Abstract
Limited evidence exists on the effects of weight loss on chronic disease risk and patient-reported outcomes in breast cancer survivors. Breast cancer survivors (stage I–III; body mass index 25–45 kg/m2) were randomized to a 12-month, remotely delivered (22 telephone calls, mailed material, optional text messages) weight loss (diet and physical activity) intervention (n = 79) or usual care (n = 80). Weight loss (primary outcome), body composition, metabolic syndrome risk score and components, quality of life, fatigue, musculoskeletal pain, menopausal symptoms, fear of recurrence, and body image were assessed at baseline, 6 months, 12 months (primary endpoint), and 18 months. Participants were 55 ± 9 years and 10.7 ± 5.0 months post-diagnosis; retention was 81.8% (12 months) and 80.5% (18 months). At 12-months, intervention participants had significantly greater improvements in weight (−4.5% [95%CI: −6.5, −2.5]; p < 0.001), fat mass (−3.3 kg [−4.8, −1.9]; p < 0.001), metabolic syndrome risk score (−0.19 [−0.32, −0.05]; p = 0.006), waist circumference (−3.2 cm [−5.5, −0.9]; p = 0.007), fasting plasma glucose (−0.23 mmol/L [−0.44, −0.02]; p = 0.032), physical quality of life (2.7 [0.7, 4.6]; p = 0.007; Cohen’s effect size (d) = 0.40), musculoskeletal pain (−0.5 [−0.8, −0.2]; p = 0.003; d = 0.49), and body image (−0.2 [−0.4, −0.0]; p = 0.030; d = 0.31) than usual care. At 18 months, effects on weight, adiposity, and metabolic syndrome risk scores were sustained; however, significant reductions in lean mass were observed (−1.1 kg [−1.7, −0.4]; p < 0.001). This intervention led to sustained improvements in adiposity and metabolic syndrome risk.
Highlights
Attention has been focused on modifiable risk factors as a means to improve breast cancer outcomes [1,2]
Physical activity has been associated with reduced breast cancer recurrence risk and increased survival [3,4], with exercise interventions producing improvements in quality of life, physical function, and fatigue [5,6,7]
This paper reports on the effects of the intervention on the primary outcome, body composition, metabolic syndrome risk, and patient-reported outcomes [28], including whether intervention effects were sustained 6 months after intervention completion
Summary
Attention has been focused on modifiable risk factors (diet, obesity, physical activity) as a means to improve breast cancer outcomes [1,2]. Physical activity has been associated with reduced breast cancer recurrence risk and increased survival [3,4], with exercise interventions producing improvements in quality of life, physical function, and fatigue [5,6,7]. Breast cancer survivors who maintain a healthful weight (body mass index (BMI) = 18.5–24.9 kg/m2) have 30–40% reduced mortality risk compared to those with obesity (BMI ≥ 30 kg/m2) [8]. With limited evidence on prognostic benefit, there remains a need to understand the broader effects of weight loss on outcomes such as body composition [16], chronic disease risk (given that cardiovascular disease deaths surpass cancer-specific mortality for the majority of breast cancer survivors) [17], and patient-reported outcomes, i.e., quality of life and treatment-related side effects. A cluster of risk factors that increases cardiovascular disease and type 2 diabetes risk [25], has been associated with increased breast cancer mortality and recurrence risk [26,27]
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