Abstract
Sixty-one women with newly diagnosed locoregional breast cancer (T 1–3, N0-1, M0) having an initial Body Mass Index (BMI) between 20 and 35 kg/m2 who were receiving standard adjuvant treatment (chemotherapy, tamoxifen, and/or radiation) were asked to avoid weight gain (if initial BMI ≤ 25 kg/m2) or to lose up to 10 kg (if initial BMI 25–35 kg/m2) over one year. Women participated in twenty group sessions (10 weekly, 10 monthly) which involved a psychological supportive-expressive group intervention supplemented by individual weight goals, and nutrition and exercise programs. Fifty-five non-censored women (5 developed recurrence, 1 died of a subarachnoid hemorrhage) lost a mean of 0.53 ± 3.72 kg. Weight loss was greatest in initially overweight women (BMI ≥ 25 kg/m2) who lost 1.63 ± 4.11 kg (p = 0.01 compared to normal weight women) and in those not receiving chemotherapy who lost 2.15 ± 2.83 kg (p=0.0004 compared to those receiving chemotherapy). 70.9% met predefined criteria for success. Aerobic exercise increased significantly during the intervention (p = 0.00005) and was the strongest predictor of success (OR 1.73 for each additional 30 minutes of exercise weekly, p=0.003). Changes in caloric intake were not significant, but fat intake decreased and carbohydrate and fibre intake increased significantly during the intervention. Eating behavior and psychological status improved significantly. Thus, this multidisciplinary weight management intervention successfully prevented weight gain in women with newly diagnosed locoregional breast cancer, and helped overweight women lose weight.
Similar content being viewed by others
References
Abe R, Kumagi G, Kimura M et al.: Biological characteristics of breast cancer in obesity. Tohoku J Exp Med 120: 351–359, 1976
Donegan WL, Hartz AJ, Rimm AA: The association of body weight with recurrent cancer of the breast. Cancer 41: 1590–1594, 1978
Donegan WL, Jayich S, Koehler MR et al.: The prognostic implications of obesity for the surgical cure of breast cancer. Breast, Diseases of the Breast 4: 14–17, 1978
Sohrabi A, Sandoz J, Spratt JS et al.: Recurrence of breast cancer. Obesity, tumor size, and axillary lymph node metastases. JAMA 244: 264–265, 1980
Boyd NF, Campbell JE, Germanson T et al.: Body weight and prognosis in breast cancer. J Natl Cancer Inst 67: 785–789, 1981
Tartter PI, Papatestas AE, Ioannovich J et al.: Cholesterol and obesity as prognostic factors in breast cancer. Cancer 47: 2222–2227, 1981
Zumoff B, Gorzynski JG, Katz JL et al.: Nonobesity at the time of mastectomy is highly predictive of 10-year disease free survival in women with breast cancer. Anticancer Res 2: 59–62, 1982
Eberlein T, Simon R, Fisher S et al.: Height, weight, and risk of breast cancer relapse. Breast Cancer Res Treat 5: 81–86, 1985
Heasman KZ, Sutherland HJ, Campbell JA et al.: Weight gain during adjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 5: 195–200, 1985
Gregorio DI, Emrich LJ, Graham S et al.: Dietary fat consumption and survival among women with breast cancer. J Natl Cancer Inst 75: 37–41, 1985
Ownby HE, Frederick J, Russo J et al.: Racial differences in breast cancer patients. J Natl Cancer Inst 75: 55–60, 1985
Greenberg ER, Vessey MP, McPherson K et al.: Body size and survival in premenopausal breast cancer. Br J Cancer 51: 691–697, 1985
Newman SC, Miller AB, Howe GR: A study of the effect of weight and dietary fat on breast cancer survival time. Am J Epidemiol 123: 767–774, 1986
