) compared to grade I breast cancer, and refusal of radiotherapy (P < .001). Factors associated with weight loss were being postmenopausal compared to premenopausal (P = .033), PR positive compared to PR negative (P < .001), refusal of chemotherapy (P < .001) and radiotherapy recommended (P < .001). CONCLUSIONS The maintenance of weight in a majority of women in this cohort is a novel finding. Early identification of women at risk of weight gain post a breast cancer diagnosis can assist health professionals identify, and therefore assisting patients in the prevention and management of weight gain and associated sequela. Investigating the weight-related communications between a patient and specialist, their access to allied health professionals and social support may assist in understanding the overall positive changes in this cohort.
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Affiliation(s)
- Kate L Pumpa
- Discipline of Sport & Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | | | - Jocelyn K Mara
- Discipline of Sport & Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Yanping Zhang
- Quality Assurance Project, ACT and SE NSW Breast Cancer Treatment Group, ACT Health, Canberra, ACT, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital. ANU Medical School, Australian National University, Canberra, ACT, Australia
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15
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Fardad F, Bagheri Valami K, Ansarinejad N, Abbasi B, Khataii Khosroshahi SM, Ramim T. Relationship between weight gain and survival rate in patients with metastatic lung cancer. Med J Islam Repub Iran 2021; 35:22. [PMID: 34169034 PMCID: PMC8214037 DOI: 10.47176/mjiri.35.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Lung cancer accounts for about 13% of all cancers and about 60% of patients with lung cancer also experience weight loss during treatment. There seems to be a clear correlation between the therapeutic outcomes of patients based on their weight changes during treatment. The aim of this study was to investigate the relationship between weight changes during and after treatment and the therapeutic outcomes of a patient with metastatic lung cancer.
Methods: This cohort study was performed on patients with the diagnosis of non-surgical metastatic lung cancer referred to Hematology and Oncology Clinic, Rasoul-e-Akram Hospital. Patients were divided into two groups with a weight gain of more than 5% and a weight gain of 5% and less. The information was entered into the SPSS version 21 software. In the descriptive analysis, mean and standard deviation (SD) were used. To compare quantitative variables, independent samples t-test, Mann-Whitney, chi-square or Fisher exact tests were used to compare qualitative variables and correlation test was used to determine the correlation between quantitative data. Survival curves were used to show differences in two groups of studies. A regression model was used to calculate the hazard ratio. The significance level was less than 0.05.
Results: Sixty patients, including 40 males (66.7%) and 20 females (33.3%) were studied. The mean age of patients was 62.22±9.00 years (43-83 years). The mean weight changes in the patients were -1.28±6.11 kg (-16 to 16kg). Forty-seven patients (78.3%) had weight gain less than 5%. There was no significant difference in overall survival (OS) and progression-free survival (PFS) according to weight gain.
Conclusion: Finally, the findings of the study showed that, despite the fact that PFS and OS in the weight gain group were greater than 5% of the original weight; the difference was not statistically significant.
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Affiliation(s)
- Farshid Fardad
- Department of Medical Oncology and Hematology, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Bagheri Valami
- Department of Medical Oncology and Hematology, Iran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Ansarinejad
- Department of Medical Oncology and Hematology, Iran University of Medical Sciences, Tehran, Iran
| | - Bahareh Abbasi
- Department of Medical Genetic, Medical Biotechnology Ins., National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | | | - Tayeb Ramim
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Cancer Pharmacogenetics Research Group (CPGRG), Iran University of Medical Sciences, Tehran, Iran
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16
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Shaikh H, Bradhurst P, Ma LX, Tan SYC, Egger SJ, Vardy JL. Body weight management in overweight and obese breast cancer survivors. Cochrane Database Syst Rev 2020; 12:CD012110. [PMID: 33305350 PMCID: PMC8094215 DOI: 10.1002/14651858.cd012110.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies suggest that overweight and obese breast cancer survivors are at increased risk of cancer recurrence and have higher all-cause mortality. Obesity has an impact on breast cancer survivor's quality of life (QOL) and increases the risk of longer-term morbidities such as type 2 diabetes mellitus and cardiovascular disease. Many cancer guidelines recommend survivors maintain a healthy weight but there is a lack of evidence regarding which weight loss method to recommend. OBJECTIVES To assess the effects of different body weight loss approaches in breast cancer survivors who are overweight or obese (body mass index (BMI) ≥ 25 kg/m2). SEARCH METHODS We carried out a search in the Cochrane Breast Cancer Group's (CBCG's) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6), MEDLINE (2012 to June 2019), Embase (2015 to June 2019), the World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP) and Clinicaltrials.gov on 17 June 2019. We also searched Mainland Chinese academic literature databases (CNKI), VIP, Wan Fang Data and SinoMed on 25 June 2019. We screened references in relevant manuscripts. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs and randomised cross-over trials evaluating body weight management for overweight and obese breast cancer survivors (BMI ≥ 25 kg/m2). The aim of the intervention had to be weight loss. DATA COLLECTION AND ANALYSIS Two review authors independently performed data extraction and assessed risk of bias for the included studies, and applied the quality of the evidence using the GRADE approach. Dichotomous outcomes were analysed as proportions using the risk ratio (RR) as the measure of effect. Continuous data were analysed as means with the measure of effect being expressed as the mean differences (MDs) between treatment groups in change from baseline values with 95% confidence intervals (CIs), when all studies reported exactly the same outcomes on the same scale. If similar outcomes were reported on different scales the standardised mean difference (SMD) was used as the measure of effect. Quality of life data and relevant biomarkers were extracted where available. MAIN RESULTS We included a total of 20 studies (containing 23 intervention-comparisons) and analysed 2028 randomised women. Participants in the experimental groups received weight loss interventions using the core element of dietary changes, either in isolation or in combination with other core elements such as 'diet and exercise', 'diet and psychosocial support' or 'diet, exercise and psychosocial support'. Participants in the controls groups either received usual care, written materials or placebo, or wait-list controls. The duration of interventions ranged from 0.5 months to 24 months. The duration of follow-up ranged from three months to 36 months. There were no time-to-event data available for overall survival, breast cancer recurrence and disease-free survival. There was a relatively small amount of data available for breast cancer recurrence (281 participants from 4 intervention-comparisons with 14 recurrence events; RR 1.95, 95% CI 0.68 to 5.60; low-quality evidence) and the analysis was likely underpowered. Overall, we found low-quality evidence that weight loss interventions for overweight and obese breast cancer survivors resulted in a reduction in body weight (MD: -2.25 kg, 95% CI: -3.19 to -1.3 kg; 21 intervention-comparisons; 1751 women), body mass index (BMI) (MD: -1.08 kg/m2, 95% CI: -1.61 to -0.56 kg/m2; 17 intervention-comparisons; 1353 women), and waist circumference (MD:-1.73 cm, 95% CI: -3.17 to -0.29 cm; 13 intervention-comparisons; 1193 women), and improved overall quality of life (SMD: 0.74; 95% CI: 0.20 to 1.29; 10 intervention-comparisons; 867 women). No increase was seen in adverse events for women in the intervention groups compared to controls (RR 0.94, 95% CI: 0.76 to 1.17; 4 intervention-comparisons; 394 women; high-quality evidence). Subgroup analyses revealed that decreases in body weight, BMI and waist circumference were present in women regardless of their ethnicity and menopausal status. Multimodal weight loss interventions (which referred to 'diet, exercise and psychosocial support') appeared to result in greater reductions in body weight (MD: -2.88 kg, 95% CI: -3.98 to -1.77 kg; 13 intervention-comparisons; 1526 participants), BMI (MD: -1.44 kg/m2, 95% CI: -2.16 to -0.72 kg/m2; 11 studies; 1187 participants) and waist circumference (MD:-1.66 cm, 95% CI: -3.49 to -0.16 cm; 8 intervention-comparisons; 1021 participants) compared to dietary change alone, however the evidence was low quality. AUTHORS' CONCLUSIONS Weight loss interventions, particularly multimodal interventions (incorporating diet, exercise and psychosocial support), in overweight or obese breast cancer survivors appear to result in decreases in body weight, BMI and waist circumference and improvement in overall quality of life. There was no increase in adverse events. There is a lack of data to determine the impact of weight loss interventions on survival or breast cancer recurrence. This review is based on studies with marked heterogeneity regarding weight loss interventions. Due to the methods used in included studies, there was a high risk of bias regarding blinding of participants and assessors. Further research is required to determine the optimal weight loss intervention and assess the impact of weight loss on survival outcomes. Long-term follow-up in weight loss intervention studies is required to determine if weight changes are sustained beyond the intervention periods.
