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Breast Cancer Research and Treatment

, Volume 105, Issue 2, pp 177–186 | Cite as

Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women’s healthy eating and living (WHEL) study

  • Nazmus Saquib
  • Shirley W. Flatt
  • Loki Natarajan
  • Cynthia A. Thomson
  • Wayne A. Bardwell
  • Bette Caan
  • Cheryl L. Rock
  • John P. PierceEmail author
Epidemiology

Abstract

Purpose

To examine predictors of weight gain following breast cancer diagnosis and subsequent return to pre-cancer weight.

Objectives

To determine (1) the associations of anti-neoplastic chemotherapy and/or, Tamoxifen® therapy on weight change following breast cancer diagnosis, (2) whether chemotherapy modified the effect of specific demographic and tumor characteristics on weight gain, (3) the proportion and characteristics of women who gained significant weight on chemotherapy and returned to their pre-cancer weight during follow-up.

Subjects and methods

Participants were 3088 breast cancer survivors, aged 27–74 years. Weight was measured at baseline and years 1 through 6; pre-cancer weight was self-reported. Cancer stage and treatment modalities were obtained by medical record review; demographic and physical activity data were obtained from questionnaires. Weight gain of ≥5% body weight following cancer diagnosis was considered significant.

Results

Chemotherapy was significantly associated with weight gain (OR = 1.65, 95% CI = 1.12, 2.43) and Tamoxifen® was not (OR = 1.03, 95% CI = 0.71, 1.51). Tamoxifen® did not modify the effect of either chemotherapy or its different regimens on weight gain. Both types (anthracycline: OR = 1.63, p-value = 0.01, non-anthracycline: OR = 1.79, p = 0.003) and all regimens of chemotherapy (AC: OR = 1.55, p-value = 0.01, CAF: OR = 1.83, p = 0.003, CMF: OR = 1.76, p = 0.004) were associated with weight gain but the associations were not different from one another. Only 10% of participants returned to their pre-cancer diagnosis weight at the follow-up visits; the degree of initial gain (p for trend <0.0001) predicted that return.

Conclusion

Chemotherapy was associated with clinically meaningful weight gain, and a return to initial weight following weight gain was unlikely.

Keywords

Body weight Chemotherapy Tamoxifen Anthracycline Cyclophosphamide Adriamycin Methotrexate Fluorouracil Cohort studies Women. 

Notes

Acknowledgements

This study was initiated with the support of the Walton Family Foundation and continued with funding from NCI grants CA 69375 and CA 72092. Some of the data were collected from General Clinical Research Centers, NIH grants M01-RR00070, M01-RR00079, and M01-RR00827. The authors thank Sheila Kealey and Christine Hayes for their editorial support.

