Obese Breast Cancer Survivors Research Articles

Changes in Body Mass Index and Physical Activity Predict Changes in Vitality During a Weight Loss Trial in Breast Cancer Survivors.

Breast cancer survivors rank fatigue (e.g., decreased vitality) as their number one concern affecting quality of life. Excess adiposity is associated with decreased vitality in breast cancer survivors, yet weight loss intervention trials report inconsistent effects on this parameter. This is a secondary analysis of the Exercise and Nutrition to Enhance Recovery and Good Health for You trial, in which 692 overweight or obese breast cancer survivors ≤5 years from diagnosis, initiated weight loss interventions, and completed assessments semi-annually for 2 years. Assessments included the Godin Leisure-Time Exercise Questionnaire and the SF-36 MOS vitality subscale as an inverse measure of fatigue. Multilevel structural equation models estimated the direct effects of physical activity on vitality and indirect effects through body mass index (BMI) changes. Within-person findings show that at assessments with greater physical activity, BMI was significantly lower (B = -0.07, p < 0.001) and vitality was higher (B = 0.22, p < 0.001). However, there was no direct relationship between lower BMI and higher vitality (B = -0.11, p = 0.262) after controlling for the relationship of physical activity with BMI and physical activity with vitality. The between-person indirect effect of physical activity change through BMI change to vitality was significant (B = 0.03, p < 0.001). Participants whose physical activity was above the mean (B = 0.37, p < 0.001) and whose BMI was below the mean (B = -1.05, p < 0.001) were more likely to report greater vitality. Improvements in vitality are primarily associated with increases in physical activity rather than BMI changes in this trial. Vitality was lower among survivors with higher BMI, although within-individual changes in BMI had no effect on vitality. Physical activity and weight loss share mechanistic links to vitality with physical activity potentially increasing (e.g., in an additive or synergistic manner) the effect of BMI reduction on vitality.

Abstract P6-12-11: Feasibility and biomarker modulation due to high levels of moderate to vigorous physical activity as part of a weight loss intervention in older, sedentary, obese breast cancer survivors

Abstract We sought to demonstrate that older, sedentary, obese breast cancer survivors could achieve &amp;gt; 200 minutes per week of moderate to vigorous physical activity (MVI PA) as part of a weight loss intervention; and to assess modulation of risk biomarkers. This level of PA in combination with moderate calorie restriction is associated with weight losses of &amp;gt;10% in women without cancer, which in turn is associated with significant modulation of cancer risk biomarkers. Eleven participants with BMI &amp;gt; 30 kg/m2 enrolled in a 12-week program that consisted of moderate caloric restriction, weekly phone group behavioral sessions, and individualized exercise plans based on measured heart rate reserve. Women were provided an accelerometer with heart rate monitor linked to GarminConnect, membership to a YMCA, twice weekly supervised exercise sessions with a personal trainer, and weekly feedback regarding weight and physical activity progress. The goal was to increase MVI PA (≥45% heart rate reserve) gradually from &amp;lt;60 to &amp;gt;200 minutes per week. The median age was 61, 5/11 women had received prior chemotherapy, and 7/11 were currently taking aromatase inhibitors. Median values of baseline anthropomorphic measures acquired by dual energy x-ray absorptiometry (GE Lunar iDXA) included BMI, 37.3 kg/m2; total mass, 97.5 kg; fat mass, 47.6 kg; visceral fat, 1.7 kg (range 1.4-3.0); and fat mass index, 17.6 kg/m2. The majority had a baseline VO2 peak in the poor range for their age. All 11 participants completed the intervention, with no reported serious adverse events. Median MVI PA achieved over weeks 5-12 was 161 minutes/week (range 48-320). VO2 peak was increased in 10/11 with a median relative change of 12% from baseline. All but one lost weight with an overall median of 8% total mass loss, which was associated with 13% total fat mass loss and 21% visceral fat mass loss. For those with MVI PA above the median, values were 11%, 17%, and 40%, respectively. Visceral fat mass loss was linearly correlated with minutes per week of MVI PA (p=0.032); these parameters in turn were associated with changes in a number of serum biomarkers, including adiponectin-leptin ratio, TNF-alpha, as well as circulating adipose stromal cells, a potential marker for metastasis. Insulin and hs-CRP were favorably modulated in almost all participants but change was not linearly correlated with activity or mass loss parameters; thus these may not be ideal biomarkers to document a dose response to level of MVI PA. Conclusion: These results demonstrate that older, sedentary, obese breast cancer survivors can safely achieve a high level of MVI PA when provided a structured program that includes an exercise trainer. It is feasible to design a clinical trial for such breast cancer survivors to examine biomarker modulation as a function of level of physical activity. Citation Format: Fabian CJ, Klemp JR, Burns JM, Vidoni ED, Nydegger JL, Kreutzjans AL, Phillips TL, Baker HA, Hendry B, John C, Amin AL, Khan QJ, Mitchell MP, O'Dea AP, Sharma P, Wagner JL, Hursting SD, Kimler BF. Feasibility and biomarker modulation due to high levels of moderate to vigorous physical activity as part of a weight loss intervention in older, sedentary, obese breast cancer survivors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-11.