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Affiliation(s)
- Hassan Shaikh
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Li Xin Ma
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
- Nutrition and Food Hygiene Department, Hebei University, Baoding, China
| | - Sim Yee Cindy Tan
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
- Nutrition and Dietetics Department, Concord Repatriation General Hospital, Concord, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sam J Egger
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Janette L Vardy
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, Australia
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Zainordin NH, Abd Talib R, Shahril MR, Sulaiman S, A Karim N. Dietary Changes and Its Impact on Quality of Life among Malay Breast and Gynaecological Cancer Survivors in Malaysia. Asian Pac J Cancer Prev 2020; 21:3689-3696. [PMID: 33369469 PMCID: PMC8046325 DOI: 10.31557/apjcp.2020.21.12.3689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Fear of cancer recurrent, side effects of treatment and belief in food taboos encourage cancer survivors to make changes in their dietary practices after diagnosis of cancer. The objective of this study was to determine the impact of dietary changes on quality of life (QoL) among Malay breast and gynaecological cancer survivors. METHODS Questionnaire of dietary changes was modified from WHEL study and adapted to typical Malay's food intake in Malaysia. A total of 23 items were listed and categorized by types of food and cooking methods. Four categories of changes "increased", "decreased", "no changes" or "stopped" were used to determine the changes in dietary practices. Score one (+1) is given to positive changes by reference to WCRF/AICR and Malaysia Dietary Guideline healthy eating recommendations. Malay EORTC QLQ-C30 were used to determine the QoL. Sociodemographic, clinical characteristics and anthropometric measurement were also collected. RESULTS The mean age of the subjects (n=77) was 50.7±7.8 years old with duration of survivorship 4.0±3.1 years. Subjects mean BMI was 27.8±4.9 kg/m2 which indicate subjects were 31.2% overweight and 32.5% obese. The percentage score of positive dietary changes was 34.7±16.4%. Positive dietary changes were increased intake of green leafy vegetable (49.4%), cruciferous vegetable (46.8%) and boiling cooking methods (45.5%). Subjects reduced their intake of red meat (42.9%), sugar (53.2%) and fried cooking method (44.2%). Subjects stopped consuming milk (41.6%), c 2008-5862 heese (33.8%) and sweetened condensed milk (33.8%). With increasing positive dietary changes, there was a significant improvement on emotional function (rs=0.27; p=0.016) and reduced fatigue symptoms (rs=-0.24; p=0.033). CONCLUSION Positive changes in dietary intake improved emotional function and reduced fatigue symptoms after cancer treatment. By knowing the trend of food changes after cancer treatment, enables the formation of healthy food intervention implemented more effective.
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Affiliation(s)
- Nadzirah Hanis Zainordin
- Nutritional Sciences Programme, Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Ruzita Abd Talib
- Nutritional Sciences Programme, Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Mohd Razif Shahril
- School of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300 Kuala Nerus, Terengganu, Malaysia
| | - Suhaina Sulaiman
- Dietetics Programme, Centre for Healthy Aging and Wellness (H-Care), School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Norimah A Karim
- Nutritional Sciences Programme, Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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Eakin EG, Reeves MM, Goode AD, Winkler EAH, Vardy JL, Boyle F, Haas MR, Hiller JE, Mishra GD, Jefford M, Koczwara B, Saunders CM, Chapman K, Hing L, Boltong AG, Lane K, Baldwin P, Millar L, McKiernan S, Demark-Wahnefried W, Courneya KS, Job J, Reid N, Robson E, Moretto N, Gordon L, Hayes SC. Translating research into practice: outcomes from the Healthy Living after Cancer partnership project. BMC Cancer 2020; 20:963. [PMID: 33023538 PMCID: PMC7539431 DOI: 10.1186/s12885-020-07454-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program. METHODS In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata. RESULTS Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed (p < 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor. CONCLUSIONS This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors' health and quality-of-life at a relatively low cost. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).
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Affiliation(s)
- Elizabeth G Eakin
- The University of Queensland, Brisbane, QLD, Australia.
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.