McNee RK, Mason BH, Neave LM et al.: Influence of height, weight, and obesity on breast cancer incidence and recurrence in Auckland, New Zealand. Breast Cancer Res Treat 9: 145–150, 1987
Mohle-Boetani JC, Grosser S, Whittemore AS et al.: Body size, reproductive factors, and breast cancer survival. Prev Med 17: 634–642, 1988
Goodwin PJ, Panzarella T, Boyd NF: Weight gain in women with localized breast cancer – a descriptive study. Breast Cancer Res Treat 11: 59–66, 1988
Hebert JR, Augustine A, Barone J et al.: Weight, height and body mass index in the prognosis of breast cancer: Early results of a prospective study. Int J Cancer 42: 315–318, 1988
Suissa S, Pollak M, Spitzer WO et al.: Body size and breast cancer prognosis: A statistical explanation of the discrepancies. Cancer Res 49: 3113–3116, 1989
Tretli S, Haldorsen T, Ottestad L: The effect of pre-morbid height and weight on the survival of breast cancer patients. Br J Cancer 62: 299–303, 1990
Kyogoku S, Hirohata T, Takeshita Y et al.: Survival of breast-cancer patients and body size indicators. Int J Cancer 46: 824–831, 1990
Kimura M: Obesity as prognostic factors in breast cancer. Diabetes Res and Clin Pract 10: S247–S251, 1990
Coates RJ, Clark WS, Eley JW et al.: Race, nutritional status, and survival from breast cancer. J Natl Cancer Inst 82: 1684–1692, 1990
Camoriano JK, Loprinzi CL, Ingle JN et al.: Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. J Clin Oncol 8: 1327–1334, 1990
Ewertz M, Gillanders S, Meyer L et al.: Survival of breast cancer patients in relation to factors which affect the risk of developing breast cancer. Int J Cancer 49: 526–530, 1991
Nomura AMY, LeMarchand L, Kolonel LN et al.: The effect of dietary fat on breast cancer survival among Caucasian and Japanese women in Hawaii. Breast Cancer Res Treat 18: S135–S141, 1991
Senie RT, Rosen PP, Rhodes P et al.: Obesity at diagnosis of breast carcinoma influences duration of disease-free survival. Ann Int Med 116: 26–32, 1992
Gordon NH, Crowe JP, Brumberg DJ et al.: Socioeconomic factors and race in breast cancer recurrence and survival. Am J Epidemiol 135: 609–618, 1992
Zhang S, Folsom AR, Sellers TA, Kushi LH, Potter JD: Better breast cancer survival for postmenopausel women who are less overweight and eat less fat. The Iowa Women's Health Study. Cancer 76: 275–283, 1995
Bastarrachea J, Hortobagyi GN, Smith TL, Kau SW, Buzdar AU: Obesity as an adverse prognostic factor for patients receiving adjuvant chemotherapy for breast cancer. Ann Intern Med 120: 18–25, 1994
Goodwin PJ, Boyd NF: Body size and breast cancer prognosis: a critical review of the evidence. Breast Cancer Res Treat 16: 205–214, 1990
Goodwin PJ, Esplen MJ, Winocur J, Butler K, Pritchard KI: Development of a weight management program in women with newly diagnosed locoregional breast cancer. In: Bitzer J, Stauber M (eds) Psychosomatic Obstetrics and Gynecology. Monduzzi Editore, International Proceedings Division, Bologna (Italy), 1995
Foltz AT: Weight gain among stage II breast cancer patients: A study of five factors. Oncology Nursing Forum 12: 21–26, 1985
Subramanin VP, Raich PC, Waler BK: Weight gain in breast cancer patients undergoing chemotherapy. Breast Cancer Res Treat 1: 170, 1981 (abstract)
Hernandez BM, Bonomi P, Hoeltgen T, Roseman DL, Slayton RE, Wolter J, Foltz A: Weight gain during adjuvant therapy for stage II breast cancer. Breast Cancer Res Treat 3: 108, 1983 (abstract)
Knobf MK, Mullen JC, Xistris D, Moritz DA: Weight gain among women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum 10: 28–33, 1983
Huntington MO: Weight gain in patients receiving adjuvant chemotherapy for carcinoma of the breast. Cancer 56: 472–474, 1985