Being slightly overweight is associated with a better quality of life in breast cancer survivors

To examine the association between BMI and QOL in breast cancer survivors in China, we conducted a cross-sectional survey and recruited 10708 breast cancer survivors. Survivors self-reported QOL was measured using the EORTC QLQ-C30 and the QLQ-BR23. The impact of BMI on QOL was examined through standard least squares regression. Normal weight and overweight survivors were more likely to have a better QOL than underweight and obese survivors and the results were similar to survivors diagnosed as having chronic diseases. After adjustment for clinical and sociodemographic factors, the QOL increased with increasing BMI in breast cancer survivors ranged from underweight to overweight with no chronic diseases, especially in the scales of emotional function and fatigue. Obese breast cancer survivors reported a significantly worse QOL compared to normal weight and overweight breast cancer survivors. Within breast cancer survivors with one or more chronic diseases, it was more obvious that overweight ones had a significantly better QOL with clear evidence of a dose relationship across underweight to overweight in almost all scales. Unlike obese breast cancer survivors without chronic diseases, the ones with chronic disease(s) had a similar QOL compared to normal weight breast cancer survivors in all scales except in the domain of fatigue.

Weight Management in Overweight and Obese Breast Cancer Survivors

Weight Management in Overweight and Obese Breast Cancer Survivors

Effects of a parallel-arm randomized controlled weight loss pilot study on biological and psychosocial parameters of overweight and obese breast cancer survivors

BackgroundWeight gain often occurs after breast cancer (BC) diagnosis and obesity along with sedentary behavior are associated with increased risk of BC recurrence and mortality. The primary objective of this study was to determine whether a significant weight loss, of approximately 10%, would lead to beneficial changes in biomarkers associated with cancer and/or cancer recurrence, and quality of life (QOL) in overweight and obese BC survivors.MethodsThis parallel-arm study took place in Minneapolis, Minnesota, from January 2009 until March 2010. Participants were overweight and obese postmenopausal BC survivors who had completed treatment at least 3 months prior to enrollment and who did not smoke. Twenty-one BC survivors were randomized, via a random number generator computer software, to a 1000-calorie deficit feeding and exercise intervention (CR) or a weight management counseling intervention (WM) for 12 weeks followed by a 6-week follow-up. Body weight, biomarkers, and QOL were measured at baseline, weeks 6, 12, and 18. Body composition and fitness level were measured at only two time points.ResultsTwenty-one women were enrolled into the study and 20 completed all time points. Weight loss occurred with both interventions. Body weight in CR changed from 85.5 (95% confidence interval (CI) 77, 94) kg to 76.7 (95% CI 68.1, 85.2) kg, whereas in WM it changed from 98.3 (95% CI 89.8, 106.8) kg to 93.2 (95% CI 84.6, 101.7) kg. Fitness in CR changed from 4.9 (95% CI 4, 5.8) to 6.3 (95% CI 5.4, 7.2). CR led to lower plasma levels of leptin, F2-isoprostanes, and CRP. Quality of life seemed to improve with both interventions, while sleep quality decreased only in CR.ConclusionsOverweight and obese BC survivors were able to adhere to a strict diet and exercise program, which significantly decreased body weight, increased fitness level, and improved biomarkers and QOL. However, the strict dietary intervention in CR seemed to decrease participants’ sleep quality and social relationships. Future larger randomized controlled trials should focus on behavioral modification and personalized nutrition counseling to help breast cancer survivors achieve a sustainable weight loss and fitness level.Trial registrationClinicalTrials.gov identifier: NCT02940470.