| | | | - Ana D Goode
- The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Frances Boyle
- University of Sydney, Sydney, NSW, Australia
- Mater Hospital, Sydney, NSW, Australia
| | - Marion R Haas
- University of Technology Sydney, Sydney, NSW, Australia
| | - Janet E Hiller
- Swinburne University of Technology, Melbourne, VIC, Australia
| | - Gita D Mishra
- The University of Queensland, Brisbane, QLD, Australia
| | - Michael Jefford
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- University of Melbourne, Carlton, VIC, Australia
| | | | | | - Kathy Chapman
- University of Sydney, Sydney, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Liz Hing
- Cancer Council New South Wales, Woolloomooloo, Australia
| | - Anna G Boltong
- University of Melbourne, Carlton, VIC, Australia
- Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | | | - Polly Baldwin
- Cancer Council South Australia, Adelaide, SA, Australia
| | - Lesley Millar
- University of Western Australia, Perth, WA, Australia
| | | | | | | | - Jennifer Job
- The University of Queensland, Brisbane, QLD, Australia
| | - Natasha Reid
- The University of Queensland, Brisbane, QLD, Australia
| | - Erin Robson
- The University of Queensland, Brisbane, QLD, Australia
| | - Nicole Moretto
- The University of Queensland, Brisbane, QLD, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sandra C Hayes
- Griffith University, Menzies Health Institute Queensland, Brisbane, QLD, Australia
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What happens to cancer survivors attending a structured cancer survivorship clinic? Symptoms, quality of life and lifestyle changes over the first year at the Sydney Cancer Survivorship Centre clinic. Support Care Cancer 2020; 29:1337-1345. [PMID: 32642951 DOI: 10.1007/s00520-020-05614-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sydney Cancer Survivorship Centre (SCSC) clinic provides multidisciplinary care after primary adjuvant treatment, with ~ 40% of attendees continuing follow-up with SCSC. METHODS SCSC survivors completed measures of symptoms, quality-of-life and lifestyle factors at initial visit (T1), first follow-up (T2) and 1 year (T3). Analyses used mixed effect models, adjusted for age, sex and tumour type. RESULTS Data from 206 survivors (2013-2019) were included: 51% male; median age 63 years; tumour types colorectal 68%, breast 12%, upper gastrointestinal 12%, other 8%. Mean time from: T1 to T2, 3.6 months; T1 to T3, 11.8 months. Mean weight remained stable, but 45% (35/77) of overweight/obese survivors lost weight from T1 to T3. Moderately-intense aerobic exercise increased by 63 mins/week at T2, and 68 mins/week T3. Proportion meeting aerobic exercise guidelines increased from 20 to 41%. Resistance exercise increased by 26 mins/week at T2. Global quality-of-life was unchanged from T1 to T2, improving slightly by T3 (3.7-point increase), mainly in males. Mean distress scores were stable, but at T3 the proportion scoring 4+/10 had declined from 41 to 33%. At T3, improvements were seen in pain, fatigue and energy, but > 20% reported moderate-severe fatigue, pain or sleep disturbance. Proportion reporting 5+ moderate-severe symptoms declined from 35% at T1 to 26% at T3, remaining higher in women. CONCLUSIONS Survivors attending SCSC increased exercise by 3 months, and sustained it at 1 year. Most overweight/obese survivors avoided further weight gain. Survivors had relatively good quality-of-life, with improvement in many symptoms and lifestyle factors at 1 year.
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Weight management barriers and facilitators after breast cancer in Australian women: a national survey. BMC WOMENS HEALTH 2020; 20:140. [PMID: 32631302 PMCID: PMC7336491 DOI: 10.1186/s12905-020-01002-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/26/2020] [Indexed: 12/24/2022]
Abstract
Background Breast cancer is the most common cancer in women worldwide. Weight gain after breast cancer is associated with poorer health outcomes. The aim of this study was to describe how Australian breast cancer survivors are currently managing their weight. Methods Online cross-sectional survey open to any woman living in Australia who self-identified as having breast cancer, between November 2017 and January 2018. Results We received 309 responses. Most respondents described their diet as good/excellent and reported moderate-high levels of weight self-efficacy. Despite this, the proportion of overweight/obesity increased from 47% at time of diagnosis to 67% at time of survey. More than three quarters of respondents did not receive any advice on weight gain prevention at the time of diagnosis. 39% of women reported being less active after cancer diagnosis, and and few weight loss interventions were perceived to be effective. Facilitators were structured exercise programs, prescribed diets, and accountability to someone else, while commonly cited barriers were lack of motivation/willpower, fatigue, and difficulty maintaining weight. Women who cited fatigue as a barrier were almost twice as likely to be doing low levels of physical activity (PA) or no PA than women who did not cite fatigue as a barrier. Conclusions We report high levels of concern about weight gain after BC and significant gaps in service provision around weight gain prevention and weight management. Women with BC should be provided with support for weight gain prevention in the early survivorship phase, which should include structured PA and dietary changes in combination with behavioural change and social support. Weight gain prevention or weight loss programs should address barriers such as fatigue. More research is required on the effectiveness of diet and exercise interventions in BC survivors, particularly with regard to weight gain prevention.
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Increases in arm volume predict lymphoedema and quality of life deficits after axillary surgery: a prospective cohort study. Br J Cancer 2020; 123:17-25. [PMID: 32362658 PMCID: PMC7341763 DOI: 10.1038/s41416-020-0844-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 03/04/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022] Open
Abstract
Background Lymphoedema develops after axillary clearance (ANC) in 25% of patients. This prospective, multi-centre study compared multi-frequency bioimpedance spectroscopy (BIS) with arm volume measurement to: (1) determine which test has better diagnostic accuracy, (2) identify factors predicting development of lymphoedema, and its effect on quality-of-life. Methods Participants (N = 1100) underwent measurements pre and post-ANC surgery for breast cancer. Relative arm volume increase (RAVI) of >10% diagnosed lymphoedema. Predictors of lymphoedema were determined using logistic regression. Optimal diagnostic method was assessed using diagnostic accuracy. Quality-of-life was assessed using the FACT B + 4 questionnaire. Results Lymphoedema was diagnosed in 22.8% women using RAVI > 10%, 45.6% using BIS criteria, while 24.5% underwent compression sleeve application by 24 months. BMI > 30 was an independent factor for both development (p = 0.005) and progression (p = 0.015) of lymphoedema. RAVI at 1 month, BMI > 30 and number of involved nodes contributed to a novel scoring model to predict lymphoedema by 36 months. Larger decreases in QoL scores post-surgery occurred in lymphoedema patients (p < 0.001). Progression to moderate lymphoedema occurred in 15% patients after sleeve application. Conclusions RAVI measurement was the best diagnostic tool for lymphoedema. BIS alone is not appropriate for lymphoedema screening or diagnosis. BMI > 30 predicted lymphoedema diagnosis and progression.
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Befort CA, Kimler BF, Bantis LE, Phillips TA, Fabian CJ. Effects of Weight Loss and Weight Regain on Circulating Biomarkers in Overweight/Obese Breast Cancer Survivors Enrolled in a Weight Loss Trial in the Rural Midwest. Cancer Epidemiol Biomarkers Prev 2020; 29:1321-1328. [PMID: 32277008 DOI: 10.1158/1055-9965.epi-19-1572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity is associated with worse breast cancer prognosis, however little is known about the level of weight loss required to improve pathway biomarkers. The effects of weight regain on biomarkers are also largely unknown. METHODS Overweight/obese breast cancer survivors enrolled in an 18-month behavioral weight loss trial provided weight and serum biomarkers [leptin, adiponectin, insulin, plasminogen activator inhibitor-1 (PAI-1), IL-6, TNFα, and hepatocyte growth factor HGF] at baseline, 6, and 18 months (n = 138). Change in biomarkers over time and by weight loss thresholds were examined. RESULTS Mean weight loss at 6 months was 13.3 ± 5.0 kg; from 6 to 18 months, mean regain was 4.0 ± 5.2 kg. Favorable biomarker modulations were observed at 6 months for leptin, adiponectin, insulin, PAI-1, IL-6, and HGF (P < 0.006 to P < 0.0001). These changes remained significant overall at 18 months despite attenuation in some. Women who lost <10% of baseline weight showed significantly smaller modulation effects for leptin (P < 0.0001), adiponectin:leptin (A/L) ratio (P < 0.0001), PAI-1 (P < 0.001), and insulin (P = 0.003) compared with women who lost >10%. Women who lost >10% observed a significant increase in adiponectin (P < 0.0001), and these women continued to show improved adiponectin from 6 to 18 months despite weight regain. Physical activity contributed additional effects on biomarker change for leptin, A/L ratio, and PAI-1. CONCLUSIONS These findings are consistent with a clinical target of 10% weight. IMPACT Sustained increases in adiponectin likely confer benefits for breast cancer prognosis even with weight regain.
