Metabolic and anthropometric changes in early breast cancer patients receiving adjuvant therapy

Abstract

Weight gain and metabolic changes have been related to survival of early breast cancer patients (EBC). ‘’However, factors influencing metabolism post-diagnosis are not fully understood. We measured anthropometric [body mass index (BMI), body weight, waist and hip circumferences, and waist-to-hip ratio] and metabolic (levels of insulin, glucose, H1Ac, total, HDL, and LDL cholesterol, triglycerides, and the homeostasis model assessment score [HOMA]) parameters in 433 pre- and post-menopausal women with EBC at diagnosis and 3, 6, 9, 12, and 24 months thereafter. At diagnosis, compared with post-menopausal women, pre-menopausal patients were more likely to be leaner and to have a lower BMI, smaller waist and hip circumferences, and waist-to-hip ratio. They had also lower glucose, HbA1c, and triglyceride levels and a lower HOMA score. Furthermore, they were more likely to have an estrogen- and/or progesterone-positive tumor and a higher proliferating breast cancer. During the first two post-diagnosis years, all women showed a significant increase of weight (+0.72 kg/year, P < 0.001), waist circumference (+1.53 cm/year, P < 0.001), and plasma levels of LDL cholesterol (+5.4 mg/dl per year, P = 0.045) and triglycerides (+10.73 mg/dl per year, P = 0.017). In patients receiving chemotherapy only, there was a significant increase in hip circumference (+3.16 cm/year, P < 0.001) and plasma cholesterol levels (+21.26 mg/dl per year, P < 0.001). We showed that weight, body fat distribution, and lipid profile changed in EBC patients receiving adjuvant therapy. These changes occurred during the first 2 years after diagnosis and were not specifically related to chemotherapy, menopausal status, or initial body weight.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-015-3586-x) contains supplementary material, which is available to authorized users.

The relationship of cognitive performance to concurrent symptoms, cancer- and cancer-treatment-related variables in women with early-stage breast cancer: a 2-year longitudinal study

“…Body mass index at baseline was also associated with lower scores on several cognitive domains over time. The importance of considering BMI in breast cancer cognition studies is highlighted by recent research showing that there was an increase in body weight, waist and hip circumferences, triglyceride, and total cholesterol serum levels over 24 months in women diagnosed with breast cancer who received adjuvant therapy (Arpino et al 2015). Obesity is now recognized as a risk factor associated with reduced cognitive functioning.…”

Effect of chemotherapy and aromatase inhibitors in the adjuvant treatment of breast cancer on glucose and insulin metabolism—A systematic review

“…The pre‐ and post‐treatment weight and/or BMI were reported in seven of the eight studies. Four of the studies reported a significant increase in weight and/or BMI in response to treatment . The women included in the studies had a pretreatment BMI >25 kg/m 2 which correspond with the fact that increased weight, is a risk factor of BC.…”

“…Among the studies on the glucose metabolism, only two have follow‐up periods of more than a year, with Guinan et al having follow‐up periods of up to 40 months showing an increase in HbA1c, insulin and HOMA. Arpino et al, on a much larger cohort found no significant change in glucose or insulin with an average follow‐up time of 14 months. Several studies have tried to examine if the negative effect could potentially lead to an increase in diabetes diagnoses.…”

“…Two studies do not specify treatment. In three of the studies it is indicated that some patients received endocrine treatment, Dieli‐Conwright et al uses a regimen including trastuzumab in 6% of patients, Guinan et al state that patients may have received trastuzumab and Arpina et al followed chemotherapy with endocrine treatment in most patients without further clarification.…”

“…Four of the studies reported a significant increase in weight and/or BMI in response to treatment. 18,20,23,25 The women included in the studies had a pretreatment BMI >25 kg/m 2 which correspond with the fact that increased weight, is a risk factor of BC. However, none of the studies included a control group, thus no comparable background information including weight and BMI exist on aged-matched women without BC.…”