1960 The perceptions of women with breast cancer during treatment with chemotherapy on changes in weight; a mixed methods approach

Abstract

Background: Weight gain and undesirable changes in body composition in women receiving chemotherapy (CT) for early stage breast cancer is a common, but poorly understood phenomenon. This sarcopenic obesity consists of an increase in fat mass and a decrease in lean body mass, which is associated with disease recurrence, an increased risk of cardiovascular disease and diabetes, lower quality of life, and a lower overall survival. The purpose of this study was to explore in-depth the perceptions of women with breast cancer on determinants of changes in body composition and muscle strength as dietary intake, physical activity and quality of life and their possible interventions on these potential changes. Interpreted against the individual measurements made during the treatment trajectory such as changes in weight, fat mass, lean body mass. Methods: As part of a greater mixed methods study, a longitudinal qualitative multiple case study was conducted. Newly diagnosed women with breast cancer were recruited and purposively selected (n = 18) from several hospitals in the Netherlands before the start of their treatment with CT. Semi structured face-to face interviews were conducted during the treatment trajectory at three time points: before start of CT, (T1), halfway (T2) and after CT (T3). Interviews (n = 54) were audiotaped and transcribed verbatim. A thematic content analysis approach was used to explore women's perceptions, such as changes in weight and taste and to interpret these qualitative findings against the individual quantitative data such as changes in weight, fat mass, lean body mass (DEXA scans), BMI, muscle strength and results of the Hospital Anxiety and Depression Scale (HADS). Results: All women, mean age 51 yr (26-65 yr) experienced known side effects from CT such as hair loss, nausea, sore mouth, mucositis. Fourteen out of 18 women gained weight between 2 and 7 kg; three women lost some weight (3-7 kg), whereas one woman lost 14 kg. All women said to be less physically active and complained about fatigue. They all experienced undesirable changes regarding taste, smell and food preferences sometimes leading to loss of appetite. Others experienced more appetite despite changes in food preferences or changes in taste and smell. Depending on their illness perception women differed in how they acted upon these changes. Some women monitored the impact of therapy reactively, other women tried to respond proactively and often creatively to all changes that happens to them. Results of the interviews were supplementary and explanatory to the weight and BMI changes and the results of the HADS. Conclusion: Suffering from weight changes, being less physically active, monitoring changes differently are important elements to take into account for the development of interventions to prevent weight gain in women with breast cancer during CT.