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Affiliation(s)
- Christie A Befort
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas.
| | - Bruce F Kimler
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas
| | - Leonidas E Bantis
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas
| | - Teresa A Phillips
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas
| | - Carol J Fabian
- University of Kansas Medical Center, University of Kansas Cancer Center, Kansas City, Kansas
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Ee C, Cave AE, Naidoo D, Bilinski K, Boyages J. Weight before and after a diagnosis of breast cancer or ductal carcinoma in situ: a national Australian survey. BMC Cancer 2020; 20:113. [PMID: 32075592 PMCID: PMC7031941 DOI: 10.1186/s12885-020-6566-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Overweight/obesity are strongly implicated in breast cancer development, and weight gain post-diagnosis is associated with greater morbidity and all-cause mortality. The aim of this study was to describe the prevalence of overweight/obesity and the pattern of weight gain after diagnosis of breast cancer amongst Australian women. METHODS We collected sociodemographic, medical, weight and lifestyle data using an anonymous, self-administered online cross-sectional survey between November 2017 and January 2018 from women with breast cancer living in Australia. The sample consisted mainly of members of the Breast Cancer Network Australia Review and Survey Group. RESULTS From 309 responses we obtained complete pre/post diagnosis weight data in 277 women, and calculated pre/post Body Mass Index (BMI) for 270 women. The proportion of women with overweight/obesity rose from 48.5% at diagnosis to 67.4% at time of survey. Most women were Caucasian with stage I-III breast cancer (n = 254) or ductal carcinoma in situ (DCIS) (n = 33) and mean age was 59.1 years. The majority of women (63.7%) reported they had gained weight after diagnosis with an average increase of 9.07 kg in this group. Of the women who provided complete weight data, half gained 5 kg or more, 17.0% gained > 20 kg, and 60.7% experienced an increase in BMI of >1 kg/m2. Over half of the women rated their concern about weight as high. Of those women who gained weight, more than half reported that this occurred during the first year after diagnosis. Two-thirds (69.1%) of women aged 35-74 years gained, on average, 0.48 kg more weight per year than age-matched controls. CONCLUSIONS Although the findings from this survey should be interpreted cautiously due to a limited response rate and self-report nature, they suggest that women in Australia gain a considerable amount of weight after a diagnosis of breast cancer/DCIS (in excess of age-matched data for weight gain) and report high levels of concern about their weight. Because weight gain after breast cancer may lead to poorer outcomes, efforts to prevent and manage weight gain must be prioritized and accelerated particularly in the first year after diagnosis.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Adele Elizabeth Cave
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Dhevaksha Naidoo
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Kellie Bilinski
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - John Boyages
- ICON Cancer Centre, Sydney Adventist Hospital, Wahroonga, NSW, 2076, Australia
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Bloomquist K, Adamsen L, Hayes SC, Lillelund C, Andersen C, Christensen KB, Oturai P, Ejlertsen B, Tuxen MK, Møller T. Heavy-load resistance exercise during chemotherapy in physically inactive breast cancer survivors at risk for lymphedema: a randomized trial. Acta Oncol 2019; 58:1667-1675. [PMID: 31354000 DOI: 10.1080/0284186x.2019.1643916] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Due to long-standing concerns that heavy-load lifting could increase the risk of developing lymphedema, breast cancer survivors have been advised to refrain from resistance exercise with heavy loads. This study prospectively evaluated the effect of heavy-load resistance exercise on lymphedema development in women receiving chemotherapy for breast cancer.Material and Methods: Physically inactive women receiving adjuvant chemotherapy for breast cancer (n = 153) were randomized to a HIGH (supervised, multimodal exercise including heavy-load resistance exercise: 85-90% 1 repetition maximum [RM], three sets of 5-8 repetitions) versus LOW (pedometer and one-on-one consultations) 12-week intervention. Outcomes (baseline, 12 and 39 weeks) included lymphedema status (extracellular fluid [bioimpedance spectroscopy] and inter-arm volume % difference [dual-energy X-ray absorptiometry], lymphedema symptoms [numeric rating scale 0-10]), upper-extremity strength (1 RM), and quality of life domains (EORTC- BR23). Linear mixed models were used to evaluate equivalence between groups for lymphedema outcomes (equivalence margins for L-Dex, % difference and symptoms scale: ±5, ±3% and ±1, respectively). Superiority analysis was conducted for muscle strength and quality of life domains.Results: Postintervention equivalence between groups was found for extracellular fluid (0.4; 90% CI -2.5 to 3.2) and symptoms of heaviness (-0.2; -0.6 to 0.2), tightness (-0.1; -0.8 to 0.6) and swelling (0.2; -0.4 to 0.8). Nonequivalence was found for inter-arm volume % difference (-3.5%; -17.3 to 10.3) and pain (-0.7; -1.3 to 0), favoring HIGH. Strength gains were superior in the HIGH versus LOW group (3 kg; 1 to 5, p < .05). Further, clinically relevant reductions in breast (-11; -15 to -7) and arm (-6; -10 to -1) symptoms were found in the HIGH group.Conclusion: Findings suggest that physically inactive breast cancer survivors can benefit from supervised heavy-load resistance exercise during chemotherapy without increasing lymphedema risk. Trial registration: ISRCTN13816000.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Sandra C. Hayes
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
| | - Christian Lillelund
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Andersen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Karl Bang Christensen
- Department of Public Health; Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- DBCG, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
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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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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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Fararouei M, Iqbal A, Rezaian S, Gheibi Z, Dianatinasab A, Shakarami S, Dianatinasab M. Dietary Habits and Physical Activity are Associated With the Risk of Breast Cancer Among Young Iranian Women: A Case-control Study on 1010 Premenopausal Women. Clin Breast Cancer 2018; 19:e127-e134. [PMID: 30503310 DOI: 10.1016/j.clbc.2018.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several studies conducted in developed countries introduced diet and physical inactivity as major risk factors for several types of cancers. However, the impact of diet and physical inactivity on the risk of breast cancer (BC) is understudied, and the limited findings are controversial. In addition, no or limited knowledge is available from the developing world. PATIENTS AND METHODS This case-control study was performed from November 2014 to March 2016 on 1010 young women aged 20 to 50 years who were newly diagnosed with BC. Data was obtained via a validated questionnaire and the global physical activity questionnaire (GPAQ2). Also, patients' medical and histopathology reports were reviewed. RESULTS The results of multiple logistic regression suggested that, except for the common risk factors for BC (older marital age, family history of BC, smoking, and being a passive smoker), eating red meat (adjusted odds ratio [aOR] >8 portions/week [p/w] vs. 0-2 p/w, 1.15; 95% confidence interval [CI], 1.04-1.28); eating fish (aOR >8 p/w vs. 0-2 p/w, 1.55; 95% CI, 1.12-2.76), fruit consumption (aOR 0-4 p/w vs. >8 p/w, 1.96; 95% CI, 1.07-3.82), pickle consumption (aOR >8 p/w vs. 7-8 p/w, 1.46; 95% CI, 1.31-1.70), and intensity of physical activity (aOR light vs. vigorous, 1.68; 95% CI, 1.47-1.98) were directly associated with a higher risk of BC in young women. CONCLUSION Our study supported the hypothesis that unhealthy dietary habits and physical inactivity are risk factors for BC. We found that a healthy diet containing low fat and high fruits and vegetables with regular exercise are effective ways to reduce the risk of BC among young women.
