Abstract
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. 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. 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). Most patients with breast cancer showed an increase in the body mass index after adjuvant chemotherapy, especially after the AC-T chemotherapy regimen.
Highlights
In Brazil, breast cancer is the most common malignant neoplasm for women and one of the ten main causes of death[1]
There was no difference between the pre-CTx body mass index (BMI) in the groups of patients with or without a post-CTx increase in the BMI (27.3±5.1 versus 28.3±5.7 kg/m2, p=0.2)
Of the East Asian patients evaluated before CTx, 72.8% were of normal weight, 22.8% were overweight, and 4.3% were obese
Summary
In Brazil, breast cancer is the most common malignant neoplasm for women and one of the ten main causes of death[1]. Increased estrone and estradiol and reduced sex hormone-binding globulin levels, which result in an increased bio-disposable fraction of estrogen, have been observed in patients with high body mass index (BMI)[2]. CTx agents act on cancer cells, and on normal ones, causing some side effects such as nausea, vomiting, loss of appetite, alopecia, mucositis, weakness, fatigue, phlebitis, and myelotoxicity[4,5,6]. Most of these effects have an influence on body weight. Some women report weight loss, weight gain is more common after CTx7-9
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