Abstract 5321: Metabolomics and body mass index among breast cancer survivors in The Lifestyle, Exercise, and Nutrition (LEAN) Study

Abstract Background: While there is a growing body of literature on metabolomics and body mass index (BMI), there are limited studies in relation to weight change in overweight and obese individuals, and to our knowledge, no such studies in breast cancer survivors. Methods: The Lifestyle, Exercise and Nutrition (LEAN) randomized diet- and exercise-induced weight loss trial in breast cancer survivors enrolled overweight or obese breast cancer survivors (Stage 0-III) identified via the Yale-New Haven Hospital tumor registry or self-referral. Participants were randomized to either usual care group (n=33) or the 6-month lifestyle intervention (11 sessions with a registered dietitian) (n=67). Height and weight were measured by study staff at baseline and 6 months, and a fasting (≥ 12 hours) blood draw was also performed at these time points. Paired (baseline and 6-month) serum metabolomics data were available for 83 women. Only those metabolites consistently detected in &amp;gt;80% of quality control samples with a coefficient of variation &amp;lt;30% were included in data analysis. We evaluated partial Pearson correlations between the ratio of metabolites at baseline versus 6-months and change in BMI adjusted for age and intervention group. We also assessed mean changes in metabolites from baseline to 6-months by randomization group using the general estimating equation in linear regression. Adjustment for multiple comparisons was based on the False Discovery Rate (FDR) with a threshold of 0.1. Results: Overall, a total of 307 metabolites were analyzed; 168 were quantitated by LC-MS and 139 were semi-quantitated by GC-TOF/MS. For BMI change from baseline to 6-months, we observed correlations with 16 metabolites (isocitric acid, 3-hydroxybutyric acid, serine, L-cysteine, petroselinic acid, aminomalonic acid, palmitoleic acid, linoleic acid, 2-hydroxybutyric acid, and seven unidentified metabolites, p &amp;lt;0.05), however FDR correction for multiple comparisons yielded no statistically significant results. We also observed differences by randomization group for L-alanine, dopamine, serotonin, PCaaC36:1, 3-hydroxyoleoylcarnitine, and PCaeC36:1 in bivariate analyses, but in models adjusted for age and BMI only L-alanine remained significant (p&amp;lt;0.05). After correction for FDR, there were no significant differences by randomization group. Conclusions: There were no clear associations between metabolites and change in BMI or randomization group among overweight and obese breast cancer survivors enrolled in a weight loss trial. Larger sample sizes would help to clarify if any of the potential signals observed in this population may be associated with BMI or other lifestyle changes, such as diet quality. Citation Format: Leah M. Ferrucci, Brenda Cartmel, Maura Harrigan, Tara Sanft, Mary Playdon, Wei Jia, Herbert Yu, Caroline H. Johnson, Lajos Pusztai, Anees B. Chagpar, Melinda L. Irwin. Metabolomics and body mass index among breast cancer survivors in The Lifestyle, Exercise, and Nutrition (LEAN) Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5321. doi:10.1158/1538-7445.AM2017-5321

Abstract 3255: Circulating adipose stromal cells (CASCs) as a potential biomarker of response to weight loss interventions in obese women at high risk for breast cancer

