Obese Breast Cancer Survivors Research Articles

Reviewing the recurrence rates in stage I-III HR or ER positive breast cancer in obese patients given multi-modal weight loss plan post-treatment with aromatase inhibitors.

15 Background: Aromatase inhibitors (AIs) in the treatment of endocrine recepter positive breast cancer stages I-III, poses significant challenges in the management of obesity. Obesity is not only associated with an increased risk of breast cancer incidence but also with higher rates of cancer recurrence and poorer treatment outcomes. Moreover, the use of AIs, while effective in reducing estrogen levels and preventing ER or HR positive breast cancer recurrence, may exacerbate weight gain and metabolic disturbances in obese individuals. Weight management strategies have experienced increased attention in breast cancer survivors in recent years, especially overweight or obese individuals. Novel data makes it possible to infer that obesity management activities and multimodal programs that incorporate dietary counseling and physical activity can reduce recurrence rates. Methods: Participants in this study were individuals with Stage I-III endocrine receptor positive breast cancer who had completed adjuvant therapy and had a BMI in the 40s or 50s, increasing risk of recurrence. Eligible patients were identified based on the start date for endocrine therapy. High-risk patients were then assigned to either the intervention or control group. Those in the intervention group received access to a dietician, along with informational pamphlets on physiology and weight loss strategies. Additionally, they were offered discounts to certain gyms or provided free access to fitness facilities. Both intervention and control groups were briefed about the study, with those in the intervention group encouraged to utilize the provided resources for weight management. Results: The evidence from our study will underscore the potential benefits of multimodal weight loss interventions in overweight or obese breast cancer survivors, particularly in improving anthropometric outcomes and enhancing overall quality of life. Conclusions: While the studies included in our analysis demonstrated reductions in body weight, BMI, and waist circumference, as well as improvements in quality of life measures, there remains a notable gap in understanding the impact of these interventions on breast cancer recurrence rates, especially in the context of endocrine-positive breast cancer treated with Aromatase Inhibitors (AIs).

Physical activity and/or dietary intervention in overweight or obese breast cancer survivors: results of the InForma randomized trial.

This study aimed to test the efficacy of a 6-month intervention on weight loss in a group of overweight or obese breast cancer (BC) survivors. We promoted adherence to a healthy diet or/and to increase physical activity, making use of a step counter device. Here we present results regarding the change in anthropometric measures and blood parameters. 266 women treated for BC with a BMI ≥ 25kg/m2 were randomized to a 6-month intervention into four arms: Dietary Intervention (DI); Physical Activity Intervention (PAI); Physical Activity and Dietary Intervention (PADI); Minimal Intervention (MI). Women were offered individualized counseling by a dietitian, a physiotherapist and a psychologist. Participants were followed up for an additional 18months. 231 women completed the 6-month intervention and 167 completed the additional 18-month follow-up. Respectively, 37.5% and 36.7% of women included in the DI and PADI arm reached the objective of the trial (weight reduction > 5%). Significant weight and circumferences decrease was observed at 6-month in the four arms. Weight decrease was more pronounced in the DI (-4.7% ± 5.0%) and PADI (-3.9% ± 4.5%) arms, persisted over time (at 12 and 24months), where counseling was mainly focused on the dietic component. The intervention had an effect on the glucose level with a significant reduction in whole population (-0.9 ± 11.7 p-value 0.02) and most pronounced in the PADI arm (-2.4 ± 7.8 p-value 0.03). Lifestyle intervention mainly focused on the dietetic component and making use of a step counter improved body weight, circumferences and glucose levels. A personalized approach yields a potential clinical benefit for BC survivors.

Metabolomic profiles of metformin in breast cancer survivors: a pooled analysis of plasmas from two randomized placebo-controlled trials

