Abstract
Background. Weight gain is a common side effect observed in women undergoing adjuvant chemotherapy for breast cancer. Among possible causes a direct effect of chemotherapy on metabolism has been proposed. Body composition variations after adjuvant chemotherapy suggest the occurrence of sarcopenic obesity, possibly due to ovarian failure. We investigated acute and chronic effects of adjuvant chemotherapy on body weight, resting energy expenditure (REE) and plasma catecholamines in a group of menopausal women.
Patients and methods. Thirty menopausal women with stage I–II breast cancer were recruited for the study. We measured REE and respiratory quotient (RQ) and body composition at the beginning and after 3 and 6 months of adjuvant cyclophosphomide, methotrexate, and 5-fluorouracil (CMF). REE, RQ, and plasma catecholamines were assessed before and after each chemotherapy session. At each session food intake was also assessed in all patients, by a food diary. Seven patients out of the group of 30 were also evaluated after a placebo infusion (saline).
Results. A significant weight gain was observed in all women (70.5 ± 3 v.s. 67.7 ± 3 kg, p < 0.001), with increase in both fat-free mass (FFM) (45.2 ± 1.5 v.s. 43.6 ± 1.3 kg, p < 0.001) and fat-mass (FM) (25.3 ± 1.7 v.s. 24.1 ± 1.8 kg, p < 0.005). A decrease in REE and RQ was observed both during CMF and placebo infusion (p < 0.05). During acute CMF and placebo infusion a reduction of plasma levels of noradrenaline was observed at the first and last session. REE increased progressively during the study period.
Conclusions. CMF therapy apparently has no effect on REE either acutely or during a 6-month-period; the increased REE observed in the long-term is likely due to the concomitant increase in FFM. The lack of evidence of sarcopenic obesity, at variance with previous literature, is likely due to different patient selection.
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Knobf MT, Mullen JC, Xistris D, Moritz DA: Weight gain in women with breast cancer receiving adjuvant chemotherapy. Oncol Nurs Forum 10: 28–34, 1983
Chlebowski RT, Rose D, Buzzard IM, Blackburn GL, Insull W, Grosvenor M, Elashoff R, Wynder EL: Adjuvant dietary fat intake reduction in postmenopausal breast cancer patient management. Breast Cancer Res Treat 20: 73–84, 1991
Huntington MO: Weight gain in patients receiving adjuvant chemotherapy for carcinoma of the breast. Cancer 56: 472–474, 1985
Heasman KZ, Sutherland HJ, Campbell JA, Elhakim T, Boyd NF: Weight gain during adjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 5: 195–200, 1985
Foltz AT: Weight gain among stage II breast cancer patient: a study of five factors. Oncol Nurs Forum 12: 21–26, 1985
Hernandez BM, Bonomi P, Hoeltgen T: Weight gain during adjuvant chemotherapy for stage II breast cancer (Abstract). Proc Am Soc Clin Oncol 2: 108, 1983
Knobf MT: Symptoms and rehabilitation needs of patients with early stage breast cancer during primary therapy. Cancer 66: 1392–1401, 1990
Cheney CL, Mahloch J, Freeny P: Computerized tomography assess-ment of women with weight changes associated with adjuvant treatment for breast cancer. Am J Clin Nutr 66: 141–146, 1996
Camoriano JK, Loprinzi CL, Ingle JN, Therneau TM, Krook JE, Veeder MH: Weight change in women treated with adjuvant therapy or observed following mastectomy for nodepositive breast cancer. J Clin Oncol 8: 1327–1334, 1990
Goodwin P, Panzarella T, Boyd N: Weight gain in women with localized breast cancer: a descriptive study. Breast Cancer Res Treat 11: 59–66, 1988
Chlebowsky RT, Weiner JM, Reynolds R, Luce J, Bulcavage L, Bateman JR: Long term survival following relapse after 5-FU but not CMF adjuvant breast cancer therapy. Breast Cancer Res Treat 7: 23–29, 1986
Cruz JM, Muss HB, Brockshmidt JK, Evans GW: Weight changes in women with metastatic breast cancer treated with megestrol acetate: a comparison of standard versus high-dose therapy. Semin Oncol 17: 63–67, 1990
De Conti RC: Weight gain in the adjuvant chemotherapy of breast cancer. Proc Am Soc Clin Oncol 1: 73, 1982
Dixon J, Moritz D, Baker F: Breast cancer and weight gain: an unexpected finding. Oncol Nurs Forum 5: 5–7, 1978
Donegan WL, Hartz AJ, Rimm AA: The association of body weight gain and recurrence cancer of the breast. Cancer 41: 1590–1594, 1978