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Affiliation(s)
- Mohammad Fararouei
- Department of Epidemiology, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aqsa Iqbal
- Physiology and Biophysics Department, University of Illinois at Chicago, Chicago, IL
| | - Shahab Rezaian
- Research Center for Environmental Determinants of Health (RCEDH), School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Gheibi
- Department of Epidemiology, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aria Dianatinasab
- Department of Biochemistry, Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saba Shakarami
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mostafa Dianatinasab
- Bahar Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran.
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Anderson C, Nichols HB, Deal AM, Park YMM, Sandler DP. Changes in cardiovascular disease risk and risk factors among women with and without breast cancer. Cancer 2018; 124:4512-4519. [PMID: 30291812 DOI: 10.1002/cncr.31775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/13/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) risk is an important health concern among survivors of breast cancer. However, few studies to date have examined whether trajectories of CVD risk and major risk factors are worse among women with a breast cancer diagnosis compared with those without. METHODS Changes in weight, body mass index, waist circumference, systolic blood pressure, and 10-year CVD risk were compared between women with (813 women) and without (1049 women) an incident breast cancer diagnosis while they were enrolled in the National Institute of Environmental Health Sciences Sister Study cohort. Blood pressure and adiposity measures were collected by trained examiners at an enrollment visit (≥1 year before breast cancer diagnosis) and a second home visit 4 to 11 years later (≥1 year after breast cancer diagnosis). The non-laboratory-based Framingham risk score, a measure of 10-year general CVD risk, was calculated at both the enrollment and second visits. All analyses were stratified by menopausal status at the time of enrollment. RESULTS Women who were premenopausal at the time of enrollment experienced moderate increases in weight, waist circumference, systolic blood pressure, and CVD risk over the study period. Those who were postmenopausal at the time of enrollment demonstrated little change in weight, but were found to have increases in waist circumference, systolic blood pressure, and CVD risk. In both groups, changes over time did not differ significantly according to breast cancer status. Neither chemotherapy nor endocrine therapy were found to be associated with greater increases in CVD risk or risk factors. CONCLUSIONS In the current study cohort, changes over time in CVD risk, adiposity measures, and blood pressure were similar between women who developed an incident breast cancer and those who did not.
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Affiliation(s)
- Chelsea Anderson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Biostatistics and Clinical Data Management Core, University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yong-Moon Mark Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
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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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Coughlin SS, Williams V, Moore N, Bowen D, Anglin J, Mansur N, Leo GD. The Augusta, Georgia Breast Cancer Survivor Study. JOURNAL OF CANCER TREATMENT & DIAGNOSIS 2018; 2:10-15. [PMID: 30320304 PMCID: PMC6183059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Several studies have provided important information about health conditions and other challenges faced by women diagnosed with breast cancer and how they can improve their quality of life and reduce their risk of cancer recurrence. Although African American and Hispanic breast cancer patients have a poorer survival than their white counterparts, few studies have compared the experiences of African American, Hispanic, and non-Hispanic white breast cancer survivors. OBJECTIVES To facilitate collaborative studies on breast cancer survivorship in a multicultural population, including future intervention research on nutrition, and physical activity, and clinical substudies. METHODS This cohort study consists of a postal survey of up to 1,000 women with a history of a breast cancer diagnosis who reside in Augusta-Richmond County, Georgia, USA, and a repeat survey in 4 to 5 years to obtain longitudinal data. The follow-up survey in 4 to 5 years will allow for longitudinal changes in health to be assessed. CONCLUSION The survey will provide a comprehensive picture of the health of breast cancer survivors, across the lifespan, in a large Southern city. A broad range of health issues will be addressed including physical activity, diet, nutrition, personal and family history of cancer, quality-of-life, psychosocial concerns, and beliefs about cancer recurrence risk reduction through lifestyle changes. Through its longitudinal design, the study will also provide important information about changes in physical and mental health as breast cancer survivors advance in age.
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Affiliation(s)
- Steven S Coughlin
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
- Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, GA
| | | | - Nicole Moore
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
| | - Deborah Bowen
- University of Washington School of Medicine, Seattle, WA
| | - Judith Anglin
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
| | - Nadine Mansur
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
| | - Gianluca De Leo
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
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Abstract
High BMI is associated with an increased risk of breast cancer in post-menopausal women but poorer outcomes in all age groups. The underlying mechanism is likely to be multi-factorial. Patients with a high BMI may present later due to body habitus. Some studies have also indicated an increased incidence of biologically adverse features, including a higher frequency of oestrogen receptor (ER negative) tumours, in obese patients. Obese patients have a higher frequency of surgical complications, potentially delaying systemic therapies, and reports suggest that chemotherapy and endocrine therapy are less effective in patients with BMI ≥30 kg/m2.High BMI is generally interpreted as excess adiposity and a World Cancer Research Fund report judged that the associations between BMI and incidence of breast cancer were due to body fatness. However, BMI cannot distinguish lean mass from fat mass, or characterise body fat distribution. Most chemotherapy drugs are dosed according to calculated body surface area (BSA). Patients with a similar BSA or BMI may have wide variations in their distribution of adipose tissue and skeletal muscle (body composition); however, few studies have looked at the effect of this on chemotherapy tolerance or effectiveness. Finally, adjuvant treatments for breast cancer can themselves result in body composition changes.Research is required to fully understand the biological mechanisms by which obesity influences cancer behaviour and the impact of obesity on treatment effectiveness and tolerance so that specific management strategies can be developed to improve the prognosis of this patient group.
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Validity of self-reported weight, height, and body mass index among African American breast cancer survivors. J Cancer Surviv 2018. [PMID: 29536415 DOI: 10.1007/s11764-018-0685-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Self-reported weight, height, and body mass index (BMI) are commonly used in cancer epidemiology studies, but information on the validity of self-reports among cancer survivors is lacking. This study aimed to evaluate the validity of these self-reported measures among African American (AA) breast cancer survivors, known to have high obesity prevalence. METHODS We compared the self-reported and measured values among 243 participants from the Women's Circle of Health Follow-Up Study (WCHFS), a population-based longitudinal study of AA breast cancer survivors. Multivariable-adjusted linear regressions were used to identify factors associated with reporting errors. We also examined the associations of self-reported and measured BMI with obesity-related health outcomes using multivariable logistic regressions, with hypertension as an example, to evaluate the impact of misreporting. RESULTS We found that self-reported and measured values were highly correlated among all and when stratified by participants' characteristics (intraclass correlation coefficients ≥ 0.99, 0.84, and 0.96 for weight, height, and BMI, respectively). The agreement between BMI categories (normal, overweight and obese) based on self-reported and measured data was excellent (kappa = 0.81). Women who were older, never smoked, had higher grade tumors, or had greater BMI tended to have overestimated BMI calculated from self-reported weight and height. The BMI-hypertension association was similar using self-reported (OR per 5 kg/m2 increase 1.63; 95% CI 1.27-2.10) and measured BMI (1.58; 95% CI 1.23-2.03). CONCLUSIONS Self-reported weight, height, and BMI were reasonably accurate in the WCHFS. IMPLICATIONS FOR CANCER SURVIVORS Our study supports the use of these self-reported values among cancer survivors when direct measurements are not possible.
