Weight Gain During Adjuvant and Neoadjuvant Chemotherapy for Breast Cancer: an Audit of 100 Women Receiving FEC or CMF Chemotherapy

Cai

Molecular and Clinical Oncology

et al. 2013

Abstract. Weight gain commonly occurs in breast cancer patients who receive adjuvant chemotherapy. Weight gain may cause psychosocial stress and is associated with patient prognosis and survival. Several factors contributing to weight gain have been identified in Western populations. However, there was lack of information associated with body weight changes following adjuvant chemotherapy in Chinese breast cancer patients. To the best of our knowledge, this is the first such study to be conducted in the Chinese population. A total of 98 patients who received adjuvant chemotherapy following a modified radical mastectomy were included in this study. Their weight was measured prior to the first and following the last cycle of chemotherapy. A weight gain, or loss, of >1 kg following adjuvant chemotherapy was considered to be significant. Cancer stage, treatment modalities, menopausal status and other clinical information were obtained through medical record review. The results revealed that the weight changes ranged from -11 to +9 kg, with a mean value of -0.4±4.4 kg. A total of 66.7% of the patients exhibited weight changes (34.6% gained >1 kg and 32.1% lost weight), whereas 33.3% of the patients maintained a stable weight (P<0.001). Patients aged ≤40 years [odds ratio (OR)=1.429, P=0.028], with a weight of ≥60 kg at diagnosis (OR=2.211, P=0.023), who received ≥4 cycles of chemotherapy (OR=1.591, P=0.039) and a total hormone dose of ≥200 mg (OR=2.75, P=0.013) exhibited a higher risk of weight gain. In conclusion, the body weight changes observed in Chinese breast cancer patient post-adjuvant chemotherapy were different from those observed among Western populations, represented predominantly by weight gain and were reflected by approximately equal percentages of weight gain, stable weight and weight loss. IntroductionOver the previous two decades, weight gain has been shown to be a dominant event among Western breast cancer patients following adjuvant chemotherapy, exerting a negative effect on the quality of life of the patients, since weight gain is associated with secondary diseases, such as diabetes and cardiovascular diseases (1-7). Furthermore, weight gain is also associated with cancer recurrence and poor prognosis (8-13). Several previous studies have demonstrated that the majority of breast cancer survivors exhibited a mean body weight gain of 1-6 kg following chemotherapy and identified adjuvant chemotherapy as an independent prognostic factor for weight gain, with a potential long-term effect (2,3,5,6,11). However, other studies did not report a significant difference in weight gain between breast cancer patients receiving adjuvant chemotherapy and healthy controls (14). Therefore, the frequency and extent of body weight gain reported by previous studies may be considered to be overestimated (14,15).The causes of weight gain may include reduced physical activity and menopause prior to diagnosis. However, the exact mechanisms have not been fully elucidated. In addition, the previous observations were focus...

Section: Linear Correlation Linear Regressioncontrasting

confidence: 45%

Body weight changes in breast cancer patients following adjuvant chemotherapy and contributing factors

Cai

Molecular and Clinical Oncology

et al. 2013

Rev. Bras. Ginecol. Obstet.

“…Most of these effects have an influence on body weight. Although some women report weight loss, weight gain is more common after CTx [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

“…Others describe reductions in the energy expended, basal metabolic rate, and physical activity 9,10 . Another important factor is the combination of glucocorticoids and antiemetics used to minimize the side effects of CTx agents 8,11 . Psychological stress-related emotional volatility and start of menopause may also be related to weight gain during CTx 12 .…”

Section: Introductionmentioning

confidence: 99%

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

Ricci

Formigoni

Zuliani

et al. 2014

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...

European Journal of Endocrinology

“…In a cohort of more than 500 newly diagnosed women with breast cancer, tamoxifen increased weight by 1.0 kg over 1 year (31). However, another long-term study in breast cancer patients showed no difference in weight gain between tamoxifen users and non-users (32). However weight is not a reliable indicator of adiposity.…”

Section: European Journal Of Endocrinologymentioning

confidence: 98%

Estrogen receptor antagonism uncovers gender-dimorphic suppression of whole body fat oxidation in humans: differential effects of tamoxifen on the GH and gonadal axes

Birzniece

2015

Context: Tamoxifen, a selective estrogen receptor modulator, suppresses GH secretion in women but not in men. It increases testosterone levels in men. As GH and testosterone stimulate fat metabolism, the metabolic consequences of tamoxifen may be greater in women than in men. Objective: To determine whether tamoxifen suppresses fat oxidation (Fox) to a greater degree in women than in men.Design: An open-label study of ten healthy postmenopausal women and ten healthy men receiving 2-week treatment with tamoxifen (20 mg/day). Endpoint measures: GH response to arginine stimulation, serum levels of IGF1, testosterone and LH (men only), sex hormone binding globulin (SHBG) and whole body basal and postprandial Fox. Results: In women, tamoxifen significantly reduced the mean GH response to arginine stimulation (D K87%, P!0.05) and circulating IGF1 levels (D K23.5G5.4%, P!0.01). Tamoxifen reduced postprandial Fox in women (D K34.6G10.3%; P!0.05). In men, tamoxifen did not affect the GH response to arginine stimulation but significantly reduced mean IGF1 levels (D K24.8G6.1%, P!0.01). Tamoxifen increased mean testosterone levels (D 52G14.2%; P!0.01). Fox was not significantly affected by tamoxifen in men. Conclusion: Tamoxifen attenuated the GH response to stimulation and reduced postprandial Fox in women but not in men. We conclude that at a therapeutic dose, the suppressive effect of tamoxifen on fat metabolism is gender-dependent. Higher testosterone levels may mitigate the suppression of GH secretion and Fox during tamoxifen treatment in men.