Freedman L, Clifford C, Messina M: Analysis of dietary fat, calories, body weight and the development of mammary tumors in rats and mice: a review. Cancer Res 50: 5710–5719, 1990
Ingram DM, Nottage E, Ng S, Sparrow L, Roberts A, Willcox D: Obesity and breast disease, the role of the female sex hormones. Cancer 64: 1049–1053, 1989
Plymate SR, Jones LA, Matej LA, Friedl KE: Regulation of sex hormone binding globulin (SHBG) production in Hep G2 cells by insulin. Steroids 52: 339–340, 1988
Pugeat M, Crave JC, Elmidani M, Nicolas MH, Garoscio-Cholet M, Lejeune N, Dechaud H, Tourniaire J: Pathophysiology of sex hormone binding globulin (SHBG): relationship to insulin. J Steroid Biochem Mol Biol 40: 841–849, 1991
Shah M, Jeffery RV: Is obesity due to overeating and inactivity, or a defective metabolic rate ? A review. Ann Behav Med 13: 73–81, 1991
Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J, Sidlofsky S, Trideau M, Hood N, Redwood S: Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol 17: 120–129, 1999
Demark-Wahnefried W, Hars V, Conaway MR, Havlin K, Rimer BK, McElveen G, Winer EP: Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. Am J Clin Nutr 65: 1495–1501, 1997
Denmark-Wahnefried W, Winer EP, Rimer BK: Why women gain weight with adjuvant chemotherapy for breast cancer. J Clin Oncol 11: 1418–1429, 1993
Aslani A, Smith RC, Allen BJ, Levi JA: Changes in body composition during adjuvant chemotherapy for breast cancer. Appl Radiat Isotop 49: 637–638, 1998
Aslani A, Smith RC, Allen BJ, Pavlakis N, Levi JA: Changes in body composition during breast cancer chemotherapy with the CMF-regimen. Breast Cancer Res Treat 57: 285–290, 1999
Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, Blackwell K, Rimer B: Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 19: 2381–2389, 2001
Kushner RF, Kunigk A, Alspaugh M, Andronis PT, Leitch CA, Schoeller DA: Validation of bioelectrical-impedance analysis as a measurement of change in body composition in obesity. Am J Clin Nutr 52: 219–223, 1990
Mansell PI, Macdonald IA: Reappraisal of the Weir equation for calculation of metabolic rate. Am J Physiol 27: R1347–R1354, 1990
Guo SS, Zeller C, Chumlea WC, Siervogel RM: Aging, body composition and lifestyle: the Fels longitudinal study. Am J Clin Nutr 70: 405–411, 1999
Hoskin PJ, Hashley S, Yarnold JR: Weight gain after primary surgery for breast cancer-effect of tamoxifene. Breast Cancer Res Treat 22: 129–132, 1992
Boyd NF: Nutrition and breast cancer. J Natl Cancer Inst 85: 6–7, 1993
Bonadonna G, Valagussa P, Rossi A: Ten-year experience with CMF-based adjuvant chemotherapy in resectable breast cancer. Breast Cancer Res Treat 5: 95–115, 1985
Saad MF, Alger SA, Zurlo F, Young JB, Bogardus C, Ravussin E: Ethnic differences in sympathetic nervous system mediated energy expenditure. Am J Physiol 261: E789-E794, 1991
Del Rio G, Marrama P, Fiorani P, Della Casa L: Very low calorie diet induces opposite effects on sympathetic nervous system and adrenomedullary responses. Int J Obes 13 (suppl 2): 173–175, 1989
Webber J, Taylor J, Greathead, Dawson J, Buttery PJ, Macdonald IA: A comparison of thermogenic, metabolic and haemodynamic responses to infused adrenaline in lean and obese subjects. Int J Obes 18: 717–724, 1994
Ravussin E, Bogardus C: Relationship of genetics, age, and physical fitness to daily energy expenditure and fuel utilisation. Am J Clin Nutr 49: 968–975, 1989
Mukhopadhyay MG, Larkin S: Weight gain in cancer patients on chemotherapy (abstract). Proc Am Soc Clin Oncol 5: 254, 1986
Brewin T: Can a tumor cause the same appetite perversion or taste change as pregnancy? Lancet 2: 907–908, 1980
Grindel C, Cahill C, Walker M: Food intake of women with breast cancer during their first six months of chemotherapy. Oncol Nurs Forum 16: 401–407, 1989
Kutynec CL, McCargar L, Barr SI, Hislop TG: Energy balance in women with breast cancer during adjuvant treatment. J Am Diet Assoc 99 (10): 1222–1227, 1999
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Rio, G.D., Zironi, S., Valeriani, L. et al. Weight Gain in Women with Breast Cancer Treated with Adjuvant Cyclophosphomide, Methotrexate and 5-Fluorouracil. Analysis of Resting Energy Expenditure and Body Composition. Breast Cancer Res Treat 73, 267–273 (2002). https://doi.org/10.1023/A:1015892714162
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DOI: https://doi.org/10.1023/A:1015892714162