BackgroundObesity is a major health concern for breast cancer survivors, being associated with high recurrence and reduced efficacy during cancer treatment. Metformin treatment is associated with reduced breast cancer incidence, recurrence and mortality. To better understand the underlying mechanisms through which metformin may reduce recurrence, we aimed to conduct metabolic profiling of overweight/obese breast cancer survivors before and after metformin treatment.MethodsFasting plasma samples from 373 overweight or obese breast cancer survivors randomly assigned to metformin (n = 194) or placebo (n = 179) administration were collected at baseline, after 6 months (Reach For Health trial), and after 12 months (MetBreCS trial). Archival samples were concurrently analyzed using three complementary methods: untargeted LC–QTOF-MS metabolomics, targeted LC–MS metabolomics (AbsoluteIDQ p180, Biocrates), and gas chromatography phospholipid fatty acid assay. Multivariable linear regression models and family-wise error correction were used to identify metabolites that significantly changed after metformin treatment.ResultsParticipants (n = 352) with both baseline and study end point samples available were included in the analysis. After adjusting for confounders such as study center, age, body mass index and false discovery rate, we found that metformin treatment was significantly associated with decreased levels of citrulline, arginine, tyrosine, caffeine, paraxanthine, and theophylline, and increased levels of leucine, isoleucine, proline, 3-methyl-2-oxovalerate, 4-methyl-2-oxovalerate, alanine and indoxyl-sulphate. Long-chain unsaturated phosphatidylcholines (PC ae C36:4, PC ae C38:5, PC ae C36:5 and PC ae C38:6) were significantly decreased with the metformin treatment, as were phospholipid-derived long-chain n-6 fatty acids. The metabolomic profiles of metformin treatment suggest change in specific biochemical pathways known to impair cancer cell growth including activation of CYP1A2, alterations in fatty acid desaturase activity, and altered metabolism of specific amino acids, including impaired branched chain amino acid catabolism.ConclusionsOur results in overweight breast cancer survivors identify new metabolic effects of metformin treatment that may mechanistically contribute to reduced risk of recurrence in this population and reduced obesity-related cancer risk reported in observational studies.Trial registrationClinicalTrials.gov identifier: NCT01302379 and EudraCT Protocol #: 2015-001001-14.

Abstract CT531: A 16-week circuit interval-based exercise intervention reduces systemic inflammation in obese, sedentary cancer survivors

Abstract Introduction: Obesity and a lack of physical activity lead to systemic and chronic inflammation among cancer survivors, which are highly associated with various comorbidities (e.g., type 2 diabetes, hypertension, and metabolic syndrome) and poor oncologic prognosis. Exercise, optimized to benefit physiological responses, can be an effective strategy to reduce systemic inflammation. The objective of the study was to investigate the effects of a 16-week circuit, interval-based exercise training program on proinflammatory cytokines in cancer survivors who are obese and sedentary. Methods: This study was a single center, pilot randomized controlled trial in 90 survivors of breast, prostate, and colorectal cancers who were sedentary (<60 mins of exercise per week) and overweight/obese (body mass index > 25.0 kg/m2). Participants were randomly assigned to either the exercise group (n=60) or the usual care group (n=30). The exercise intervention was moderate to vigorous intensity aerobic (65-85% of VO2max) and resistance (65-85% of 1-repetition maximum) exercise training in a supervised, circuit, interval-based format performed thrice-weekly for 16 weeks. Blood samples were obtained at baseline and post-intervention to measure serum levels of proinflammatory cytokines, including interleukin (IL)-6, IL-8, tumor necrosis factor-α (TNF-α), and high-sensitive c-reactive protein (hsCRP). Paired t-test and repeated measure ANOVA were used to determine the between-group differences. Results: Participants were aged 63.2±10.8 years and diagnosed with breast (35%), prostate (30%), and colorectal (35%) cancers. 55% were female and mean BMI was 34.7±5.9. 75% completed chemotherapy and/or radiation therapy. Retention and adherence rates to the exercise intervention was high (100% and 92%, respectively). Compared to usual care, circuit, interval-based exercise significantly reduced IL-6 (between group mean difference, -1.2 pg/mL; p<0.001), IL-8 (-2.4; p<0.001), TNF-α (-1.9 pg/mg; p<0.001), and hsCRP (-0.8 mg/L; p=0.02). Conclusions: A 16-week circuit, interval-based aerobic and resistance exercise training program induced a reduction in systemic levels of proinflammatory cytokines among sedentary and obese breast, prostate, and colorectal cancer survivors. Our findings suggest that combined aerobic and resistance exercise may be an effective strategy to offset elevated systemic inflammation associated with obesity and sedentary behavior in cancer survivors. Citation Format: Dong-Woo Kang, Cami N. Christopher, Amber J. Normann, Mary K. Norris, Christina M. Dieli-Conwright. A 16-week circuit interval-based exercise intervention reduces systemic inflammation in obese, sedentary cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT531.

Episodic future thinking: A behavioral intervention to promote weight loss in breast cancer survivors.