Abstract Background Obesity is a modifiable risk factor for breast cancer in the United States. White adipose tissue is increased in obese (BMI ≥ 30 kg/m2) women, releasing estrogens and pro-inflammatory cytokines. Adipose stromal cells play a key role in releasing estrogens, while circulating adipose stromal cells (CASCs, characterized as CD34+CD31-CD45-) home to tumor sites and promote angiogenesis and vascularization. CASCs have been correlated with BMI in both cancer and non-cancer patients. However, BMI alone as a marker of adiposity has its limitations. We examined whether CASCs correlate with additional measures of adiposity in women who are at high risk for development of breast cancer. Methods Women at high risk for development of breast cancer but without prior breast cancer were recruited for random periareolar fine needle aspiration (RPFNA), DEXA body composition, anthropomorphic assessment, and non-fasting venous blood collection. Mononuclear cells were isolated and the frequency of CD34brightCD31-CD45- cells was assessed by flow cytometry. Results CASC frequency ranged from 0 to 0.018% (median 0.001%) for 13 non-obese and 20 obese women. There was no association between CASC frequency and BMI (range 19 - 46 kg/m2), either as a linear correlation or when dichotomized at a BMI of 30 kg/m2. However, there were tendencies for greater CASC frequencies in pre-menopausal women, women with greater waist circumference (p&amp;lt;0.050), and women with visceral fat mass greater than 50%. With limited numbers, there was no apparent association of CASC frequency with cytology or proliferation (Ki-67) of benign breast epithelial cells acquired by RPFNA. Conclusions This is the first study to investigate CASC frequency in a cohort of women at high-risk for development of breast cancer. Our results to date do not show an association between CASC frequency and obesity (BMI). However, associations with other indices of visceral fat suggest that evaluation of circulating adipose stromal cells could have value as a biomarker of response in clinical trials of obese breast cancer survivors and high risk women undergoing weight loss (especially fat mass) interventions. Citation Format: Hailey Baker, Amy L. Kreutzjans, Jennifer L. Nydegger, Teresa L. Phillips, Richard C. Hasting, Dan A. Dixon, Bruce F. Kimler, Carol J. Fabian. Circulating adipose stromal cells (CASCs) as a potential biomarker of response to weight loss interventions in obese women at high risk for breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3255. doi:10.1158/1538-7445.AM2017-3255

Gender-varying associations between physical activity intensity and mental quality of life in older cancer survivors.

Physical activity can enhance quality of life in cancer survivors, but this conclusion is based largely on research linking moderate-to-vigorous physical activity with quality of life. Light-intensity physical activity may be more feasible than more strenuous exercise for many older cancer survivors. This study reports a secondary analysis of baseline data from a lifestyle behavior intervention trial and examines the hypothesis that older cancer survivors who engage in more light-intensity physical activity, independent of moderate-to-vigorous activity, will report better mental quality of life. Older (≥65years), overweight or obese breast, prostate, or colorectal cancer survivors (n=641, 54% female) self-reported their physical activity and mental quality of life (i.e., mental health, emotional role functioning, vitality, and social role functioning from the Short-Form 36 Health Status Survey) as a part of the RENEW trial baseline assessment. Analysis of covariance was used to test hypotheses. For older women (but not men), light physical activity was positively associated with mental quality of life after adjusting for moderate-to-vigorous physical activity. Light physical activity that involved social participation appeared to be responsible for this association. For older men (but not women), moderate-to-vigorous physical activity was positively associated with mental quality of life. Some activity appears to be better than none for important dimensions of mental quality of life. Experimental research is needed to test the hypothesis that older cancer survivors should strive to avoid inactivity regardless of whether they are able to engage in moderate-to-vigorous physical activity.

