Weight changes according to treatment in a diverse cohort of breast cancer patients

Jami Fukui,Kami White,Timothy B Frankland,Lynne Wilkens,Caryn Oshiro

doi:10.1186/s12885-021-08740-5

Abstract

BackgroundWeight changes are common among breast cancer patients. The majority of studies to date have focused on weight gain after a breast cancer diagnosis and its implications on health in survivors. Fewer studies have examined weight loss and its related characteristics. Weight changes have been reported to be influenced by several factors such as age, treatment, stage and pre-diagnostic weight. We evaluated weight changes during key treatment time points in early stage breast cancer patients.MethodsWe characterized 389 female patients diagnosed in Hawaii with early stage breast cancer from 2003 to 2017 in the Multiethnic Cohort (MEC) linked with Kaiser Permanente Hawaii electronic medical record data. We evaluated weight changes from surgery to 4 years post-diagnosis with six time points along a patient’s treatment trajectory (chemotherapy, radiation, endocrine, or surgery alone) and annually thereafter, adjusting for age, race/ethnicity and initial body mass index (BMI).ResultsWe found key time points of significant weight change for breast cancer patients according to their adjuvant treatment. In patients who had surgery alone (S), surgery-radiation (SR), or surgery-endocrine therapy (SE), the majority of patients had stable weight, although this consistently decreased over time. However, the percentages of patients with weight loss and weight gain during this time steadily increased up to 4 years after initial surgery. Weight loss was more common than weight gain by about 2 fold in these treatment groups. For patients with surgery-chemotherapy (SC), there was significant weight loss seen within the first 3 months after surgery, during the time when patients receive chemotherapy. And this weight loss persisted until year 4. Weight gain was less commonly seen in this treatment group.ConclusionsWe identified key time points during breast cancer treatment that may provide a therapeutic window to positively influence outcomes. Tailored weight management interventions should be utilized to promote overall health and long term survivorship.

Highlights

Weight changes are common among breast cancer patients
A study by Del Fabbro et al examined sarcopenia in women with early stage breast cancer and found it to be associated with improved outcomes [13]
Our study evaluates changes in weight from surgery to 4 years post-diagnosis, across six time points along a patient’s treatment trajectory; chemotherapy, radiation, endocrine treatment, or surgery alone, adjusting for age, race/ethnicity, and body mass index (BMI) at surgery

Summary

Introduction

Weight changes are common among breast cancer patients. The majority of studies to date have focused on weight gain after a breast cancer diagnosis and its implications on health in survivors. We evaluated weight changes during key treatment time points in early stage breast cancer patients. The prevalence of sarcopenia is between 12 to 57% in older cancer patients [9] Cancer treatments such as surgery, chemotherapy, and radiation may further contribute to muscle loss [10]. Sarcopenia is as common and important a risk factor as obesity for cancer outcomes, including survival, chemotherapy toxicity and surgical outcomes [11]. In a recent meta-analysis, sarcopenia was found to be a risk factor for mortality among early stage female breast cancer patients [12]. A study by Del Fabbro et al examined sarcopenia in women with early stage breast cancer and found it to be associated with improved outcomes [13]

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Discussion

Conclusion