TPS12139 Background: Obesity at diagnosis is associated with an increase in breast cancer (BC) specific mortality. Behavioral interventions targeting obesity-related health choices offer a scalable approach to improve patient engagement in the community. Episodic Future Thinking (EFT) is a novel remotely delivered behavioral intervention which engages the science of prospection where participants mentally simulate positive, detailed, and personal events that can occur in the future. EFT targets a key behavioral economic measure – Delay Discounting (DD). As DD rate rises, an individual devalues future outcomes to a greater degree and has a higher bias for immediate gratification. EFT can decrease DD in obese patients, leading to improved diet quality and weight loss. However, valuation of the future may impact cancer survivors differently. Herein, we propose the first randomized Phase II trial evaluating adherence and changes in DD and body weight with 12-week remotely delivered EFT vs control in overweight or obese BC survivors. Methods: Eligible patients have a history of DCIS or stage 1 to 3 BC, BMI > 25 kg/m2, have completed surgery, radiation, and chemotherapy, and are motivated to lose weight. They are randomized 1:1 to a 12-week EFT intervention or control (Episodic Recent Thinking; ERT). ERT is a validated control in which patients imagine events in the recent past. Randomization will be stratified by baseline DD rate. There is an optional 12 week follow up period where patients can continue to receive EFT or ERT cues. DD will be measured at baseline and every 4 weeks for 24 weeks. The primary endpoint is adherence, measured by percentage of thrice daily smartphone prompts participants open and attend to during the 12-week trial. Secondary endpoints are changes in body weight and DD rate at 12 and 24 weeks and change in PROs (PROMIS scales), insulin resistance (HOMA-IR), hs-CRP, and diet quality (HEI 2015) at 12 weeks from baseline. With 20 subjects per arm, the study has 80% power to detect deviation of 14 points from a target adherence rate of 80% using a 1 sample t-test. The primary endpoint is evaluable for all subjects, regardless of drop-out. Secondary endpoints will be evaluated using a linear mixed effects model. Hypothesis tests and confidence intervals will be two-sided at 5% significance/95% confidence level. Since trial activation in November 2021, 9 of the planned 46 patients are enrolled. Accrual is closely integrated with the dedicated Ohio State University Comprehensive Cancer Center Survivorship Program. This work is supported by the Alliance Cancer Control Program Pilot Award (5UG1CA189823-08). Clinical trial information: NCT05012176.

Targeting adiposity and inflammation with movement to improve prognosis in breast cancer survivors (the AIM trial): Rationale, design, and methods.

TPS12140 Background: Obesity is considered a leading modifiable contributor to breast cancer mortality worldwide due to its association with increased recurrence and decreased overall survival rate. A central mechanism by which obesity stimulates cancer progression is through chronic, low-grade inflammation in adipose tissue. Exercise has shown potential in improving inflammation but has not been implemented with breast cancer survivors. Our hypothesis is that exercise designed to target chronic inflammation and associated sarcopenic obesity will improve prognosis in obese breast cancer survivors. Methods: The AIM trial is a prospective, three-armed, phase II randomized controlled trial investigating the effects of a 16-week supervised circuit aerobic and resistance exercise (CARE) program compared to a traditional aerobic and resistance exercise (TARE) program, and attention control (AC) group, on adipose tissue inflammation in 300 breast cancer survivors. Main inclusion criteria are histologically confirmed breast cancer stage 0-III, completion of chemotherapy and/or radiation, sedentary, centrally obese, and free from musculoskeletal disorders. The primary endpoint is adipose tissue inflammation as assessed by core biopsy and blood draw; secondary endpoint is sarcopenic obesity; and exploratory endpoints are physical fitness and function and patient reported outcomes. Participants randomized to the exercise groups participate in three weekly supervised exercise sessions for 16-weeks. Participants randomized to the attention control group are offered the CARE intervention after the 16-week period of observation. Discussion: This is the first randomized controlled trial examining the effects of exercise on adipose tissue inflammation in obese, breast cancer survivors. Results will contribute to a better understanding of exercise modality on adipose tissue inflammation that can potentially improve patient prognosis. Clinical trial information: NCT03091842.

Abstract PD5-01: Cardiovascular disease risk of breast cancer therapies: The pathways heart study