References

  1. 1.
    Tao MH, Shu XO, Ruan ZX, Gao YT, Zheng W (2006) Association of overweight with breast cancer survival. Am J Epidemiol 163(2):101–107PubMedCrossRefGoogle Scholar
  2. 2.
    Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA (2005) Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 14(8):2009–2014PubMedCrossRefGoogle Scholar
  3. 3.
    Borugian MJ, Sheps SB, Kim-Sing C, Olivotto IA, Van Patten C, Dunn BP, Coldman AJ, Potter JD, Gallagher RP, Hislop TG (2003) Waist-to-hip ratio and breast cancer mortality. Am J Epidemiol 158(10):963–968PubMedCrossRefGoogle Scholar
  4. 4.
    Camoriano JK, Loprinzi CL, Ingle JN, Therneau TM, Krook JE, Veeder MH (1990) Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. J Clin Oncol 8(8):1327–1334PubMedGoogle Scholar
  5. 5.
    Chlebowski RT, Weiner JM, Reynolds R, Luce J, Bulcavage L, Bateman JR (1986) Long-term survival following relapse after 5-FU but not CMF adjuvant breast cancer therapy. Breast Cancer Res Treat 7(1):23–30PubMedCrossRefGoogle Scholar
  6. 6.
    Caan BJ, Emond JA, Natarajan L, Castillo A, Gunderson EP, Habel L, Jones L, Newman VA, Rock CL, Slattery ML et al (2006) Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer. Breast Cancer Res Treat 99(1):47–57PubMedCrossRefGoogle Scholar
  7. 7.
    Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378PubMedCrossRefGoogle Scholar
  8. 8.
    Demark-Wahnefried W, Rimer BK, Winer EP (1997) Weight gain in women diagnosed with breast cancer. J Am Diet Assoc 97(5):519–526, 529; quiz 527–518Google Scholar
  9. 9.
    Dixon JK, Moritz DA, Baker FL (1978) Breast cancer and weight gain: an unexpected finding. Oncol Nurs Forum 5(3):5–7PubMedGoogle Scholar
  10. 10.
    Foltz AT (1985) Weight gain among stage II breast cancer patients: a study of five factors. Oncol Nurs Forum 12(3):21–26PubMedGoogle Scholar
  11. 11.
    Tormay D, Taylor S, Kalish L (1996) Adjuvant systemic therapy in pre-menopausal and post-menopausal women with node positive breast cancer. In: Adjuvant therapy of cancer, 4th edn. Grune and Stratton, Philadelphia Pa 359–368Google Scholar
  12. 12.
    DeGeorge D, Gray JJ, Fetting JH, Rolls BJ (1990) Weight gain in patients with breast cancer receiving adjuvant treatment as a function of restraint, disinhibition, and hunger. Oncol Nurs Forum 17(3 Suppl):23–28; discussion 28–30Google Scholar
  13. 13.
    Knobf MK, Mullen JC, Xistris D, Moritz DA (1983) Weight gain in women with breast cancer receiving adjuvant chemotherapy. Oncol Nurs Forum 10(2):28–33PubMedGoogle Scholar
  14. 14.
    Levine EG, Raczynski JM, Carpenter JT (1991) Weight gain with breast cancer adjuvant treatment. Cancer 67(7):1954–1959PubMedCrossRefGoogle Scholar
  15. 15.
    Freedman RJ, Aziz N, Albanes D, Hartman T, Danforth D, Hill S, Sebring N, Reynolds JC, Yanovski JA (2004) Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. J Clin Endocrinol Metab 89(5):2248–2253PubMedCrossRefGoogle Scholar
  16. 16.
    Goodwin PJ, Panzarella T, Boyd NF (1988) Weight gain in women with localized breast cancer–a descriptive study. Breast Cancer Res Treat 11(1):59–66PubMedCrossRefGoogle Scholar
  17. 17.
    Hoskin PJ, Ashley S, Yarnold JR (1992) Weight gain after primary surgery for breast cancer–effect of tamoxifen. Breast Cancer Res Treat 22(2):129–132PubMedCrossRefGoogle Scholar
  18. 18.
    Rose DP, Connolly JM, Chlebowski RT, Buzzard IM, Wynder EL (1993) The effects of a low-fat dietary intervention and tamoxifen adjuvant therapy on the serum estrogen and sex hormone-binding globulin concentrations of postmenopausal breast cancer patients. Breast Cancer Res Treat 27(3):253–262PubMedCrossRefGoogle Scholar
  19. 19.
    Anelli TF, Anelli A, Tran KN, Lebwohl DE, Borgen PI (1994) Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer 74(1):74–77PubMedCrossRefGoogle Scholar
  20. 20.
    Rohatgi N, Blau R, Lower EE (2002) Raloxifene is associated with less side effects than tamoxifen in women with early breast cancer: a questionnaire study from one physician’s practice. J Womens Health Gend Based Med 11(3):291–301PubMedCrossRefGoogle Scholar
  21. 21.