DeGeorge D, Gray JJ, Fetting JH, Rolls BJ: Weight gain in patients with breast cancer receiving adjuvant treatment as a function of restraint, disinhibition, and hunger. Oncology Nursing Forum 17 (3 suppl): 22–23, 1990
Bonomi P, Bunting N, Fishman D, Wolter J, Hernandez B, Foltz A, Shorey W, Straus A, Anderson K, Roseman D, Economou S: Weight gain during adjuvant chemotherapy or hormono-chemotherapy for stage II breast cancer evaluated in relation to disease free survival (DFS). Breast Cancer Res Treat 4: 339, 1984 (abstract)
Levine EG, Raczynski JM, Carpenter JT: Weight gain with breast cancer adjuvant treatment. Cancer 67: 1954–1959, 1991
Demark-Wahnefried W, Winer EP, Rimer BK: Why women gain weight with adjuvant chemotherapy for breast cancer? J Clin Oncol 11: 1418–1429, 1993
Gaston-Grindel C, Cahill CA, Walker M: Food intake of women with breast cancer during their first six months of chemotherapy. Oncology Nursing Forum 16: 401–407, 1989
Stunkard AJ: Current views on obesity. Am J Med 100: 230–236, 1996
Health Canada. Canada's Food Guide to Healthy Eating. Supply and Services Canada. Ottawa, Canada, 1992
McNair DM, Lorr M, Droppleman LF: EDITS Manual for the Profile of Mood States. EDITS/Educational and Industrial Testing Service. San Diego, CA, 1992
Derogatis LR, Derogatis MF: The Psychosocial Adjustment to Illness Scale (PAIS and PAIS-SR) – Administration, Scoring and Procedures Manual – II. Clinical Psychometric Research, Baltimore, MD, 1983
Moos RH, Moos BS: Family Environment Scale Manual. Consulting Psychologists Press, Palo Alto, CA, 1986
Watson M, Greer S, Young J et al.: Development of a questionnaire measure of adjustment to cancer: The MAC scale. Psychological Medicine 18: 203–209, 1988
Watson M, Greer S: A manual for the Courtauld Emotional Control Scale (CECS). CRC Psychological Medicine Research Group, Royal Marsden Hospital, Sutton, UK, 1983
Horowitz M, Wilner N, Alvarez W: Impact of Events Scale: A measure of subjective stress. Psychosomatic Medicine 41: 209–218, 1979
Stunkard AJ, Messick S: Eating Inventory manual. The Psychological Corporation, Harcourt Brace Jovanovich Inc, Toronto, 1988
Wells S, Wells JE, McKenzie JM, Hornblow AR: Eating and weight problems among women attending their general practitioner. New Zealand Med J 99: 671–673, 1986
Aaronson NK and the EORTC Study Group: The EORTC Core Quality-of-Life: instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85: 365–376, 1993
Schakel SF, Sievert YA, Buzzard IM: Sources of data for developing and maintaining a nutrient database. J Am Diet Assoc 88: 1268–1271, 1988
deWaard F, Ramlan R, Mulders Y, deVries T, van Waveren S: A feasibility study on weight reduction in obese postmenopausal breast cancer patients. Eur J Cancer Prev 2: 233–238, 1993
Brownell KD: Exercise and obesity treatment: Psychological aspects. Int J Obesity Related Mental Disorders 19 (suppl 4): S122–125, 1995
Wood PD: Impact of experimental manipulation of energy intake and metabolism on body composition. Crit Rev Food Sci Nutr 33: 369–373, 1993
Winningham ML, MacVicer MG, Bondol M, Anderson JI, Minton JP: Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy. Oncology Nursing Forum 16; 5: 683–689, 1989
Rights and permissions
About this article
Cite this article
Goodwin, P., Esplen, M.J., Butler, K. et al. Multidisciplinary weight management in locoregional breast cancer: results of a phase II study. Breast Cancer Res Treat 48, 53–64 (1998). https://doi.org/10.1023/A:1005942017626
Issue Date:
DOI: https://doi.org/10.1023/A:1005942017626