Abstract Purpose: Studies on long-term cardiovascular disease (CVD) risk in breast cancer (BC) survivors are limited. We examined CVD risk associated with exposure to specific BC therapies and explored whether body mass index (BMI) or prevalent CVD risk factors at BC diagnosis modified these associations. Methods: The Pathways Heart Study is a prospective cohort study examining incident CVD outcomes and risk factors in women with BC at Kaiser Permanente Northern California (KPNC). Eligible women were diagnosed with stage I-IV invasive BC from 2005-2013, ≥21 years old, and KPNC members ≥12 months at diagnosis. KPNC records provided demographic and BC therapy characteristics. Incident CVD outcomes [ischemic heart disease, heart failure/cardiomyopathy (HF/CM), stroke] were assessed from ICD9/10 codes. Multivariable Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI) of each CVD outcome by cancer therapy received compared to not receiving that therapy, excluding those with prevalent CVD. Separate regression models included interaction terms for cancer therapy by overweight, obesity, diabetes, dyslipidemia, and hypertension to test whether the CVD outcome risk varied by presence of these factors at diagnosis. Results: Among 4,181 BC survivors with mean age of 59.6±12.0 years and mean follow-up of 7.9±3.5 years (range: 0.04-13.3), cancer therapies were not associated with incident CVD. However, CVD risks varied by BMI and prevalence of CVD risk factors at BC diagnosis. Normal weight (NW) women who received anthracyclines had higher risk of ischemic heart disease and HF/CM relative to NW women not receiving these therapies; interaction terms indicated HF/CM risk was statistically different than risks for obese women (Table). NW women who received cyclophosphamide or left-sided radiation had higher risk of HF/CM and stroke relative to NW women not receiving these therapies; these risks were statistically different from obese (for cyclophosphamide) or overweight (for radiation) women. Relative to women not receiving these therapies, higher HRs for HF/CM were observed among non-diabetic women who received cyclophosphamide (2.03, CI: 1.22-3.37), non-dyslipidemic women who received anthracyclines (3.65, CI: 1.69-7.87), and non-hypertensive women who received either anthracyclines (4.04, CI: 1.81-9.03) or cyclophosphamide (2.66, CI: 1.23-5.74) (P for interaction range: 0.04 to 0.06). Conclusion: Certain chemotherapy drugs may increase the risk of CVD in NW BC survivors; overweight and obese BC survivors may experience less risk than NW women. While chemotherapy also appears to increase HF/CM risk for women without diabetes, dyslipidemia, and hypertension, these conditions are more prevalent among overweight/obese women. Analysis within these subgroups is needed and forthcoming. Table. Adjusted HRs (95% CI) of CVD outcomes among breast cancer survivors receiving select cancer therapies* stratified by BMI status at diagnosisBMI Ischemic heart diseaseHeart failure/CardiomyopathyStrokeAnthracycline, n=1283Normal4.22 (1.59, 11.2)5.27 (2.54, 10.9)1.89 (0.79, 4.53)Overweight1.66 (0.73, 3.77)2.17 (1.15, 4.11)0.40 (0.16, 0.99)Obese1.26 (0.56, 2.85)1.1 (0.54, 2.27)a0.33 (0.13, 0.83)aCyclophosphamide, n=1705Normal1.63 (0.61, 4.31)3.28 (1.59, 6.75)2.21 (1.01, 4.84)Overweight1.59 (0.75, 3.39)1.63 (0.9, 2.97)0.73 (0.34, 1.58)Obese0.85 (0.39, 1.86)0.75 (0.38, 1.47)a0.31 (0.13, 0.71)aLeft-Side Radiation, n=1331Normal1.44 (0.56, 3.69)2.04 (1.0, 4.18)2.38 (1.28, 4.42)Overweight1.47 (0.68, 3.16)0.68 (0.34, 1.34)b0.72 (0.37, 1.4)bObese1.32 (0.73, 2.38)1.30 (0.79, 2.16)1.05 (0.61, 1.82)*Cancer therapies with non-significant findings (i.e., Trastuzumab, taxanes, aromatase inhibitors, Tamoxifen, and any-side radiation) are not shown.ap≤0.05 normal weight v. obese; bp≤0.05 normal weight v. overweight Citation Format: Heather Greenlee, Eileen Rillamas-Sun, Carlos Iribarren, Richard Cheng, Romain Neugebauer, Jamal S. Rana, Mai Nguyen-Huynh, Zaixing Shi, Cecile A. Laurent, Valerie S. Lee, Janise M. Roh, Hanjie Shen, Dawn L. Hershman, Lawrence H. Kushi, Marilyn L. Kwan. Cardiovascular disease risk of breast cancer therapies: The pathways heart study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD5-01.