    Kumar NB, Allen K, Cantor A, Cox CE, Greenberg H, Shah S, Lyman GH (1997) Weight gain associated with adjuvant tamoxifen therapy in stage I and II breast cancer: fact or artifact? Breast Cancer Res Treat 44(2):135–143PubMedCrossRefGoogle Scholar
  22. 22.
    Fisher B, Dignam J, Bryant J, DeCillis A, Wickerham DL, Wolmark N, Costantino J, Redmond C, Fisher ER, Bowman DM et al (1996) Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors. J Natl Cancer Inst 88(21):1529–1542PubMedCrossRefGoogle Scholar
  23. 23.
    Day R, Ganz PA, Costantino JP, Cronin WM, Wickerham DL, Fisher B (1999) Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Clin Oncol 17(9):2659–2669PubMedGoogle Scholar
  24. 24.
    Lankester KJ, Phillips JE, Lawton PA (2002) Weight gain during adjuvant and neoadjuvant chemotherapy for breast cancer: an audit of 100 women receiving FEC or CMF chemotherapy. Clin Oncol (R Coll Radiol) 14(1):64–67Google Scholar
  25. 25.
    Del Rio G, Zironi S, Valeriani L, Menozzi R, Bondi M, Bertolini M, Piccinini L, Banzi MC, Federico M (2002) 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(3):267–273PubMedCrossRefGoogle Scholar
  26. 26.
    Aslani A, Smith RC, Allen BJ, Pavlakis N, Levi JA (1999) Changes in body composition during breast cancer chemotherapy with the CMF-regimen. Breast Cancer Res Treat 57(3):285–290PubMedCrossRefGoogle Scholar
  27. 27.
    Kutynec CL, McCargar L, Barr SI, Hislop TG (1999) Energy balance in women with breast cancer during adjuvant treatment. J Am Diet Assoc 99(10):1222–1227PubMedCrossRefGoogle Scholar
  28. 28.
    DeConti R (1982) Weight gain in the adjuvant chemotherapy of breast cancer. Proc Am Soc Clin Oncol 1:73(abstr C-279)Google Scholar
  29. 29.
    Grindel CG, Cahill CA, Walker M (1989) Food intake of women with breast cancer during their first six month of chemotherapy. Oncol Nurs Forum 16(3):401–407PubMedGoogle Scholar
  30. 30.
    Ball K, Brown W, Crawford D (2002) Who does not gain weight? Prevalence and predictors of weight maintenance in young women. Int J Obes Relat Metab Disord 26(12):1570–1578PubMedCrossRefGoogle Scholar
  31. 31.
    Harris TB, Savage PJ, Tell GS, Haan M, Kumanyika S, Lynch JC (1997) Carrying the burden of cardiovascular risk in old age: associations of weight and weight change with prevalent cardiovascular disease, risk factors, and health status in the Cardiovascular Health Study. Am J Clin Nutr 66(4):837–844PubMedGoogle Scholar
  32. 32.
    Meltzer AA, Everhart JE (1995) Self-reported substantial 1-year weight change among men and women in the United States. Obes Res 3(Suppl 2):123s–134sPubMedGoogle Scholar
  33. 33.
    Ganz PA, Schag CC, Polinsky ML, Heinrich RL, Flack VF (1987) Rehabilitation needs and breast cancer: the first month after primary therapy. Breast Cancer Res Treat 10(3):243–253PubMedCrossRefGoogle Scholar
  34. 34.
    Faber-Langendoen K (1996) Weight gain in women receiving adjuvant chemotherapy for breast cancer. Jama 276(11):855–856PubMedCrossRefGoogle Scholar
  35. 35.
    Demark-Wahnefried W, Hars V, Conaway MR, Havlin K, Rimer BK, McElveen G, Winer EP (1997) Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. Am J Clin Nutr 65(5):1495–1501PubMedGoogle Scholar
  36. 36.
    Schwartz AL (2000) Exercise and weight gain in breast cancer patients receiving chemotherapy. Cancer Pract 8(5):231–237PubMedCrossRefGoogle Scholar
  37. 37.
    Brewin TB (1980) Can a tumour cause the same appetite perversion or taste change as a pregnancy? Lancet 2(8200):907–908PubMedCrossRefGoogle Scholar
  38. 38.
    Mukhopadhyay M, Larkin S (1986) Weight gain in cancer patients on chemotherapy. Proc Am Soc Clin Oncol 5:254(abs 992)Google Scholar
  39. 39.
    Huntington MO (1985) Weight gain in patients receiving adjuvant chemotherapy for carcinoma of the breast. Cancer 56(3):472–474PubMedCrossRefGoogle Scholar
  40. 40.
    Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, Blackwell K, Rimer BK (2001) Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 19(9):2381–2389PubMedGoogle Scholar
  41. 41.