Cardiovascular risk and communication among early stage breast cancer survivors

ObjectiveAfrican American (AA) women have disproportionately high rates of cardiovascular (CV) risk factors that, coupled with potentially cardiotoxic breast cancer (BC) therapies, place them at risk of adverse CV outcomes. The purpose of this study was to assess CV risk factors among white and AA BC survivors and perceptions of patient-provider CV-related communication and post-treatment information needs. MethodsEarly-stage, English-speaking BC survivors were recruited through community-based survivorship organizations/clinics in New Jersey. Qualitative, semi-structured interviews and a brief survey of socio-demographics and comorbidities were conducted. ResultsBC survivors reported high rates of CV risk factors. Most reported their health as good/excellent despite their cancer history and CV risk profile. Approximately half of overweight/obese BC survivors reported no weight-related conversation with their health care team and, among those who reported discussion, 36% indicated it was self-initiated and dismissed. More than half of BC survivors’ reported a desire for lifestyle-related information and guidance. ConclusionBC survivors may not understand how their separate, yet cumulative, health issues can impact their CV risk. Practice implicationsPatient-provider communication on behavioral risk factor modification and CV risk is needed, particularly among at-risk subgroups such as AA and obese BC survivors, to improve BC and CV outcomes.

Effect of aerobic exercise intervention on markers of insulin resistance in breast cancer women.

Insulin may affect breast cancer (BC) risk and prognosis. Exercise reduces insulin in obese BC survivors. We designed a randomised controlled trial to test the effect of an aerobic exercise intervention (AEI) on insulin parameters and body composition in non-obese BC women without insulin resistance. Thirty-eight BC women were randomised into an intervention group (IG=18) or control group (CG=20). IG participated in a structured AEI for 3months, while CG received only the Word Cancer Research Fund/American Institute Cancer Research (WCRF/AICR) recommendation to be physically active. Fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) index, metabolic parameters and body composition were collected at baseline and after the AEI. IG reduced insulin and HOMA-IR index by 15% and 14%, while CG increased these parameters (+12% and +16%). Insulin changed differently over time in the two randomised groups (pinteraction =.04). The between-group differences in the change of insulin (IG=-1.2μU/ml versus CG=+0.8μU/ml) and HOMA-IR index (IG=-0.26 versus CG=+0.25) were respectively significant (p=.04) and non-significant (p=.06). IG significantly improved lower limb muscle mass in comparison with CG (p=.03). A structured AEI may improve insulin, HOMA-IR index and body composition in non-obese BC survivors without insulin resistance.

Navigating the Transition From Cancer Care to Primary Care: Assistance of a Survivorship Care Plan.

To examine symptom and quality-of-life (QOL) trajectories in breast cancer and lymphoma survivors enrolled in a survivorship navigation intervention and to explore patient, caregiver, and primary care provider (PCP) satisfaction with receipt of a survivorship care plan (SCP). . Prospective, cohort, longitudinal. . The Billings Clinic, an integrated cancer center in Montana. . 67 patients with breast cancer or lymphoma who recently completed cancer treatment, along with 39 of their caregivers and 23 PCPs. . Data collection at one, three, and six months by the Functional Assessment of Cancer Therapy-General and satisfaction surveys. . Symptoms, QOL, and satisfaction with the survivorship navigator and the SCP. . Symptoms persisted six months following treatment. Symptoms and QOL indicators with worst intensity were energy, sleep, coping, and satisfaction with sex life. Patients with more comorbidities reported worse QOL, telephoned the survivorship navigator more often, and were more satisfied with the SCP. Patients with lymphoma reported higher QOL, but it was not significantly different from patients with breast cancer. Patients were significantly more satisfied than caregivers with the SCP at time 1. PCPs were highly satisfied with the SCP. . Some symptoms persist, even when cancer treatment has ended. Patients with comorbidities are at higher risk for more severe symptoms and worse QOL and may benefit from ongoing support. SCPs can facilitate patients' transition to primary care following cancer treatment. . Healthcare professionals who care for breast cancer survivors need to routinely assess them for the presence of comorbid conditions. Obese breast cancer survivors may benefit from weight reduction interventions to possibly decrease their risk of developing lymphedema and improve their overall health status.