Body composition and serum levels of matrix metalloproteinase-9, adiponectin and AMP-activated protein kinase in breast cancer survivors

Background:Available data suggest that obesity is related to changes in the several adipocyte-derived proteins levels, which are involved in cancer recurrence. The purpose of this work was to investigate the correlation between obesity with metalloproteinase-9 (MMP-9), adiponectin and adiponectin and AMP-activated protein kinase (AMPK) levels by comparing serum levels of MMP-9, AMPK in normal weight and obese breast cancer survivors.Materials and Methods:In this cross-sectional study, 30 normal weight breast cancer survivors (body mass index [BMI] 18.5-25 kg/m2) and 30 obese breast cancer survivors (BMI ≥30 kg/m2) were investigated. Anthropometric parameters and serum levels of MMP-9, adiponectin, and AMPK were compared between the two groups.Results:No differences were detected in the serum levels of MMP-9, adiponectin, and AMPK in obese patients and normal weight patients (P > 0.05). There were no correlations between MMP-9, adiponectin, and AMPK levels with anthropometric measurements in two groups (P > 0.05).Conclusion:We found that there was a lack of correlation between obesity measures and serum levels of MMP-9, adiponectin, and AMPK. In breast cancer survivors, it seems that circulating levels of adiponectin, AMPK, and MMP-9 do not change in obesity state.

Effects of High-Intensity Interval Training on Cardiorespiratory Fitness, and Body Composition in Overweight and Obese Breast Cancer Survivors: A Randomized Controlled Trial: Erratum

Effects of High-Intensity Interval Training on Cardiorespiratory Fitness, and Body Composition in Overweight and Obese Breast Cancer Survivors: A Randomized Controlled Trial: Erratum

The development of a lifestyle modification mobile application, "Health for You" for overweight and obese breast cancer survivors in Korea.

PurposeThis study aimed to develop a lifestyle modification (LSM) mobile application based on the Android operating system for overweight and obese breast cancer survivors (BCS) in Korea and evaluate its usability.MethodsThe content analysis, design, development, implementation, and evaluation of the LSM intervention mobile application for overweight and obese BCS was conducted by identifying survivors’ needs, searching the literature, and reviewing existing mobile applications. The survey was conducted from June 1 to December 28, 2020 at Jeonju city, Korea.ResultsThe mobile application for BCS included dietary and exercise information, weight logs, as well as distress and daily achievement check. It also included information and videos on the prevention of breast cancer recurrence and used a communication bulletin board. Expert and user usability evaluation of its content and functions confirmed that it was appropriate and satisfactory for overweight and obese BCS.ConclusionThis LSM mobile application developed for overweight and obese BCS was found to be appropriate for use. It can be applied for further study of effectiveness on improving their health and maintaining a healthy lifestyle, to ultimately improve quality of life.

Association between Dietary Intake of Flavonoids and Cancer Recurrence among Breast Cancer Survivors.

Intake of flavonoids is associated with the incidence of breast cancer, but the association between the intake of flavonoids and cancer recurrence is unclear. This study aimed to investigate the hypothesis that intake of flavonoids and flavonoid-rich foods is negatively associated with cancer recurrence. Among 572 women who underwent breast cancer surgery, 66 patients had a cancer recurrence. Dietary data were collected using a structured 24-h dietary recall, and intake of flavonoids was calculated based on the Korea Rural Development Administration flavonoid database. Among overweight and obese patients, disease-free survival was associated with intake of flavonoids (p = 0.004) and flavonoid-rich foods (p = 0.003). Intake of flavonoids (hazard ratio (HR) = 0.249, 95% confidence interval (CI): 0.09–0.64) and flavonoid-rich foods (HR = 0.244, 95% CI: 0.09–0.66) was negatively associated with cancer recurrence after adjusting for confounding factors in overweight and obese patients. Consumption of flavonoids and flavonoid-rich foods was lower in overweight and obese patients with cancer recurrence than those without recurrence and in normal-weight patients. This study suggests that intake of flavonoids and flavonoid-rich foods could have beneficial effects on cancer recurrence in overweight and obese breast cancer survivors.

Can weight loss interventions improve outcomes for overweight and obese breast cancer survivors?

Can weight loss interventions improve outcomes for overweight and obese breast cancer survivors?

Effect of Flavonoid-Rich Foods and Flavonoids on the Risk of Cancer Recurrence Among Korean Breast Cancer Survivor