    Kumar N, Allen KA, Riccardi D, Bercu BB, Cantor A, Minton S, Balducci L, Jacobsen PB (2004) Fatigue, weight gain, lethargy and amenorrhea in breast cancer patients on chemotherapy: is subclinical hypothyroidism the culprit? Breast Cancer Res Treat 83(2):149–159PubMedCrossRefGoogle Scholar
  42. 42.
    Sammel MD, Grisso JA, Freeman EW, Hollander L, Liu L, Liu S, Nelson DB, Battistini M (2003) Weight gain among women in the late reproductive years. Fam Pract 20(4):401–409PubMedCrossRefGoogle Scholar
  43. 43.
    Pierce JP, Faerber S, Wright FA, Rock CL, Newman V, Flatt SW, Kealey S, Jones VE, Caan BJ, Gold EB et al (2002) A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) Study. Control Clin Trials 23(6):728–756PubMedCrossRefGoogle Scholar
  44. 44.
    Cocconi G, Di Blasio B, Boni C, Bisagni G, Rondini E, Bella MA, Leonardi F, Savoldi L, Vallisneri C, Camisa R et al (2005) Primary chemotherapy in operable breast carcinoma comparing CMF (cyclophosphamide, methotrexate, 5-fluorouracil) with an anthracycline-containing regimen: short-term responses translated into long-term outcomes. Ann Oncol 16(9):1469–1476PubMedCrossRefGoogle Scholar
  45. 45.
    WHO (1998) Obesity: preventing and managing the global epidemic.WHO/NUT/98.1. In: World Health Organization, Geneva, SwitzerlandGoogle Scholar
  46. 46.
    Design of the women’s health initiative clinical trial and observational study. The women’s health initiative study group (1998). Control Clin Trials 19(1):61–109Google Scholar
  47. 47.
    Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR, Jr., Schmitz KH, Emplaincourt PO et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl):S498–504PubMedGoogle Scholar
  48. 48.
    Harvie MN, Campbell IT, Baildam A, Howell A (2004) Energy balance in early breast cancer patients receiving adjuvant chemotherapy. Breast Cancer Res Treat 83(3):201–210PubMedCrossRefGoogle Scholar
  49. 49.
    Costa LJ, Varella PC, del Giglio A (2002) Weight changes during chemotherapy for breast cancer. Sao Paulo Med J 120(4):113–117PubMedGoogle Scholar
  50. 50.
    Rock CL, Flatt SW, Newman V, Caan BJ, Haan MN, Stefanick ML, Faerber S, Pierce JP (1999) Factors associated with weight gain in women after diagnosis of breast cancer. Women’s Healthy Eating and Living Study Group. J Am Diet Assoc 99(10):1212–1221PubMedCrossRefGoogle Scholar
  51. 51.
    Heasman KZ, Sutherland HJ, Campbell JA, Elhakim T, Boyd NF (1985) Weight gain during adjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 5(2):195–200PubMedCrossRefGoogle Scholar
  52. 52.
    Bonadonna G, Valagussa P, Rossi A, Tancini G, Brambilla C, Zambetti M, Veronesi U (1985) Ten-year experience with CMF-based adjuvant chemotherapy in resectable breast cancer. Breast Cancer Res Treat 5(2):95–115PubMedCrossRefGoogle Scholar
  53. 53.
    Knobf MT (1990) Symptoms and rehabilitation needs of patients with early stage breast cancer during primary therapy. Cancer 66(6 Suppl):1392–1401PubMedCrossRefGoogle Scholar
  54. 54.
    Williamson DF (1993) Descriptive epidemiology of body weight and weight change in U.S. adults. Ann Intern Med 119(7 Pt 2):646–649PubMedGoogle Scholar
  55. 55.
    Lahmann PH, Lissner L, Gullberg B, Berglund G (2000) Sociodemographic factors associated with long-term weight gain, current body fatness and central adiposity in Swedish women. Int J Obes Relat Metab Disord 24(6):685–694PubMedCrossRefGoogle Scholar
  56. 56.
    Olivarius NF, Andreasen AH, Loken J (1997) Accuracy of 1-, 5- and 10-year body weight recall given in a standard questionnaire. Int J Obes Relat Metab Disord 21(1):67–71PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Nazmus Saquib
    • 1
  • Shirley W. Flatt
    • 1
  • Loki Natarajan
    • 1
  • Cynthia A. Thomson
    • 2
  • Wayne A. Bardwell
    • 1
  • Bette Caan
    • 3
  • Cheryl L. Rock
    • 1
  • John P. Pierce
    • 1
    Email author
  1. 1.Cancer Prevention and Control Program, Moores UCSD Cancer CenterUniversity of CaliforniaSan Diego, La JollaUSA
  2. 2.Arizona Cancer Center University of ArizonaTucsonUSA
  3. 3.Kaiser Permanente Northern CaliforniaThe Permanente Medical GroupOaklandUSA

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