Changes in diet quality in a randomized weight loss trial in breast cancer survivors: the lifestyle, exercise, and nutrition (LEAN) study.

Obesity is associated with increased breast cancer recurrence and mortality. Though some post-diagnosis weight loss interventions have achieved weight loss outcomes, it is unclear whether they also improve diet quality. In the Lifestyle, Exercise, and Nutrition (LEAN) study, overweight or obese breast cancer survivors were randomized to either usual care group (n=33) or the 6-month lifestyle intervention (n=67). Dietary intake was assessed at baseline and 6 months using a validated food frequency questionnaire, and overall diet quality was calculated using the Healthy Eating Index (HEI)-2010 (range 0–100). Intervention effects on diet were evaluated with generalized linear models. Among the 81 participants (51 intervention, 30 usual care) with dietary data, the mean baseline HEI score was 70.5 (s.d.=8.8) and was improved at 6 months (intervention group=6.8 point increase vs usual care=3.1, P=0.09). Intervention group participants achieved greater reductions in percent of energy from total fat (−4.2% vs −1.2%; P=0.013) and saturated fat (−2.2% vs −1.1%; P=0.003), and greater increases in fiber (4.8 g per 1000 kcal vs 1.3 g per 1000 kcal; P=0.007) and fruit (0.5 servings vs 0.0 servings; P=0.006) intake. Intervention group participants who lost ⩾5% body weight (n=27) demonstrated significantly greater improvements in HEI score (10.4 vs 2.8) than those who lost <5% (n=23). The intervention increased fruit and fiber intake and decreased percent energy from fat, and those with greater weight loss achieved greater increases in overall diet quality. These findings support the ability of a weight loss intervention to improve diet among breast cancer survivors.

Promoting weight loss through diet and exercise in overweight or obese breast cancer survivors (InForma): study protocol for a randomized controlled trial.

BackgroundMost women with breast cancer experience a progressive weight gain during and after treatment. Obesity is associated with an increased risk of recurrence, contralateral breast cancer, and death. Physical activity after cancer diagnosis has been reported to have positive effects on body composition and quality of life. We present the protocol of the InForma study, a trial testing the efficacy of an intervention on weight loss (≥5 % of the baseline body weight) in a group of overweight or obese breast cancer survivors.Methods/designThis is a four-arm randomized controlled trial. Patients will receive a 6-month intervention and be followed for a further 18 months. Intervention is designed to improve adherence to a healthy diet and/or to increase physical activity, taking advantage of a wrist-based activity monitor. Participants will be recruited among overweight or obese breast cancer patients treated at the European Institute of Oncology, after completion of eventual adjuvant chemotherapy and/or radiotherapy. It is envisaged that 260 patients will be randomized into four arms: Dietary Intervention; Physical Activity Intervention; Physical Activity and Dietary Intervention; and Less Intensive Intervention. Women will be offered individualized counseling consisting of face-to face discussion and phone calls in addition to group meetings. A motivational interviewing approach will be used to encourage health behavior change. All participants will be given a pedometer device to monitor their physical activity. Participants’ dietary intake will be repeatedly assessed using a validated food frequency questionnaire. Participants’ quality of life and anxiety will be assessed with the Functional Assessment of Cancer Therapy-Breast and the State-Trait Anxiety Inventory questionnaires. Blood samples will be collected at baseline and follow-up visits to assess lipid and hormone profiles. Body composition will be repeatedly assessed using bioelectrical impedance vector analysis for identifying changes of fat and fat-free mass. Women allocated to the less intensive intervention arm will be considered as the control group.DiscussionWhile there is a rising concern about the role of obesity in cancer recurrence and survival, this trial with its multi-arm design, motivational approach and use of a pedometer device will provide important insights regarding the most effective approach in promoting weight control in breast cancer survivors.Trial registrationISRCTN53325751 (registration date: 16 October 2015); ClinicalTrials.gov NCT02622711 (registration date: 2 December 2015).

Relative validity of a brief Fat and Fibre Behaviour Questionnaire in a population of overweight and obese breast cancer survivors: A note of caution.