Abstract Objectives Flavonoid intakes have been shown to associate with breast cancer incidence, but it is not clear the association between flavonoids and cancer recurrence. The purpose of the present study was to investigate the hypothesis that intakes of flavonoids and flavonoid-rich foods were negatively associated with cancer recurrence. Methods Among 572 women after breast cancer surgery, 66 patients had cancer recurrence during follow–up until 114 months with a median period of disease-free survival of 43 months ranged 6–103 months. Dietary data were collected using structured 24-h dietary recall, and the intake of flavonoid was calculated based on the Korea Rural Development Administration flavonoid database. Results There was no significant association of flavonoid and flavonoid-rich food intake with cancer recurrence and disease-free survival among all patients. On the other hand, among overweight and obese patients, Kaplan-Meier survival curves revealed a significant effect of dietary flavonoids (P = 0.04) and flavonoid-rich foods (P = 0.03) on disease-free survival, but not overall survival. Intakes of flavonoid (HR = 0.244, 95% CI: 0.09–0.66) and flavonoid-rich food (HR = 0.223, 95% CI: 0.08–0.59) were also negatively associated with cancer recurrence after adjusting for confounding factors in overweight and obese patients. Consumption of flavonoids and flavonoid-rich foods was lower in overweight and obese patients with cancer recurrence than those without recurrence. Conclusions To the best of our knowledge, this was the first study to examine the association between flavonoid intake and cancer recurrence/disease-free survival in breast cancer patients. The present study suggested that intakes of flavonoids and flavonoid-rich foods could have a beneficial effect on cancer recurrence among overweight and obese breast cancer survivors. Further clinical studies are needs to confirm whether supplementation of flavonoids reduces cancer recurrence. Funding Sources This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (NRF-2018R1A2B6002486).

The Effects of Synbiotic Supplementation on Serum Anti-Inflammatory Factors in the Survivors of Breast Cancer with Lymphedema following a Low Calorie Diet: A Randomized, Double-Blind, Clinical Trial

Background and Aim Breast cancer-related lymphedema (BCRL) is a treatment-related inflammatory complication in breast cancer survivors (BCSs). This study was aimed to evaluate the effect of synbiotic supplementation on serum concentrations of IL-10, TGF-β, VEGF, adiponectin, and edema volume among overweight or obese BCSs with lymphedema following a low-calorie diet (LCD). Method In a randomized double-blind, controlled clinical trial, 88 obese and overweight BCSs women were randomized to synbiotic supplement (n = 44) or placebo (n = 44) groups and both groups followed an LCD for 10 weeks. Pre- and post-intervention comparisons were made regarding the anti-inflammatory markers which included IL-10, TGF-β, VEGF, adiponectin, edema volume, and anthropometric measurements. Also, the same factors were analyzed to find inter-group disparities. Results There were no significant differences among participants in the baseline, except for IL-10 and adiponectin. Post-intervention, no significant differences were observed regarding the anti-inflammatory markers, including IL-10, VEGF, adiponectin, and TGF-β between the groups. After 10 weeks of intervention edema volume significantly decreased in the synbiotic group; additionally, anthropometric measurements (body weight, BMI, body fat percent, and WC) decreased in both groups significantly (P < 0.001 and P < 0.005; respectively). Conclusion Synbiotic supplementation coupled with an LCD in a 10-week intervention had beneficial effects on increasing the serum TGF-β, IL-10, and adiponectin levels in women with BCRL. It also reduced arm lymphedema volume. Therefore, synbiotic supplementation can be effective in improving health status in BCRL patients.

The impact of weight loss on physical function and symptoms in overweight or obese breast cancer survivors: results from POWER-remote.

In pre-planned observational analysis of the POWER-remote trial, we examined the impact of weight loss on patient-reported outcomes (PROs). We hypothesized a priori that survivors with ≥ 5% weight loss would have improved physical function (PF) at 6months vs. those who did not. Patients with stage 0-III breast cancer who completed local therapy and chemotherapy with BMI ≥ 25kg/m2 were randomized to POWER-remote (telephone coaching; diet/activity tracking) or self-directed weight loss (booklet). Participants completed PROs at baseline, 6, and 12months: PROMIS PF, pain, fatigue, anxiety, depression, sleep; FACT-endocrine symptoms; MOS-sexual function. Changes in PROs among those with ≥ 5% weight loss vs. those with < 5% were tested with multivariable mixed effect models, across randomized groups. Of 94 women who completed PROs, 84 and 69 participants were evaluable at 6 and 12months, respectively. Regardless of intervention, PF improved in those with ≥ 5% weight loss vs. those with < 5% at 6months (4.4 vs. 0.3 points; p = 0.02) and 12months (3.6 vs. 0 points; p = 0.04). While endocrine symptoms, fatigue, and anxiety improved at 6months in those who lost ≥ 5%, differences were not significant vs. those who lost < 5%. There was no significant change within or between groups in sexual function, depression, or sleep. Findings at 12months were similar, except pain improved in those losing ≥ 5%. These results support the benefits of weight loss in overweight/obese breast cancer survivors. Weight management in breast cancer survivors may improve PF.

