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March 7, 2024
Clinical relevance: Incorporating weight monitoring and management into clinical care for breast cancer patients focusing on both weight gain and loss is essential for improving survival and overall health outcomes.
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A recent Yale University study highlights the importance of monitoring weight changes in women receiving breast cancer treatment. Oncologists should consider weight fluctuations—both gains and losses—as they can significantly impact a patient’s survival prospects. This study suggests that adapting treatment plans to address weight changes could improve outcomes.
Published in Nature Partner Journals (NPJ) Breast Cancer, the study included more than 5,400 women diagnosed with breast cancer at various stages to learn the effect chemotherapy after initial treatment has on body weight and mortality.
“Many breast cancer treatments can impact weight,” Dr. Eleonora Teplinsky, head of Breast Medical Oncology at Valley Health System, tells SurvivorNet.
“This study evaluated BMI at diagnosis and weight change at one year after diagnosis in relation to all-cause and breast cancer-specific mortality,” Dr. Teplinsky adds.
Study Findings
The study’s results detailed that weight change after a breast cancer diagnosis varied significantly across demographic and clinical characteristics.
A large weight loss after breast cancer diagnosis among patients diagnosed with stages 1, 2, and 3 was associated with a 41% higher risk of overall mortality compared with weight stability over two years after a diagnosis, the report found.
Notably, weight gain was associated with certain tumor types (ER/PR− HER2+), a BMI ≤ 18.5 kg/m², and younger age (≤45 years).
Conversely, weight loss was linked to a BMI ≥ 35 kg/m² and older age (≥70 years).
Extreme weight changes within the first year post-diagnosis—both significant weight loss (≥10%) and moderate weight gain (5–10%)—were associated with higher all-cause mortality. This association suggests that both substantial weight gain and loss may adversely affect survival outcomes among breast cancer survivors.
Women who did not receive chemotherapy for breast cancer treatment lost an average of 4 pounds (1.8 kgs) over five years compared to women who received chemotherapy and barely gained a pound. Women who did not receive radiation lost roughly 4 pounds over five years compared to women who lost roughly a pound during the same 5-year period.
This suggests that chemotherapy can influence weight trajectories differently, potentially leading to slight weight gains in treated patients compared to those who did not receive such treatment.
Influence on survival
In the discussion of the results, the researchers stress the significance of understanding why changes in weight following a breast cancer diagnosis matter. They explain that, while their findings examining the relationship between weight gain and mortality among women with breast cancer are inconsistent, weight gain can negatively impact the quality of life, cause psychological distress through body image changes, and increase the risk of comorbidities.
Significant weight loss, on the other hand, may be partially attributable to sarcopenia, the depletion of skeletal muscle, which can be compounded by age-related muscle atrophy and exacerbated by cancer and its treatment.
Sarcopenia affects up to 45% of women with breast cancer and is associated with worse physical function, higher chemotherapy toxicity, and lower survival rates.
Clinical application
The researchers went on to say that given the adverse health outcomes associated with weight changes after breast cancer, their findings can help inform clinical practice by, “generating awareness around monitoring weight change in the short and long term, identifying populations most at risk for post-diagnosis weight change, and supporting the design and implementation of tailored weight management lifestyle interventions.”
Dr. Teplinsky agrees.
“Monitoring weight changes and incorporating early interventions for weight management should be part of clinical care,” she says. “While not discussed in this study, a multidisciplinary approach is critical for weight management. Lifestyle modifications, patient counseling, and education, referral to specialists such as registered dietitians, obesity medicine specialists, and endocrinologists, and consideration of weight loss medications are some approaches that may be helpful.”