Resting Energy Expenditure and Body Mass Changes in Women During Adjuvant Chemotherapy for Breast Cancer

Campbell, Kristin L.; Lane, Kirstin; Martin, A. D.; Gelmon, Karen A.; McKenzie, D. C.

doi:10.1097/01.ncc.0000265004.64440.5f

Cited by 66 publications

(71 citation statements)

References 33 publications

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“…Changes in BMI during anthracycline-based CTx have been associated with poorer prognosis, in terms of increased recurrence and mortality rates 13,14 . However, other studies have recorded only slight weight gains or unchanged weight with anthracycline-based regimens 22,24,32 .…”

Section: Discussionmentioning

confidence: 99%

Variations in the body mass index in Brazilian women undergoing adjuvant chemotherapy for breast cancer

Ricci

Formigoni

Zuliani

et al. 2014

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To evaluate variations in the body mass index in patients undergoing adjuvant chemotherapy for breast cancer, and to associate these changes with patient's age and adjuvant chemotherapy regimen. METHODS: We performed a retrospective cohort study in order to correlate any variation in the body mass index before and after adjuvant chemotherapy with patient's age and adjuvant chemotherapy regimen. Patients who received any form of prior hormone therapy, such as tamoxifen or aromatase inhibitors, were excluded. We selected data for 196 patients with stage I to III breast cancer who were treated by radical or conservative surgery and received adjuvant chemotherapy at the Cancer Institute of the State of São Paulo, Brazil. RESULTS: Before adjuvant chemotherapy, 67.8% of patients were classified as overweight or obese according to their body mass indices. Around 66.3% (95% CI 59.7-73.0) of the patients exhibited an increase in the body mass index after adjuvant chemotherapy. The average age of all patients was 56.3±11.3 years. Participants whose body mass index increased were younger than those with no increase (54.7±11.1 versus 59.3±11.2 years; p=0.007). Patients were treated with the following adjuvant chemotherapy regimens: doxorubicin, cyclophosphamide, and paclitaxel (AC-T, 129 patients, 65.8%); 5-fluoracil, doxorubicin, and cyclophosphamide (36 patients, 18.4%); cyclophosphamide, methotrexate, and 5-fluoracil (16 patients, 8.2%); docetaxel and cyclophosphamide (7 patients, 3.6%); and other regimen (8 patients, 4.1%). The AC-T regimen showed a statistically significant association with increase in the body mass index (p<0.001 by ANOVA). CONCLUSIONS: Most patients with breast cancer showed an increase in the body mass index after adjuvant chemotherapy, especially after the AC-T chemotherapy regimen. ResumoOBJETIVO: Avaliar variações no índice de massa corpórea em pacientes que estão passando por quimioterapia devido ao câncer de mama, e relacionar tais alterações com a idade da paciente e o regime de quimioterapia. MÉTODOS: Estudo de coorte retrospectivo que correlacionou variações no índice de massa corpórea pré-e pós-quimioterapia com a idade da paciente e o regime de quimioterapia. Foram excluídas as pacientes que receberam terapia hormonal prévia, seja como tamoxifeno ou inibidores da aromatase. Os dados de 196 pacientes com estágio I a III de câncer de mama foram selecionados, e elas foram tratadas por cirurgia radical ou conservadora que receberam quimioterapia adjuvante no Instituto do Câncer do Estado de São Paulo, Brasil. RESULTADOS: Antes da quimioterapia adjuvante, 67,8% das pacientes foram classificadas com sobrepeso ou obesas de acordo com seus índices de massa corpórea. Aproximadamente 66,3% (IC95% 59,7-73,0) das pacientes exibiram aumento no índice de massa corpórea após a quimioterapia adjuvante. A média de idade das pacientes foi de 56,3±11,3 anos. Pacientes que apresentaram aumento no índice de massa corpórea eram mais jovens do que aquelas que não apresentaram aumento algum (54,7...

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Section: Discussionmentioning

confidence: 99%

Variations in the body mass index in Brazilian women undergoing adjuvant chemotherapy for breast cancer

Ricci

Formigoni

Zuliani

et al. 2014

Rev. Bras. Ginecol. Obstet.

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“…A small study by Campbell et al [34] followed 10 women undergoing adjuvant chemotherapy and measured resting energy expenditure using dual energy x-ray absorptiometry across cycles of treatment. Although participants did not gain weight, and there was no change in resting energy expenditure, there was an increase in total fat mass.…”

Section: Menopause and Age Effectmentioning

confidence: 99%

Weight gain following breast cancer diagnosis: Implication and proposed mechanisms