Preliminary efficacy of a community-based, group-mediated cognitive behavioral lifestyle intervention among breast cancer survivors.

e24035 Background: Post-treatment weight gain places breast cancer (BCa) survivors at heightened risk for cardiovascular disease, metabolic syndrome, and functional decline. Lifestyle weight management (LWM) interventions combining exercise and dietary weight loss represents an effective approach to mitigating the adverse cardiometabolic and functional effects frequently observed in BCa survivors. Unfortunately, community access to cost-effective, sustainable, LWM interventions among BCa survivors remains limited. The purpose of this study is to determine the preliminary efficacy of a community-based LWM intervention in BCa survivors on select body composition (BC), physical function, and social cognitive outcomes of the first wave of participants in the Healthy New Albany Breast Cancer (HNABC) pilot trial. Methods: The 24-week, community-based pilot trial promotes lifestyle behavior changes through a group-mediated cognitive behavioral (GMCB) approach driven by Social Cognitive Theory. The measures analyzed were BC done via Dual-energy X-ray Absorptiometry, physical function via the 400m walk test, and social cognitive outcomes via satisfaction with function and appearance and perceived competence with exercise and diet at 6-months via effect size calculations using Cohen’s d. Results: Meaningful changes were observed in fat mass ( d= -0.46), percent lean mass ( d= 0.33), lean mass ( d= -0.45), and physical function ( d= -0.59), some of which reached clinical relevance. Select self-reported outcomes also saw meaningful improvements from this LWM intervention. Conclusions: Findings from this study demonstrate the preliminary efficacy of implementing a GMCB-based LWM intervention among overweight or obese BCa survivors. Given the meaningful impact that successful weight management has on reducing risk for chronic diseases, these results highlight the utility of implementing a LWM intervention in the community for BCa survivors in an effort to extend the access, reach, and scalability of supportive care approaches during BCa survivorship.

Abstract PD11-04: The impact of sleep on weight loss in overweight or obese breast cancer survivors

Abstract BACKGROUND: Sleep disturbance, common in cancer survivors, is associated with obesity, eating behaviors and metabolism, and may impact weight loss treatment outcomes. Weight loss promotion in breast cancer survivors is important because it can potentially decrease cancer recurrence. We have previously demonstrated the efficacy of a behavioral weight loss (BWL) intervention for overweight/obese breast cancer survivors in the POWER-remote breast cancer trial. In the current study we aimed to evaluate the impact of baseline sleep on weight outcomes at 6 and 12 months. We hypothesized that participants with poor sleep at baseline will lose significantly less weight. METHODS: Women with a history of stage 0-III breast cancer, who completed local therapy and chemotherapy, with a body mass index ≥25 kg/m2 were randomized to a self-directed approach or the 12-month POWER-remote intervention, a BWL intervention consisting of telephone-based coaching, online educational materials and tracking of diet, physical activity and weight. Participants completed demographic questionnaires at baseline, and patient-reported outcomes (PROs) at baseline, 6 and 12 months, including the 6-item NIH PROMIS Adult Sleep Disturbance Version 1.0 Short Form, assessing sleep quality, depth, and restoration over the last week. Weight was measured at baseline, 6 and 12 months and % total weight loss (%TWL) was calculated from baseline weight. Those with poor sleep were defined as having a sleep T-score &amp;gt;55, and associations between sleep scores and change in weight at 6 and 12 months were made using a linear regression model, while adjusting for baseline weight. Fisher’s exact test was also used to compare the number of patients who had 5% weight-loss between sleep groups. RESULTS: A total of 48 women with early stage breast cancer received BWL. Those with poor sleep in the BWL group (n= 16) lost significantly less weight than those with normal sleep in the BWL group (n=32) at both 6 (-4.06% vs -6.77% TWL, p&amp;gt;0.05) and 12 months (-3.87% vs -7.54% TWL, p&amp;gt;0.05), respectively. Similar findings were seen in poor sleepers in the BWL group and attaining 5% weight loss at 6 (p&amp;gt;0.05) and 12 months (p&amp;gt;0.05). There were no significant differences in weight loss outcomes among those in usual care. CONCLUSION: Breast cancer survivors receiving the weight loss intervention who reported normal sleep at baseline had double the weight loss than those with sleep disturbance at 12 months (-7.54% vs -3.87%). While this is not statistically significant, it is clinically significant and leaves room for further study. These results suggest that sleep may affect weight loss. Updated data, including comparison with control group and analyses by weight loss irrespective of arm, will be reported at the conference. Further studies are need to evaluate the association between baseline sleep and weight loss, and determine if interventions that detect and treat underlying sleep disturbance may augment behavioral interventions for weight loss. FUNDING: Breast Cancer Research Foundation, Cigarette Restitution Fund Table 1: Weight Loss Summary in BWL group based on Sleep DisturbanceVariablesPoor sleep (T-score &amp;gt;55)Normal sleep (T-Score &amp;lt;55)TotalSample SizeN = 16N = 32N = 48Baseline Weight - Mean (SD)202.1 (32.26)182.64 (27.73)Weight Loss 6mo. (lbs) - Mean (SD)-8.5 (10.02)-11.58 (11.03)Weight Loss 12mo. (lbs) - Mean (SD)-7.92 (14.61)-12.63 (13.72)Percent change in weight from BL to 6mo. - Mean (SD)-4.06 (4.83)-6.77 (6.45)p&amp;gt;0.05Percent change in weight from BL to 12mo. - Mean (SD)-3.87 (7.29)-7.54 (7.91)p&amp;gt;0.05 Citation Format: Jennifer Y Sheng, Amanda K Montanari, Amanda L Blackford, David D Lim, Cesar A Santa-Maria, Vered Stearns, Michael T Smith, Janelle W Coughlin. The impact of sleep on weight loss in overweight or obese breast cancer survivors [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD11-04.

