Temporal influence of endocrine therapy with tamoxifen and chemotherapy on nutritional risk and obesity in breast cancer patients

Abstract

BackgroundThe effect of endocrine therapy with tamoxifen (TMX) on weight gain has been reported in the literature, but the outcomes are still controversial. Moreover, previous treatment options, such as chemotherapy (CT), also include body changes. The focus of this study was to verify the temporal influence of endocrine therapy with TMX on nutritional risk and obesity and its association with CT in breast cancer patients.MethodsIn this cross-sectional study, 84 breast cancer surviving women were evaluated during endocrine therapy with TMX. Anthropometric, biochemical and body composition parameters were measured. A generalized estimating equation (GEE) was used to examine the association between CT and groups of women using TMX categorized by the duration of the treatment (group 1, women using TMX for the first 3 years; group 2, women using TMX between 3 and 4 years and group 3, women using TMX for more than 4 years).ResultsThe interaction of CT with duration of TMX use showed a significant effect on Body Mass Index (BMI), waist circumference (WC) and body fat percentage (BFP) (GEE p-value = 0.002, 0.000, 0.000, respectively). Women from group 1 who underwent CT presented higher values of body variables compared to those women from group 2 who also underwent CT (BMI = 29.14 ± 0.93, 26.76 ± 0.85 kg/m2; WC = 94.45 ± 1.96, 91.07 ± 2.44 cm; BFP = 36.36 ± 1.50, 33.43 ± 1.66%, respectively). On the other hand, women from group 1 who did not undergo CT presented lower values of body variables compared to those women from group 2 who also did not undergo CT (BMI = 25.29 ± 0.46, 28.40 ± 0.95 kg/m2; WC = 85.84 ± 0.90, 97.75 ± 0.88 cm; BFP = 30.32 ± 0.43; 42.95 ± 1.03%, respectively).ConclusionsWomen on endocrine therapy with TMX are mostly overweighed and obese, most evidently in women who received CT, and who were at the beginning of treatment. Women that did not undergo CT, despite presenting lower values of body variables in the first 3 years, still deserve special attention because significantly higher values were observed in women between 3 and 4 years of therapy.

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

“…This fact can be related to age and nutritional status at diagnosis, therapy used during the treatment, tumour characteristics, menopausal status [ 10 ], reduced basal metabolic rate and total energy expenditure, decreased physical activity, sleep disorders, abnormal thyroid function [ 11 ] and frequent use of steroids during CT [ 12 ]. In addition, our group recently found that women with BC on endocrine therapy with Tamoxifen are mostly overweighed and obese, most evidently in women who received CT, and who were at the beginning of the treatment [ 13 ].…”

Longer Times of Receipt of Adjuvant Endocrine Therapy Correspond to Improved Functional Capacity and Lower Adiposity in Women Receiving Adjuvant Therapy

“…42 In addition, higher BMI, WC, and BF values in the first years of endocrine therapy for BC can be influenced by previous treatments such as chemotherapy. 43 Therefore, the greater functional disability in the first years could have arisen from the prolonged effects of previous treatments before endocrine therapy, such as chemotherapy or the concomitant steroids provided to patients with this treatment, rather than AI use. Similarly, in a recent study published by our group, we found a significant effect of the interaction of chemotherapy with a shorter duration of tamoxifen use relative to adiposity parameters.…”

“…Similarly, in a recent study published by our group, we found a significant effect of the interaction of chemotherapy with a shorter duration of tamoxifen use relative to adiposity parameters. 43 In addition, psychological factors such as anxiety and depression are common in the first years of endocrine therapy 44 and may interfere with changes in body composition. To our knowledge, ours is the first study to compare groups at different duration of AI therapy with body composition and FC.…”

Weight Gain after Hormone Receptor-Positive Breast Cancer

“…Women in the highest quintile of BMI are twice as likely to die from breast cancer compared to women without obesity [ 6 ]. Endocrine therapy with tamoxifen is associated with weight gain/obesity, with a higher risk for women who first undergo chemotherapy [ 7 ]. During menopause, estradiol levels decrease and often contribute to weight gain/obesity as well [ 8 ].…”