Weight gain following breast cancer diagnosis: Implication and proposed mechanisms

Abstract

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...

Body mass index and weight change in relation to triple-negative breast cancer survival

“…Weight gain is a common and persistent problem in breast cancer patients, especially those who are younger, closer to ideal body weight and who have been treated with chemotherapy [15]. Several studies [16-18] have demonstrated that weight gain post-diagnosis increases the risk of all-cause mortality and recurrence, including a report from our study [19]; whereas other studies found no relation [20-22].…”

Chemosensory Science in the Context of Cancer Treatment: Implications for Patient Care

“…Some described how they used less healthy 'comfort' foods as rewards in the context of challenging cancer diagnosis and treatment scenarios or that they were driven toward high sugar, high fat foods because flavour sensitivity was diminished. Despite these observations, overeating has been deemed an unlikely reason for weight gain in breast cancer populations in light of empirical data demonstrating total reductions in caloric intake in the first year following a breast cancer diagnosis (Makari-Judson et al 2014). …”

Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence?

“…To date, most of the research pertaining to weight gain as a breast cancer treatment side effect has focused on weight changes during or following adjuvant chemotherapy [21,22]. By contrast, research pertaining to weight change during adjuvant endocrine treatment (ET) is very limited.…”