Effects of synbiotic supplementation on serum adiponectin and inflammation status of overweight and obese breast cancer survivors: a randomized, triple-blind, placebo-controlled trial.

Adipokines and inflammatory factors can affect breast cancer (BC) prognosis and recurrence among breast cancer survivors (BCSs). This study was to evaluate the effects of synbiotic supplementation along with a low-calorie diet on some recurrence-related factors such as adiponectin, tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) among obese and overweight BCSs. We performed a randomized, triple-blind, placebo-controlled clinical trial among 76 overweight or obese postmenopausal women with a history of hormone-receptor-positive BC. Participants were randomly divided into 2 groups to intake either 109 CFU/day synbiotic supplement or placebo (n = 38 each group) for 8 weeks. All participants were given a low-calorie diet program. The primary outcome was serum concentration of adiponectin which was measured at baseline and after 8 weeks. Compared with the placebo, synbiotic intake significantly increased adiponectin (+ 13.58 (10.08, 18.17) vs. - 0.42 (- 2.90, 1.98) μg/ml; P < 0.001). In addition, synbiotic supplementation resulted in significant reduction in TNF-α levels (- 17.09 (- 32.05, - 13.60) vs. 0.20 (- 3.97, 2.00) ng/L; P < 0.001) and hs-CRP levels (- 1.14 (- 1.90, - 0.88 vs. - 0.06 (- 0.38, 0.15) mg/L; P < 0.001) compared with the placebo. In conclusion, 8-week synbiotic consumption by overweight and obese postmenopausal BCSs had beneficial effects on adiponectin, TNF-α, and hs-CRP. IRCT, IRCT20091114002709N49. Registered 18 May 2018, http://www.irct.ir : IRCT20091114002709N49.

Fluctuations in depression and anxiety predict dysregulated leptin among obese breast cancer survivors.

Leptin influences inflammation and tumor growth and leptin signaling is often dysregulated among obese breast cancer survivors. This leads to a lack of satiety and, ultimately, risk for further weight gain. Breast cancer survivors also experience high rates of depression and anxiety, which are linked to leptin production. This study examined how a woman's anxiety and depressive symptoms, in combination with their obesity status, were associated with leptin. Breast cancer survivors (n= 200, stages 0-IIIa) completed a baseline visit before treatment and two follow-up visits, 6 and 18months after treatment ended. Women completed anxiety and depression measures, and blood samples provided leptin data at each visit. This study related fluctuations in a survivor's own depression and anxiety (i.e., within-person effects), as well as average effects of depression and anxiety (i.e., between-person effects) to changes in leptin depending on BMI. Obese survivors' leptin was significantly higher at visits when they had higher anxiety and depression symptoms than their own average level of symptoms. In contrast, within-person fluctuations in depression and anxiety were not related to leptin levels among non-obese survivors. No significant between-person effects of depression or anxiety on leptin emerged. Leptin is a critical risk factor for recurrence and further health consequences. Our findings highlight how psychological health influences leptin production among breast cancer survivors. These results highlight a biological pathway that may facilitate further weight gain and health risks among distressed, obese breast cancer survivors.

Body weight management in overweight and obese breast cancer survivors.

Body weight management in overweight and obese breast cancer survivors.