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Hagen KB, Aas T, Kvaløy JT, Søiland H, Lind R. Diet in women with breast cancer compared to healthy controls – What is the difference? Eur J Oncol Nurs 2018; 32:20-24. [DOI: 10.1016/j.ejon.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 12/13/2022]
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Mentoor I, Engelbrecht AM, van Jaarsveld PJ, Nell T. Chemoresistance: Intricate Interplay Between Breast Tumor Cells and Adipocytes in the Tumor Microenvironment. Front Endocrinol (Lausanne) 2018; 9:758. [PMID: 30619088 PMCID: PMC6297254 DOI: 10.3389/fendo.2018.00758] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/29/2018] [Indexed: 12/24/2022] Open
Abstract
Excess adipose tissue is a hallmark of an overweight and/or obese state as well as a primary risk factor for breast cancer development and progression. In an overweight/obese state adipose tissue becomes dysfunctional due to rapid hypertrophy, hyperplasia, and immune cell infiltration which is associated with sustained low-grade inflammation originating from dysfunctional adipokine synthesis. Evidence also supports the role of excess adipose tissue (overweight/obesity) as a casual factor for the development of chemotherapeutic drug resistance. Obesity-mediated effects/modifications may contribute to chemotherapeutic drug resistance by altering drug pharmacokinetics, inducing chronic inflammation, as well as altering tumor-associated adipocyte adipokine secretion. Adipocytes in the breast tumor microenvironment enhance breast tumor cell survival and decrease the efficacy of chemotherapeutic agents, resulting in chemotherapeutic resistance. A well-know chemotherapeutic agent, doxorubicin, has shown to negatively impact adipose tissue homeostasis, affecting adipose tissue/adipocyte functionality and storage. Here, it is implied that doxorubicin disrupts adipose tissue homeostasis affecting the functionality of adipose tissue/adipocytes. Although evidence on the effects of doxorubicin on adipose tissue/adipocytes under obesogenic conditions are lacking, this narrative review explores the potential role of obesity in breast cancer progression and treatment resistance with inflammation as an underlying mechanism.
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Affiliation(s)
- Ilze Mentoor
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Anna-Mart Engelbrecht
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Paul J. van Jaarsveld
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Theo Nell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
- *Correspondence: Theo Nell
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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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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: 19] [Impact Index Per Article: 2.7] [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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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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39
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Fassier P, Zelek L, Bachmann P, Touillaud M, Druesne-Pecollo N, Partula V, Hercberg S, Galan P, Cohen P, Hoarau H, Latino-Martel P, Srour B, Gonzalez R, Deschasaux M, Touvier M. Sociodemographic and economic factors are associated with weight gain between before and after cancer diagnosis: results from the prospective population-based NutriNet-Santé cohort. Oncotarget 2017; 8:54640-54653. [PMID: 28903371 PMCID: PMC5589610 DOI: 10.18632/oncotarget.17676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/27/2017] [Indexed: 01/26/2023] Open
Abstract
Purpose While many cancer patients are affected by weight loss, others tend to gain weight, which may impact prognosis and risk of recurrence and of second cancer. The aim of this prospective study was to investigate weight variation between before and after cancer diagnosis and socio-demographic, economic, lifestyle and clinical factors associated with moderate-to-severe weight gain. Methods 1051 incident cases of first primary cancer were diagnosed in the NutriNet-Santé cohort between 2009 and 2015. Weight was prospectively collected every 6 months since subjects’ inclusion (i.e. an average of 2y before diagnosis). Mean weights before and after cancer diagnosis were compared with paired Student's t-test. Factors associated with moderate-to-severe weight gain (≥5% of initial weight) were investigated by age and sex-adjusted logistic regression. Results Weight loss was observed in men (-3.54±4.39kg in those who lost weight, p=0.0002) and in colorectal cancer patients (-3.94±4.40kg, p=0.001). Weight gain was observed in breast and skin cancers (2.83±3.21kg, p=0.04, and 2.96±2.75kg, p=0.04 respectively). Women (OR=1.75[1.06-2.87],p=0.03), younger patients (2.44[1.51-3.70],p<0.0001), those with lower income (OR=1.30[1.01-1.72],p-trend=0.007), lower education (OR=1.32[1.03-2.70],p-trend=0.03), excess weight before diagnosis (OR=1.64[1.12-2.42],p=0.01), lower physical activity (OR=1.28[1.01-1.64],p=0.04) and those who stopped smoking (OR=4.31[1.99-9.35],p=0.005]) were more likely to gain weight. In breast cancer patients, induced menopause was associated with weight gain (OR=4.12[1.76-9.67]), but no association was detected for tumor characteristics or treatments. Conclusion This large prospective cohort provided original results on weight variation between before and after cancer diagnosis, highlighting different weight trajectories. Socio-demographic and economic factors appeared to influence the risk of weight gain, illustrating social inequalities in health.
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Affiliation(s)
- Philippine Fassier
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France
| | - Laurent Zelek
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France.,Oncology Department, Avicenne Hospital, F-93017, Bobigny, France
| | - Patrick Bachmann
- Cancer, Environment and Nutrition Unit, Léon Bérard Center, F-69000, Lyon, France
| | - Marina Touillaud
- Cancer, Environment and Nutrition Unit, Léon Bérard Center, F-69000, Lyon, France
| | - Nathalie Druesne-Pecollo
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France
| | - Valentin Partula
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France
| | - Serge Hercberg
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France.,Public Health Department, Avicenne Hospital, F-93017, Bobigny, France
| | - Pilar Galan
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France
| | - Patrice Cohen
- Sociology Department, University of Rouen, DySola, EA 4701, F-76821, Rouen, France
| | - Hélène Hoarau
- Sociology Department, University of Rouen, DySola, EA 4701, F-76821, Rouen, France
| | - Paule Latino-Martel
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France
| | - Bernard Srour
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France
| | - Rebeca Gonzalez
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France
| | - Mélanie Deschasaux
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France
| | - Mathilde Touvier
- Nutritional Epidemiology Research Team (EREN): Inserm U1153, Inra U1125, Cnam, Paris 5, 7 and 13 Universities, Sorbonne Paris Cité Epidemiology and Statistics Research Center, F-93017, Bobigny, France
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Schmidt T, Schwarz M, Van Mackelenbergh M, Jonat W, Weisser B, Röcken C, Mundhenke C. Feasibility study to evaluate compliance of physical activity over a long time period and its influence on the total activity score, glucose metabolism and physical and psychological parameters following breast cancer. Mol Clin Oncol 2017; 6:397-402. [PMID: 28451420 DOI: 10.3892/mco.2017.1144] [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: 02/03/2016] [Accepted: 10/19/2016] [Indexed: 02/04/2023] Open
Abstract
Despite recommendations that patients with breast cancer ought to undertake physical exercise, a majority of breast cancer patients fail to change their lifestyle and to increase their physical activity following diagnosis. In this clinical intervention feasibility study, compliance and sustainability of a walking training program over 24 weeks in patients with breast cancer following treatment were examined. The endpoints were retention rates after 12 and 24 weeks (6 months) and serum levels of glucose metabolism, the total activity score, endurance, a subjectively perceived exertion-during-endurance stress test, quality of life and fatigue. A supervised walking training session for 60-75 min twice-weekly over 6 months in 35 patients with breast cancer following treatment was examined. The study retention at 12 weeks was 27/35 (77%), and at 24 weeks 24/35 (69%). After 24 weeks, the glycated hemoglobin (HbA1c) score was significantly lowered following the intervention (P=0.001). Insulin and glucose levels remained unchanged. Significant improvements were measured in the patients' body mass index (P=0.001), endurance (P=0.013) and in psychological parameters such as fatigue (P=0.008) and the quality of life (P=0.007). Furthermore, the patients exhibited significant improvements in their subjectively perceived exertion during an endurance-stress test (P=0.079) and in their total activity score (P=0.931). The present study demonstrated an increase in total activity resulting from the supervised walking training program twice-weekly over 6 months. Significant changes in long-term parameters of glucose metabolism, such as in the HbA1c score, also occurred. Furthermore, significant improvements in physical and psychological parameters were observed.