Dietary intake assessment is often difficult in research contexts because of time and resource constraints and participant burden. Valid, reliable and brief assessments of dietary behaviour are needed. Additionally, examination of instrument performance in a variety of populations is needed. This study assessed relative validity and responsiveness to change of the Fat and Fibre Behaviour Questionnaire (FFBQ) in a population of breast cancer survivors compared with dietary intake measured by 24-hour recalls. Data were collected at baseline and six months after baseline of a six-month, randomised controlled trial that evaluated a telephone-based behavioural weight loss intervention (n = 45) compared to usual care (n = 45) among overweight and obese breast cancer survivors. The FFBQ's total index, fat index and fibre index were assessed for relative validity against two 24-hour recalls (Pearson's correlations). Responsiveness to change was assessed as intervention group change divided by standard deviation of usual care group change. Pearson's correlations of the fat index with fat intake measures ranged from -0.09 to -0.30 (P < 0.05) at baseline and from -0.19 to -0.28 (P < 0.05) for dietary change. Correlations of the fibre index with unadjusted and energy-adjusted fibre intake measures (0.25-0.32, P < 0.05) were significant at baseline only. Both the FFBQ and 24-hour recall were responsive to fat-related dietary changes and not responsive to fibre-related changes. The FFBQ showed small to medium relative validity against 24-hour dietary recall for assessing fat and fibre dietary behaviours and changes in dietary fat, and was responsive to fat-related dietary changes in this population.

Body weight management in overweight and obese breast cancer survivors

Body weight management in overweight and obese breast cancer survivors

Underserved community-based walking program for breast cancer survivors.

e288 Background: Advancements in early detection and new treatment options have improved outcomes for breast cancer survivors (BCS). With increased survivorship, improving quality of life (QOL) may be a challenge for some women. Exercise improves QOL for BCS and decreases recurrence, but, despite this many women do not routinely exercise. Underserved areas are at particular risk. Few studies have examined factors influencing exercise initiation and maintenance in underserved areas among minority overweight women. The purpose of this mixed methods study was to examine physiological outcomes and motivational factors in a community-based goal oriented walking program for BCS. Methods: A convenience sample of female BCS was recruited from an inner-city community center 12-week walking program. Women participated in physiological testing and focus groups before and after the program. Data was collected regarding strength, fitness, quality of life, and motivation of the women. Quantitative data was analyzed with paired t-tests. Two researchers independently analyzed focus groups’ transcriptions and like statements and phrases were coded. Themes emerged after discussions between the researchers. Results: The 13 participants [overweight BMI (n = 2), and obese BMI (n = 11)] had a mean survivorship of 5.4 years (range .25-14.5) years. Only 7 participants completed both pre and post physiological testing. Functional endurance significantly improved as indicated by the 6 Minute Walk Test (pre = 503(56), post = 570 (63) meters, mean(sd)), p = 0.02). While overall QOL did not improve, functional well-being showed significant improvement. Two focus group sessions were held at the beginning (n = 13) and end (n = 11) of the program. Themes emerged identifying 1) Treatment Weight Gain, 2) Familial Support, 3) Not Wanting to Go it Alone, 4) The Team Made the Difference Conclusions: Female BCS spoke of interpersonal and environmental factors involved in the decision to engage and maintain exercise with the walking program. Further research is needed to examine exercise motivation in underserved, overweight and obese breast cancer survivors.

Determinants of adherence to physical activity guidelines among overweight and obese African American breast cancer survivors: Implications for intervention approach.