Makari-Judson

Braun

Jerry

et al. 2014

WJCO

135

106

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Weight gain occurs in the majority of women following breast cancer treatment. An overview of studies describing weight gain amongst women treated with early to modern chemotherapy regimens is included. Populations at higher risk include women who are younger, closer to ideal body weight and who have been treated with chemotherapy. Weight gain ranges between 1 to 5 kg, and may be associated with change in body composition with gain in fat mass and loss in lean body mass. Women are unlikely to return to pre-diagnosis weight. Possible mechanisms including inactivity and metabolic changes are explored. Potential interventions are reviewed including exercise, dietary changes and pharmacologic agents. Although breast cancer prognosis does not appear to be significantly impacted, weight gain has negative consequences on quality of life and overall health. Future studies should explore change in body composition, metabolism and insulin resistance. Avoiding weight gain in breast cancer survivors following initial diagnosis and treatment should be encouraged.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast cancer; Weight gain; Exercise; Survivorship; Insulin resistance Core tip: Weight gain occurs in the majority of women following breast cancer treatment, especially those who are younger, closer to ideal body weight and who have been treated with chemotherapy. Although weight gain may be modest, changes are consistent with sarcopenic obesity. Women are unlikely to return to pre-diagnosis weight. Although the degree of weight gain does not appear to significantly alter prognosis, associated changes in metabolism and inactivity are of concern. Interventions should be promoted to avoid weight gain. INTRODUCTIONWeight gain following a diagnosis of breast cancer has been reported consistently in women treated for breast cancer, but was an unexpected finding when first described Dixon and colleagues in 1978 [1] . After subsequent reports confirmed this observation, weight gain was included as a known side effect of adjuvant chemotherapy [2] . Despite this, most women appear to be inadequately informed about this possibility, as demonstrated by one study reporting concern about treatment-associated weight gain in only 27% of survivors prior to therapy [3] . WHY IS POST-TREATMENT WEIGHT GAIN OF CONCERN?Obesity is a global issue associated with increased risk of developing post-menopausal breast cancer [4] and a worse prognosis at the time of diagnosis [5] . However, the effect of weight gain following a diagnosis of breast cancer is less well understood. While weight gain following diagnosis does not necessarily lead to obesity or its consequences, any impact on breast cancer prognosis and overall health, patient self-image, or quality of life (QoL) would be an undesirable outcome. These outcomes may be interrelated: weight gain can influence other medical conditions such as diabetes, heart disease, hypertension and hypercholesterolemia that may impact overall survival. For example, Erick...

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“…While some retrospective studies identified a number of potential patient and therapy-related factors associated with weight gain over time, the reasons for postdiagnosis weight gain have not been clearly identified. Chemotherapy (CT), being or becoming postmenopausal after diagnosis, decreased physical activity, dietary factors such as increased caloric intake, psychosocial factors have all been implicated for postdiagnosis weight gain in patients with early BC [8,9,17,[19][20][21][22][23]. It is important to know that all studies showing evidence of significant weight gain following adjuvant treatment were reported from the United States and Western European countries.…”

Section: Introductionmentioning

confidence: 99%

Weight gain after adjuvant chemotherapy in patients with early breast cancer in Istanbul Turkey

et al. 2010

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Weight gain is a well-known and unwanted complication of adjuvant chemotherapy in breast cancer. We observed that the female Turkish cancer patients frequently gain weight with adjuvant treatment of breast cancer and planned to examine the magnitude of this problem in early breast cancer patients treated at our hospital. A total of 176 early breast cancer patients who received their adjuvant systemic therapy in Marmara University Hospital between 2003 and 2007 are included in the study. We recorded their weight before and after chemotherapy and also a year after chemotherapy to find out whether the change with weight is transitory. We have also recorded demographic information, including the educational level, menopausal status, the type of chemotherapy or hormonal treatment administered stage of disease, marital status, occupation and the underlying diseases to analyze the relationship between change in weight and these parameters. Median age of patients was 53 and 72% of patients were postmenopausal. Educational level was equally distributed for primary education (27%), high school (40%), and university (33%). The majority of the patients (76%) was married, had two children (69%) and was housewife (60%). Family history of any cancer was high (32%). Most of the patients had stage II cancer (56%), received anthracyclines+/- taxane based chemotherapy (98%) and had no underlying disease (68%). The majority also did not smoke (73%) or drink alcohol (93%). A total of 67% and 72% patients gained weight upon completion and one year after completion of chemotherapy. Mean weight before the chemotherapy, upon completion of chemotherapy and one year after completion of chemotherapy were 68.9 kg, 70.6 kg (P = 0.000) and 71.9 kg (P = 0.000) respectively. Mean body mass index was 27.1 at baseline, 27.8 upon completion of chemotherapy (P = 0.000) and 28.3 one year after completion of chemotherapy (P = 0.000). Age, menopausal status, multiparity and presence of comorbid diseases had statistically significant impact on weight gain following adjuvant therapy in breast cancer patients (P = 0.000, P = 0.008, P = 0.015 and P = 0.017 respectively). This study shows that Turkish women with early breast cancer gain weight after adjuvant systemic therapy, in line with European and American counterparts. This increase in weight is maintained at least one year after adjuvant therapy. Given the adverse consequences of weight gain in terms of both breast cancer prognosis and general health, it is necessary to inform patients about this change and to develop strategies for weight maintenance during and after systemic therapy.

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Resting Energy Expenditure and Body Mass Changes in Women During Adjuvant Chemotherapy for Breast Cancer

Cited by 66 publications

References 33 publications

Variations in the body mass index in Brazilian women undergoing adjuvant chemotherapy for breast cancer

Variations in the body mass index in Brazilian women undergoing adjuvant chemotherapy for breast cancer

Weight gain following breast cancer diagnosis: Implication and proposed mechanisms

Weight gain after adjuvant chemotherapy in patients with early breast cancer in Istanbul Turkey

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