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Affiliation(s)
- Thorsten Schmidt
- Comprehensive Cancer Center North, University of Kiel, UKSH, D-24105 Kiel, Germany
| | - Madalena Schwarz
- OB/GYN, Breast Unit, University of Kiel, UKSH, D-24105 Kiel, Germany
| | | | - Walter Jonat
- OB/GYN, Breast Unit, University of Kiel, UKSH, D-24105 Kiel, Germany
| | - Burkhard Weisser
- Institute of Sport Science, University of Kiel, D-2408 Kiel, Germany
| | - Christoph Röcken
- Comprehensive Cancer Center North, University of Kiel, UKSH, D-24105 Kiel, Germany
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Preoperative implant selection for unilateral breast reconstruction using 3D imaging with the Microsoft Kinect sensor. J Plast Reconstr Aesthet Surg 2017; 70:1059-1067. [PMID: 28595842 DOI: 10.1016/j.bjps.2017.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/31/2017] [Accepted: 04/14/2017] [Indexed: 11/22/2022]
Abstract
AIMS This study aimed to investigate whether breast volume measured preoperatively using a Kinect 3D sensor could be used to determine the most appropriate implant size for reconstruction. METHODS Ten patients underwent 3D imaging before and after unilateral implant-based reconstruction. Imaging used seven configurations, varying patient pose and Kinect location, which were compared regarding suitability for volume measurement. Four methods of defining the breast boundary for automated volume calculation were compared, and repeatability assessed over five repetitions. RESULTS The most repeatable breast boundary annotation used an ellipse to track the inframammary fold and a plane describing the chest wall (coefficient of repeatability: 70 ml). The most reproducible imaging position comparing pre- and postoperative volume measurement of the healthy breast was achieved for the sitting patient with elevated arms and Kinect centrally positioned (coefficient of repeatability: 141 ml). Optimal implant volume was calculated by correcting used implant volume by the observed postoperative asymmetry. It was possible to predict implant size using a linear model derived from preoperative volume measurement of the healthy breast (coefficient of determination R2 = 0.78, standard error of prediction 120 ml). Mastectomy specimen weight and experienced surgeons' choice showed similar predictive ability (both: R2 = 0.74, standard error: 141/142 ml). A leave one-out validation showed that in 61% of cases, 3D imaging could predict implant volume to within 10%; however for 17% of cases it was >30%. CONCLUSION This technology has the potential to facilitate reconstruction surgery planning and implant procurement to maximise symmetry after unilateral reconstruction.
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Breast cancer survivors' experience of making weight, dietary and physical activity changes during participation in a weight loss intervention. Support Care Cancer 2016; 25:1455-1463. [PMID: 27988868 DOI: 10.1007/s00520-016-3542-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/12/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study is to explore breast cancer survivors' experience of a weight loss intervention and identify potential facilitators and barriers of initiating and maintaining weight, dietary or physical activity changes. METHOD Fourteen women randomised to and completing the 12-month weight loss intervention completed semi-structured interviews 7.5 ± 0.5 months after intervention completion. An inductive thematic analysis was conducted whereby interviews were independently coded and themes identified. RESULTS Women were (mean ± SD) 55.6 ± 8.5 years, 30.2 ± 4.6 kg/m2 and 17.1 ± 3.4 months post-diagnosis at study baseline. Four themes emerged: (1) perceived motivation to participate in the intervention, (2) facilitators, (3) challenges and (4) maintenance of weight loss and behaviour changes. All women noted the impact of social/family environments, either to facilitate (e.g., support from family members) or impede (e.g., major family event) changes. The structure and support of the intervention, particularly accountability to their coach, was also seen as facilitating. Formation of habitual physical activity facilitated dietary changes. Dietary change strategies most perceived to facilitate weight loss were reducing energy intake by dietary self-monitoring, increasing vegetable intake and portion control. Challenges included breast cancer-specific issues such as post-diagnosis weight gain, treatment-related side effects and psychological issues around readiness to change and self-regulation. Diminished accountability following intervention completion impacted the maintenance of weight loss and behaviour changes, notably dietary self-monitoring. CONCLUSIONS Results suggest that formal involvement of a support person (e.g. family member/friend) and referring women to ongoing, community-based services to maintain patient-perceived accountability may be particularly useful strategies for future weight loss intervention trials targeting women with breast cancer.
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Renehan AG, Harvie M, Cutress RI, Leitzmann M, Pischon T, Howell S, Howell A. How to Manage the Obese Patient With Cancer. J Clin Oncol 2016; 34:4284-4294. [DOI: 10.1200/jco.2016.69.1899] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Obesity (body mass index [BMI] ≥ 30 kg/m2) is common among patients with cancer. We reviewed management issues in the obese patient with cancer, focusing on how obesity influences treatment selection (including chemotherapy dosing), affects chemotherapy toxicity and surgical complications, and might be a treatment effect modifier. Methods The majority of evidence is drawn from observational studies and secondary analyses of trial data, typically analyzed in N × 3 BMI categories (normal weight, overweight, and obese) matrix structures. We propose a methodological framework for interpretation focusing on sample size and composition, nonlinearity, and unmeasured confounding. Results There is a common perception that obesity is associated with increased treatment-related toxicity. Accordingly, cytotoxic chemotherapy dose reduction is common in patients with elevated BMI. Contrary to this, there is some evidence that full dosing in obese patients does not result in increased toxicity. However, these data are from a limited number of regimens, and fail to fully capture cytotoxic drug pharmacodynamics and pharmacokinetic variability in obese patients. Among patients undergoing surgery, there is evidence that elevated BMI is associated with increased perioperative mortality and increased rates of infectious complications. A novel finding is that these relationships hold after surgery for malignancy, but not for benign indications. There are biologic plausibilities that obesity might be an effect modifier of treatment, but supporting evidence from clinical studies is inconsistent. Conclusion In line with the ASCO 2012 guidelines, chemotherapy dosing is probably best performed using actual body weight in obese patients. However, specific regimens known to be associated with increased toxicity in this group should be used with caution. There is no guidance on dose for obese patients treated with biologic agents. Currently, there are no specific recommendations for the surgical management of the obese patient with cancer.