178 Background: Public health agencies encourage breast cancer survivors (BCSs) to follow their physical activity guidelines (PAGs). However, adherence to these guidelines is low. African American (AA) BCSs are more often overweight or obese and less likely than women of other races to report adherence to physical activity (PA) recommendations. To address the research question, “what prevents AA BCSs from following PAGs,” we examined socioeconomic, clinical, and psychosocial correlates with PA levels. Methods: AA women diagnosed and treated for breast cancer participating in a breast cancer support group (n = 191) completed a lifestyle assessment tool (LAT) capturing demographic characteristics; breast cancer diagnosis and treatment history; health-related quality of life (HR-QoL); weight history, including body mass index and post-diagnosis weight gain; and physical activity. Logistic regression and analysis of variance were used to determine whether these covariates were associated with meeting ( &gt; 17.5 MET h/wk); partially meeting (8.75-17.5 MET h/wk); or not meeting ( &lt; 8.75 MET h/wk) PAGs. Results: Preliminary results indicate that 44.44% of AA BCSs met PAGs. This percent is below the national average for AA women (56.5%) and white women (67.5%). Conclusions: Identifying factors that influence adherence to physical activity behaviors is important in developing effective interventions. These findings may help generate hypotheses for future research to undergird efforts to increase PA among AA BCSs.

Weight fluctuation during adulthood and weight gain since breast cancer diagnosis predict multiple dimensions of body image among rural breast cancer survivors.

Obesity and weight gain after breast cancer treatment are common among survivors, yet the relationship between weight and body image has received little attention. The purpose of the current study was to examine the relationship between current body mass index, weight gain since diagnosis, and largest weight fluctuation in adulthood with six dimensions of body image among overweight/obese breast cancer survivors. The current study used data obtained from a weight control trial with 210 rural overweight/obese breast cancer survivors. Using data collected at baseline, multiple regression models were constructed to examine the relative association of the three weight variables with breast cancer-specific dimensions of body image while controlling for demographic characteristics and cancer treatment-related variables. Largest weight fluctuation in adulthood significantly predicted overall body image (p = 0.01) and was associated with the three socially oriented dimensions of body image: social activity restriction, embarrassment about appearance, and sexuality (all ps = 0.01). Weight gain since diagnosis approached statistical significance in predicting overall body image (p = 0.05) and was associated with embarrassment about appearance (p = 0.03). Current body mass index was not significantly associated with overall body image when controlling for the other weight variables (p = 0.07) and was negatively associated with social activity restriction (p = 0.01) and sexuality (p = 0.01). Obese breast cancer survivors with a history of a large weight fluctuation in adulthood may be prone to poorer breast cancer-specific body image several years after treatment. Copyright © 2015 John Wiley & Sons, Ltd.

Results of the Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) Trial: A Behavioral Weight Loss Intervention in Overweight or Obese Breast Cancer Survivors.

Obesity increases risk for all-cause and breast cancer mortality and comorbidities in women who have been diagnosed and treated for breast cancer. The Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) study is the largest weight loss intervention trial among survivors of breast cancer to date. In this multicenter trial, 692 overweight/obese women who were, on average, 2 years since primary treatment for early-stage breast cancer were randomly assigned to either a group-based behavioral intervention, supplemented with telephone counseling and tailored newsletters, to support weight loss or a less intensive control intervention and observed for 2 years. Weight and blood pressure were measured at 6, 12, 18, and 24 months. Longitudinal mixed models were used to analyze change over time. At 12 months, mean weight loss was 6.0% of initial weight in the intervention group and 1.5% in the control group (P<.001). At 24 months, mean weight loss in the intervention and control groups was 3.7% and 1.3%, respectively (P<.001). Favorable effects of the intervention on physical activity and blood pressure were observed. The weight loss intervention was more effective among women older than 55 years than among younger women. A behavioral weight loss intervention can lead to clinically meaningful weight loss in overweight/obese survivors of breast cancer. These findings support the need to conduct additional studies to test methods that support sustained weight loss and to examine the potential benefit of intentional weight loss on breast cancer recurrence and survival.

Results of the exercise and nutrition to enhance recovery and good health for you (ENERGY) trial: A behavioral weight loss intervention in overweight or obese breast cancer survivors.

Results of the exercise and nutrition to enhance recovery and good health for you (ENERGY) trial: A behavioral weight loss intervention in overweight or obese breast cancer survivors.