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Affiliation(s)
- Andrew G. Renehan
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Michelle Harvie
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Ramsey I. Cutress
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Michael Leitzmann
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Tobias Pischon
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Sacha Howell
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
| | - Anthony Howell
- Andrew G. Renehan, Sacha Howell, and Anthony Howell, University of Manchester; Michelle Harvie and Anthony Howell, University Hospital of South Manchester NHS Foundation Trust, Manchester; Ramsey I. Cutress, University Hospitals Southampton; Ramsey I. Cutress, University of Southampton, Southampton, United Kingdom; Michael Leitzmann, University of Regensburg, Regensburg; and Tobias Pischon, Max Delbrück Center for Molecular Medicine (MDC), Berlin-Buch, Germany
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Bachmann P, Bertrand A, Roux P. Prise en charge nutritionnelle dans les parcours de soins des cancers. NUTR CLIN METAB 2016. [DOI: 10.1016/j.nupar.2016.10.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Hardcastle SJ, Glassey R, Salfinger S, Tan J, Cohen P. Factors influencing participation in health behaviors in endometrial cancer survivors. Psychooncology 2016; 26:1099-1104. [DOI: 10.1002/pon.4288] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Sarah J. Hardcastle
- Health Psychology and Behavioural Medicine Research Group; Curtin University; Perth Australia
| | - Rachael Glassey
- School of Surgery; University of Western Australia; Perth Australia
| | | | - Jason Tan
- St John of God Hospital; Subiaco Perth Australia
| | - Paul Cohen
- St John of God Hospital; Subiaco Perth Australia
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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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Nyrop KA, Williams GR, Muss HB, Shachar SS. Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence? Breast Cancer Res Treat 2016; 158:203-17. [PMID: 27342454 DOI: 10.1007/s10549-016-3874-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 12/14/2022]
Abstract
Most breast cancer (BC) tumors are early stage and hormone receptor positive, where treatment generally includes adjuvant endocrine treatment (ET). Oncology providers and women about to start ET want to know about side effects, including potential weight gain. The aim of this study was a literature review to identify the independent effect of ET on post-diagnosis weight gain. Weight gain is of concern with regard to potential associations with BC recurrence, mortality, and quality of life in survivorship. We conducted a targeted review of the literature. Thirty-eight studies met our inclusion criteria. Patient-reported weight gain ranged widely from 18 to 52 % of patients in Year 1 and from 7 to 55 % in Year 5. Some studies reported categories of weight change: lost weight (9-17 %), stable weight (47-64 %), and gained weight (27-36 %). Most studies comparing ET with placebo or tamoxifen with AI reported no significant difference between the two groups. Wide-ranging and inconsistent results point to the need for further research to clarify annual weight change (loss, gain, stability) from BC diagnosis through 5 years of ET and beyond. There is also a need to explore weight change by type of ET and to explore risk factors for weight gain in women on ET, including tumor type, sociodemographic characteristics, and health behaviors. More specific information is needed to identify high-risk BC patients who could be targeted for weight management interventions.
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Affiliation(s)
- K A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA.
| | - G R Williams
- School of Medicine, University of North Carolina at Chapel Hill, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - H B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Campus Box 7305, Chapel Hill, NC, 27599-7305, USA
| | - S S Shachar
- School of Medicine, University of North Carolina at Chapel Hill, Haifa, Israel
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Cintolesi V, Stanton AW, Bains SK, Cousins E, Peters AM, Purushotham AD, Levick JR, Mortimer PS. Constitutively Enhanced Lymphatic Pumping in the Upper Limbs of Women Who Later Develop Breast Cancer-Related Lymphedema. Lymphat Res Biol 2016; 14:50-61. [DOI: 10.1089/lrb.2016.0005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Viviana Cintolesi
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, United Kingdom
| | - Anthony W.B. Stanton
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, United Kingdom
| | - Salena K. Bains
- Department of Research Oncology, King's College London, Guy's Hospital, London, United Kingdom
| | - Emma Cousins
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, United Kingdom
| | - A. Michael Peters
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Arnie D. Purushotham
- Department of Research Oncology, King's College London, Guy's Hospital, London, United Kingdom
| | - J. Rodney Levick
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, United Kingdom
| | - Peter S. Mortimer
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, United Kingdom
- Department of Dermatology, St George's University Hospitals NHS Foundation Trust, London, United Kindom
- Skin Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
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Playdon MC, Bracken MB, Sanft TB, Ligibel JA, Harrigan M, Irwin ML. Response. J Natl Cancer Inst 2016; 108:djw024. [PMID: 26933009 DOI: 10.1093/jnci/djw024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mary C Playdon
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT (MCP, MBB, MH, MLI); Yale Cancer Center, New Haven, CT (TBS, MLI); 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, MBB, MH, MLI); Yale Cancer Center, New Haven, CT (TBS, MLI); 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, MBB, MH, MLI); Yale Cancer Center, New Haven, CT (TBS, MLI); 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, MBB, MH, MLI); Yale Cancer Center, New Haven, CT (TBS, MLI); 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, MBB, MH, MLI); Yale Cancer Center, New Haven, CT (TBS, MLI); 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, MBB, MH, MLI); Yale Cancer Center, New Haven, CT (TBS, MLI); Dana-Farber Cancer Institute, Boston, MA (JAL)
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50
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Ma LX, Bulsara MK, Tan SY, Vardy J. Body weight management in overweight and obese breast cancer survivors. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Li Xin Ma
- Concord Repatriation General Hospital; Concord Cancer Centre; Hospital Rd, Concord, Sydney New South Wales Australia 2139
- Hebei University; Nutrition and Food Hygiene Department; No. 342 East Yuhua Rd Baoding Hebei Province China 071000
| | - Max K Bulsara
- The University of Notre Dame Australia; Institute for Health Research; 19 Mouat Street PO Box 1125 Fremantle WA Australia 6959
| | - Sim Yee Tan
- Concord Repatriation General Hospital; Concord Cancer Centre; Hospital Rd, Concord, Sydney New South Wales Australia 2139
- Concord Repatriation General Hospital; Nutrition and Dietetics Department; Building 38 Hospital Road Concord NSW Australia 2139
- University of Sydney; Sydney Medical School; Sydney Australia
| | - Janette Vardy
- Concord Repatriation General Hospital; Concord Cancer Centre; Hospital Rd, Concord, Sydney New South Wales Australia 2139
- University of Sydney; Sydney Medical School; Sydney Australia
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